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Growing old gracefully takes much more than funding We must invest in proper staff training for the care of the elderly
(3 days later)
For Britain to become the "good place to grow old" to which Will Hutton aspires (Comment) requires much more than merely adjusting the system of social care funding. Along with the original Dilnot inquiry proposals, Hutton's plans for a social insurance scheme would generate no new resources to address the very uncertain quality of care.For Britain to become the "good place to grow old" to which Will Hutton aspires (Comment) requires much more than merely adjusting the system of social care funding. Along with the original Dilnot inquiry proposals, Hutton's plans for a social insurance scheme would generate no new resources to address the very uncertain quality of care.
The Care Quality Commission reported recently on the percentages of nursing homes that on inspection failed the (so-called) essential standards of quality and safety. The figures included a 15% failure rate for the standard relating to respect and dignity, 17% for safeguarding residents from abuse, 20% for meeting nutritional needs and 33% for management of medicines. The percentages for residential care homes and domiciliary care agencies were only slightly better.The Care Quality Commission reported recently on the percentages of nursing homes that on inspection failed the (so-called) essential standards of quality and safety. The figures included a 15% failure rate for the standard relating to respect and dignity, 17% for safeguarding residents from abuse, 20% for meeting nutritional needs and 33% for management of medicines. The percentages for residential care homes and domiciliary care agencies were only slightly better.
Levels of staff training remain appallingly low. Skills for Care has published statistics showing that less than half of workers in social care have the relevant basic qualification (NVQ level 2), 37% have no qualification at all and 30% have not even had basic induction training. Improving care for vulnerable older people requires as a first step a very substantial investment in the quality of staff. Implementing Dilnot, as watered down by the Treasury or enhanced by Hutton's proposals, would do nothing to correct this.Levels of staff training remain appallingly low. Skills for Care has published statistics showing that less than half of workers in social care have the relevant basic qualification (NVQ level 2), 37% have no qualification at all and 30% have not even had basic induction training. Improving care for vulnerable older people requires as a first step a very substantial investment in the quality of staff. Implementing Dilnot, as watered down by the Treasury or enhanced by Hutton's proposals, would do nothing to correct this.
Jef SmithJef Smith
London N10London N10
I agreed with everything in Will Hutton's article. The idea of introducing a special social insurance tax to cover care in old age is an excellent one. While the estimated cost, at something between £2bn and £3bn, is high, it is relatively small compared with the overall NHS figure of comfortably over £100bn.I agreed with everything in Will Hutton's article. The idea of introducing a special social insurance tax to cover care in old age is an excellent one. While the estimated cost, at something between £2bn and £3bn, is high, it is relatively small compared with the overall NHS figure of comfortably over £100bn.
Well done, Will, though I disagree with most of your other predilections.Well done, Will, though I disagree with most of your other predilections.
James McGrandJames McGrand
WinchesterWinchester
Katharine Whitehorn is quite incorrect regarding her comments on the withholding of food and fluid on the Liverpool Care Pathway ("A thirst for palliative care", Magazine). Nowhere in the pathway does it state that food or drink are to be withheld from dying patients; these should always be given to the person if they wish to eat and drink. Many patients on the pathway are drowsy or unconscious; this is common as death approaches and forcing food and drink upon people in such an unconscious state would not provide care or comfort.Katharine Whitehorn is quite incorrect regarding her comments on the withholding of food and fluid on the Liverpool Care Pathway ("A thirst for palliative care", Magazine). Nowhere in the pathway does it state that food or drink are to be withheld from dying patients; these should always be given to the person if they wish to eat and drink. Many patients on the pathway are drowsy or unconscious; this is common as death approaches and forcing food and drink upon people in such an unconscious state would not provide care or comfort.
The Liverpool Care Pathway codifies best practice in end-of-life care. It is not a death pathway, it does not deny people basic comfort, but it does help to stop people in the last hours and days of their lives from being subjected to painful, undignified and death-prolonging medical interventions. By supporting the use of the pathway, Katharine Whitehorn could play a very real part in helping to improve the quality of death for all.The Liverpool Care Pathway codifies best practice in end-of-life care. It is not a death pathway, it does not deny people basic comfort, but it does help to stop people in the last hours and days of their lives from being subjected to painful, undignified and death-prolonging medical interventions. By supporting the use of the pathway, Katharine Whitehorn could play a very real part in helping to improve the quality of death for all.
Dr Miles D WithamDr Miles D Witham
Consultant geriatrician and senior lecturer, University of DundeeConsultant geriatrician and senior lecturer, University of Dundee
I have been following the "debate" regarding the Liverpool Care Pathway for a number of weeks now, my horror and incredulity increasing with every bad article I read.I have been following the "debate" regarding the Liverpool Care Pathway for a number of weeks now, my horror and incredulity increasing with every bad article I read.
First, it is not, as so many journalists would like the public to believe, a method of hastening death. It is a tool adopted by many NHS trusts over the past 10 years or so to standardise end-of-life care for patients, just as the hospice movement was set up to provide quality palliative care for patients. I found the nurses and other professionals caring for my mother in her last hours using this pathway provided incredibly professional and compassionate care. They involved us and communicated with us at every stage and were prompt to respond if we felt she was not comfortable.First, it is not, as so many journalists would like the public to believe, a method of hastening death. It is a tool adopted by many NHS trusts over the past 10 years or so to standardise end-of-life care for patients, just as the hospice movement was set up to provide quality palliative care for patients. I found the nurses and other professionals caring for my mother in her last hours using this pathway provided incredibly professional and compassionate care. They involved us and communicated with us at every stage and were prompt to respond if we felt she was not comfortable.
I have seen cases where patients have improved from being taken off much of their medication, going on to be taken off the pathway and discharged from hospital.I have seen cases where patients have improved from being taken off much of their medication, going on to be taken off the pathway and discharged from hospital.
Caroline LS Macdonald (nurse)Caroline LS Macdonald (nurse)
EdinburghEdinburgh