Social Care Brushed Aside Again

foxie48

I wouldn't howl with outrage. When the NHS was set up it was thought that there would be a gradual reduction in the care that people needed because we would become a healthier nation. We didn't and our demands on the NHS increase all the time. I'd be happy to pay towards my care as long as no one is denied care on the basis of their ability to pay, so means testing is perfectly OK with me. I'd also pay for prescriptions, currently I get three a month, basically which is over £250 a year if I paid each month, a yearly scrip is £114.50. I'm definitely not suggesting a two tier system just one that asks those of us who can afford to pay more, to do so.

There has been a reduction in the conditions which the NHS was treating in the 1940s. There has been a massive reduction in infectious diseases and childhood illnesses. If people had a heart condition or cancer, they died because there weren't effective treatments. I'm not even sure that the NHS envisaged paying for social care.

Maybe those who don't want to pay any more should get hold of a list of treatments prescribed in the 1940s or 1950s and restrict the NHS to only treating those conditions. I know I wouldn't still be alive and I wonder how many others wouldn't be either.

From what I’ve read, the nursing care and social care needs are met free for over 65s in Scotland, but there are items in non-personal care, and for residential care, that are charged for. It sounds very similar to the Scandinavian models.

I’d be in favour of that, but it would inevitably raise taxes, which not everybody would be happy with.

maddyone

I can also imagine the howls of outrage if such measures were to be introduced here Witzend.
My daughter is a GP in New Zealand. Everyone, including retired people, have to pay a charge for a GP visit there. Depending on which GP Practice it is, the charge is between twenty five dollars and one hundred dollars, that’s between £12.50 and £100 for a GP visit. Most are around fifty dollars, that’s £25. Only children are exempt from charges.

I’ve long thought there should be a small charge for a GP consultation here, with only children being the exceptions.

I think they have free social care in Scotland.

My daughter is a GP in New Zealand. Everyone, including retired people, have to pay a charge for a GP visit there.

Also in Norway.

When I lived there back in the late 90s, it was around £10-£11 equivalent per visit, maybe fractionally more, I can't quite remember.

However, there was a ceiling - something like £125 or thereabout which, when reached, ended the payments.

Also included were certain prescriptions and most appointments with consultants, the cost varied considerably between as little as £8 to a much higher charge of around £26. There was obviously a 'charging formula' but I never quite understood how it worked.

Children under (I think) 16 were excluded, as were retirees who paid the charge but were reimbursed later.

All hospital admissions requiring treatment were free.

Although wages vary in Norway, generally speaking they are considerably higher than in the UK, and I imagine these charges are, mostly, affordable, even for the lower-paid.

I know some have suggested we should do the same here.
How well it would work, I don't know. For those on low-paid contract work / zero hours, it would be very difficult to budget for it. There would have to be exclusions, and thus a whole layer of admin created for the purpose.

Apologies Gransnetters, I got mixed with my dollars and pounds in my other post, I meant to say the cost of a GP consultation in NZ is between £12.50 and £50. I quoted dollars when I meant pounds in one place. The GP Practice is free to set it’s own charges as I understand it, and so those practices in more affluent areas tend to charge more, whilst in poorer areas they charge less. All citizens pay for their prescription medication, and GPs hands are tied by the government about which medications they can prescribe, although they can prescribe other medications, usually better, if the patient can afford to pay privately. Of course that means that if a patient is on a medication long term, it can be very expensive, as some of the drugs are expensive. The only exceptions are children, there are no exceptions for the elderly or the poor. They also have long waiting lists for hospital treatment, and lists are closed at times so that it becomes impossible for a GP to even put a patient on a waiting list. For this reason we recently paid for our six year old grandson to have his tonsils and adenoids out, as the waiting list was two years, and his hearing was 50% down. Knowing the importance of hearing in a child’s learning and development we offered to pay in order to resolve this situation.

Our NHS desperately needs funding and organisation, but I prefer it to the situation in NZ.

Both my grandfathers died in their early 60's and both grandmothers lived into their 80's cared for at home by one of their daughters. My mother died at 61 following an operation to replace a heart valve and Dad died at 69 with coronary heart disease tbh both would probably have lived for many years if they had been born later and as my sister lived abroad I would have taken on the responsibility of looking after them. There was a time when putting your parent in a home for others to care for was a rarity, but women tended to be SAHMs and families were bigger. MIL lived with us for the last few years of her life until she died at 101. This idea that we have paid for social care in our old age is ridiculous, we haven't and if we need it and have some money saved then we should spend it on our care so that poorer people can have theirs paid for by the state. Some will say but that isn't fair but life isn't fair. Some get born into wealthy families, some of us don't, some have illnesses or disabilities, some of us don't, some have successful lives with plenty of money, some of us don't. Some die young whilst others linger on with horrible illnesses, some of don't. I could go on but you get the drift! IMO and some of you will no doubt disagree, the measure of how civilised we are is how much we care for our more vulnerable citizens, regardless of why they are vulnerable. The idea of the "deserving poor" and the "undeserving poor" is just an excuse for rationing our empathy. Off to walk the dog.

Re what they do elsewhere, a French friend of a dd, working in the U.K., is apparently legally required to pay €250 a month towards her dad’s care in France.

She bitterly resents it, because she says he was a useless father, feckless and workshy, which is largely why he has no assets to speak of. I gather that he’s not even all that old, only in his 60s.

Witzend

Re what they do elsewhere, a French friend of a dd, working in the U.K., is apparently legally required to pay €250 a month towards her dad’s care in France.

She bitterly resents it, because she says he was a useless father, feckless and workshy, which is largely why he has no assets to speak of. I gather that he’s not even all that old, only in his 60s.

That's correct. I believe it's called the "alimentation obligatoire". Children are responsible for their parents' upkeep, no matter where in the world the children live.

social care isn't just for old people
social care isn't free. Contribution to care is almost £400 a month, even if you are unemployed and on benefits

the things I think are problematic
agency staff getting paid more than core staff. If core staff were paid more, there would be better retention of staff and better consistent care
poor management, poor management of staff - again this contributes to poor staff retention
care for profit rather than for care itself, patient acquisition
inadequate accessible housing in the community

then add in that caring and support work is seen as a unskilled job (demeaning it all to bottom wiping springs to mind) when quite the opposite is true

Of course the main issue for the current situation was cutting the funding from central government and expecting local authorities to pick up the financial shortfall

foxie48 My experience with parents, grandparents and other ancestors is similar. My own father died quite suddenly at home. He never had any official "care", although neighbours and family helped him when we could. My mother didn't have any care either until the last couple of weeks of her life, when it was obvious she was dying and she went into a hospice.

My grandfathers died in their 60s. One grandfather went into hospital for a cancer op and never came out. My grandmothers were older. One grandmother was quite frail and paid for help at home until she was too ill and went into a nursing home to die. The alternative would have been to be admitted to a hospital ward.

Two of my gt grandparents died in a hospital geriatric ward. One gt grandparent lived until she was nearly a 100. She lived in a room in my grandparents' house for nearly 20 years until it all got too much for my (now) elderly grandparents and they paid for her to be admitted to a private (charity) home. The alternative would have been a geriatric ward.

Looking through records of other ancestors, some died in the workhouse - not because they were "down and outs", but because workhouses had wards for the elderly and "insane" (ie suffering from dementia). The only alternative was to keep relatives at home and pay for nursing care - there wasn't any state help.

I remember when my grandad was ill elderly care was carried out in hospitals long term, there were wards and wards full of elderly people. He also used t go there for a couple of weeks so my grandma could receive respite

That’s interesting growstuff.
When did the state start to take over elderly care? I can’t remember much about elderly care homes at all when I was younger, but I was aware of geriatric wards. Nowadays of course, we’re not supposed to call them geriatric wards, my daughter told me that they should be called elderly care wards. Whatever, we all know what is meant by those words. So when did the state take over and provide care homes? Although of course, most care homes are privately run and funded.

There were also asylums for younger people with disabilities and learning difficulties, where people just had a bed in a ward. The idea of treating the elderly, disabled and those with learning difficulties with some dignity is relatively modern. It's one sign of a civilised society, but we haven't worked out yet how we resource it. (And, no, I don't think we should turn the clocks back, but we do need to face some uncomfortable truths.)

There are still inappropriate and expensive services for people with learning disabilities and/or autism in the way of assessment treatment units and similar facilities. Bespoke community based care usually costs a lot less in the case of complex disabilities compared to ATU delivered care. In fact they were only supposed to bring short term care whilst alternatives were found, instead people are incarcerated in them for years

maddyone

That’s interesting growstuff.
When did the state start to take over elderly care? I can’t remember much about elderly care homes at all when I was younger, but I was aware of geriatric wards. Nowadays of course, we’re not supposed to call them geriatric wards, my daughter told me that they should be called elderly care wards. Whatever, we all know what is meant by those words. So when did the state take over and provide care homes? Although of course, most care homes are privately run and funded.

I'm not sure. My gt grandmother lived in a home run by the Salvation Army. My grandmother died in a charity home run by the Church of England.

One of my grandfathers actually owned a care home in the 1960s and 70s (and made quite a bit of money out of it). I don't think the residents received state aid - from what I've heard, most of them were wealthy.

As far as I know, the first "care homes" were run by local councils, but I'm not sure when they started. Local authorities have theoretically been responsible for their residents' wellbeing for hundreds of years. (That's why they were so keen to send people back to their "home" parish.) I guess they thought it was better to have people under one roof than begging and dying on the streets.

growstuff

Witzend

Re what they do elsewhere, a French friend of a dd, working in the U.K., is apparently legally required to pay €250 a month towards her dad’s care in France.

She bitterly resents it, because she says he was a useless father, feckless and workshy, which is largely why he has no assets to speak of. I gather that he’s not even all that old, only in his 60s.

That's correct. I believe it's called the "alimentation obligatoire". Children are responsible for their parents' upkeep, no matter where in the world the children live.

How would that go down in the U.K., I wonder??

Though having said that, of course a huge amount of unpaid help for elderly parents is provided by adult children - in the majority of cases the daughters.

Yes. I’m wondering if care homes started to be more frequent after the number of beds in hospitals were cut. We apparently now have fewer beds in hospitals than many other western democracies. If fewer beds were available, then every bed needed to be used for the sick, and nowadays the horrible term bed blockers is used to describe people who no longer need medical care, but have nowhere else to go because they’re not able to look after themselves at home. I’m thinking, but don’t know, that maybe that’s when care homes became more normalised.
My own grandmother went to live in a care home in the early eighties after she had a fall, broke her pelvis and suffered a small stroke. She would have been about 88 then I think. It was a council run home because she didn’t have any money. It was lovely and the staff were very caring.
My mother spent her last year in a lovely care home, but she was self funding, although the NHS paid for her first three months after she was hospitalised with a broken shoulder after a fall. My father in law also spent a little over a year in a care home, self funding, before he died. That was also a lovely home with caring staff.
I think many people who are in care homes would probably have died earlier without the care and treatment they received from the NHS.

Witzend

growstuff

Witzend

Re what they do elsewhere, a French friend of a dd, working in the U.K., is apparently legally required to pay €250 a month towards her dad’s care in France.

She bitterly resents it, because she says he was a useless father, feckless and workshy, which is largely why he has no assets to speak of. I gather that he’s not even all that old, only in his 60s.

That's correct. I believe it's called the "alimentation obligatoire". Children are responsible for their parents' upkeep, no matter where in the world the children live.

How would that go down in the U.K., I wonder??

Though having said that, of course a huge amount of unpaid help for elderly parents is provided by adult children - in the majority of cases the daughters.

That's another point. Historically, people had quite large families and one of the daughters became the carer (not the sons).

maddyone I don't think people stayed in hospitals for very long before they died. They were there, so that increasing doses of morphine could be given, until they died. The provision of state-funded long-term residential care was extremely basic and seemed to be little more than a bed in a ward, adequate nutrition and being washed. People (and their families) avoided it, if they could.

My father came from a large, quite wealthy family and he remembered being dragged round numerous uncles, gt uncles, cousins etc to pay last respects - but always at home. Presumably the families paid for the doctor and nurses to do home visits and they did the rest themselves. Family doctors used to administer morphine.

PS. I'm going back to pre-NHS times.

there were district nursing teams too, something i think has more or less diminished to very small numbers now

maddyone

That’s interesting growstuff.
When did the state start to take over elderly care? I can’t remember much about elderly care homes at all when I was younger, but I was aware of geriatric wards. Nowadays of course, we’re not supposed to call them geriatric wards, my daughter told me that they should be called elderly care wards. Whatever, we all know what is meant by those words. So when did the state take over and provide care homes? Although of course, most care homes are privately run and funded.

Where I lived for the majority of my childhood late 60s) there was a massive asylum, with acres of grounds, and also what was known as an 'old folks home' which was run by the council

JaneJudge

there were district nursing teams too, something i think has more or less diminished to very small numbers now

That's yet another point. One of my sisters was the district nursing manager for a large area. She had hundreds of small teams responsible to her. Her speciality was the elderly and learning disabilities.

I can't remember exactly when the system changed, but she was made redundant (at great cost to the NHS) and care was transferred to social services, who didn't have the expertise and started to outsource.

My sister always said it would end up in tears. In the end, she shrugged her shoulders and accepted the redundancy pay off, but she still regrets that so much expertise was effectively thrown away and we've ended up with a more expensive, less efficient system.

growstuff

JaneJudge

there were district nursing teams too, something i think has more or less diminished to very small numbers now

That's yet another point. One of my sisters was the district nursing manager for a large area. She had hundreds of small teams responsible to her. Her speciality was the elderly and learning disabilities.

I can't remember exactly when the system changed, but she was made redundant (at great cost to the NHS) and care was transferred to social services, who didn't have the expertise and started to outsource.

My sister always said it would end up in tears. In the end, she shrugged her shoulders and accepted the redundancy pay off, but she still regrets that so much expertise was effectively thrown away and we've ended up with a more expensive, less efficient system.

My sister always said it would end up in tears.

And I think she was right.

My mother was a district nurse, effectively made redundant.

Ended her career as the Sister in the 'Ambulance Room' of a huge industrial complex in Lincoln, prior to de-industrialisation.

When she returned 'down south' she began to while away her retirement looking-in on people locally as an unpaid Samaritan and began to see the downside of 'care-in-the-community'. She was from an era where nursing was regarded as a vocation.

Meanwhile in Scotland.........................................................................

Free Personal Care (FPC) is a program that provides free care of a personal nature1. Personal care has been provided for free for people aged 65 and over since 2002, and this was extended in April 2019 for people aged 18-641. Examples of personal care services that are free include2:
Help with personal hygiene
Assistance with eating
Continence management
Assistance with medication
Assistance getting in/out of bed
Help with dressing