Archive for the ‘healthcare’ Category
NHS competition regulator Monitor inadequately tries to show that competition and coordination go together
Coordinating NHS and social services has been a policy and practice for decades, arising because if you coordinate everything into one organisation, you get an oversized blob. In any case, social services and the NHS have to be separated in some way, because the government would otherwise be forced by the political obligation to provide health care to extend that to free social services, and they’re never going to do that. (You ask: why? Partly because of the cost but mainly because social care helps people with the problems of everyday living, not something exceptional and definable like an illness, and government doesn’t want to pay for what people would normally do for themselves, like getting up, getting bathed and getting fed).
Monitor, the NHS regulator which is supposed to ensure that competition works, is issuing a lot of guidance about coordination. The political reason for this is that they need to show that the competitive market that they promote does not prevent coordination. To do this, they have latched onto the idea of personalisation, or person-centred services: the idea is that services slot together around people’s needs, so they naturally coordinate.
So in its requirements of providers (a sort of contract that NHS providers are supposed to adhere to), it has an integrated care condition:
The Integrated Care Condition states that NHS provider licence holders should not do anything that could reasonably be regarded as detrimental to enabling integrated care. It also includes a patient interest test which means that the obligations only apply to the extent that they are in the interests of people who use healthcare services.
The problem is that the aim of removing barriers to coordination does not actively make it possible, and what NHS providers do is not the major barrier – lack of resources and options in service provision is. But the requirement not to do anything to the detriment of coordination provides a potential protest and advocacy point for people who want to change something that an NHS provider is doing.
Link to the Monitor Guidance, which also has lots of useful links to other documents on integration.
Simple information on cancer spread
I came across a useful article for lawyers who may be dealing with claims for medical negligence; many social workers might find it of interest, because it explains simply how cancer develops and the stages of treatment and care.
Link to simple article on cancer.
How cancer spreads is broadly predictable, depending on your age. The political point is that the government is quick to blame slow referrals for diagnosis to what is claimed to be the UK’s poor results on outcomes of treatment for cancer. There is something called a TNM (Tumour – lymph Node development – Metastases) score, which indicates how far the cancer has spread – more spreading means less likelihood of successful treatment. The spread of the tumour is measured on a 1-4 scale – 4 being the widest spread. After that, cancer spreads to lymph nodes, from which it moves on to other organs in the body.
As the article says, doctors are supposed to follow the NICE (National Institute for Health and Clinical Excellence) guidance on cancer treatment, and there is also NICE guidance on how a cancer service should be run. Unfortunately, these are written for doctors so they are largely incomprehensible, but here’s a link:
The best place for general guidance about medical conditions for normal people is the NHS Choices website
Good nursing and care for relatives in the NHS
And good care for dying people is not only available in big urban hospitals. Our uncle Don (aged 95) was recently cared for at the new Malvern Community Hospital in the last weeks of his life. It has 18 GP beds and a minor injuries unit. With her extensive experience of palliative care, Margaret says with appreciation that the nursing for patients and support for relatives was a good as any hospice.
Good care for dying people in NHS hospitals is still possible
A thoughtful article in the Guardian by Julie Myerson, who suggests that often in the NHS you can get wonderful care for dying people, even in the biggest urban hospitals and busy wards. It is a story of effective nursing and good communication with relatives in a busy London hospital. And, incidentally, the hospital that Cicely Saunders started out from in her experience as a social worker which eventually led to her contribution to the origins of the hospice movement. Good to see that the medical and nursing skills involved still exist.