It was easy to pick what I would Blog about this week because the Fair Dementia Care Commission Report was published on Tuesday (22nd. Jan 2019). The commission was established by Alzheimer Scotland to look at inequalities in access to health care and the impact of the current social care charges regime on people living with advanced dementia and their families in Scotland. Chaired by Henry McLeish, the commission brought together a small group of experts to work in partnership with Alzheimer Scotland to make a series of recommendations to the inequalities they uncovered.
Paying for care remains one of the most common issues Alzheimer Scotland is asked about principally because of the complexity and lack of transparency around the financial assessment processes used by social services across the different local authority areas. Most people, me included, don’t understand how the process works.
What they found was that although its known that advanced dementia produces complex health, nursing and social care needs people with advanced dementia did not have equality of access to the health care they need – instead advanced dementia was only considered as an Illness requiring a social care response.
As a consequence, people with advanced dementia were disproportionately subject to social care charges for what were primarily health and nursing care needs which in Scotland are generally free!
The result has been that people with advanced dementia and their families and carers have been paying an estimated £50.9m per year in social care charges for care which doesn’t provide the health or nursing care they require and perhaps if they could access that care may possibly have been delivered free of charge.
The report highlights that the complex needs associated with advanced dementia have not been fully understood or recognised as health or nursing care needs and therefore have not been delivered free.
The report calls for authorities across Scotland to accept and recognise that people with advanced dementia must have the equality of access to free health care on a par with people who are living with other progressive and terminal illnesses. Something which I fully support.
If you want to find out more and access a full copy of the report go to “Former First Minister launches advanced dementia care report” and visit and support #fairdementiacare
The paper highlights that missed general practice (GP) appointments are a significant risk marker for all-cause mortality, particularly in patients with mental health conditions. People with mental health conditions who missed appointments risk of death also increased with the number of appointments they missed. To the point that missing more than 2 appointments per year placed them at 8 times greater risk of dying (in the next year) than those who missed no appointments. They died prematurely, commonly from non-natural external factors such as suicide.
The research led by the University of Glasgow, used routinely collected primary care data from 824,374 patients across Scotland during a 3-year period from September 2013 to September 2016. They then took this information and linked it to the Scottish death records for patients who had died within a 16-month follow-up period.
The study also showed that patients with a greater number of long-term conditions had an increased risk of missing GP appointments, despite controlling for number of appointments made thus also placing them at risk. What is not obvious in the study is that that if you missed a GP appointment and had dementia and another long term illness this also placed you at a significantly higher risk of death.
So what can we learn from this. As the authors state
“…missing multiple appointments provides a risk marker of all-cause mortality even after you control for other factors. Also… GPs, the acute sector and other NHS services should consider how best to facilitate engagement of patients with patterns of repeatedly missing appointments because for non-attenders the existing primary health care appointment systems is ineffective.”
So rather than vilify people who miss GP appointments as time wasters who need to be penalised/punished maybe its time to ask “Why are you not here?”
An interesting view to take on this issue is provided by the Medical Defence Union who have an item on their website called
I would suggest reading it, particularly if you are a practice nurse or work in outpatients.
Last week saw the release of NHS England’s NHS Plan, a Plan which the Westminster government says will save almost half a million more lives with practical action on major killer conditions and investment in world-class, cutting edge treatments including genomic tests for every child with cancer. The Plan has been heralded as
…a blueprint to make the NHS (in England) fit for the future will use the latest technology, such as digital GP consultations for all those who want them, coupled with early detection and a renewed focus on prevention to stop an estimated 85,000 premature deaths each year.
While I support this development and the additional funds that accompany this move which will also filter through to the NHS in Scotland. They have their own plan, called the Health and Social Care Delivery Plan.
I remain very concerned that the Green Paper on Social Care reform and spending is still posted as missing! If the future is Integration of health and Social Care, then surely both papers needed to be released together… or at least within days of each other. However, we are still waiting…. See my own comment from June 2018 whihc you can see by clicking the link below
Rather than give my own view of the details of the plan it’s worth reading what Caroline Abrahams, Charity Director, Age UK says about the plan which she had some involvement in shaping. Her view can be read here
Also this week, The Journal of the American Geriatric Society, one of the principal journals for older people’s clinical sciences, innovative models of care, and health policy has released its list of top 10 articles from last year (according to Twitter activity). You can see the list at JAGS @AGSJournal. I’d recommend looking at 2 in particular that interested me
#1 Most Mentioned Article: Can Exercise Improve Cognitive Symptoms of Alzheimer’s Disease?
#2 Most Mentioned Article: Medical Costs of Fatal and Nonfatal Falls in Older Adults. (which I think I might have highlighted before.
The University of Hertfordshire’s Food and Public Health Research team have recently completed a study called “Food provision in later life” which was a study about older people’s experiences of getting food in the UK.
The research aimed to show how older people from different household types acquired food, what food they bought and the people and places they acquired it from. The study was funded by the Food Standards Agency and the Economic and Social Research Council to explore the resilience of older people within the UK food system. One of their outputs was a research briefing, ‘Improving food shopping for older people’ is now available to read via this link.
It’s well worth reading before your next trip down to the supermarket, particularly if you shop with or for an older person as I do.
The video the team produced which is on the BSG’s Ageing Bites Youtube channel gives you an idea of why this is such an important topic to consider, although it is often taken for granted that older people will manage.
One of the things I like most about this study though is that the researchers have gone on to to develop a “The Food in Later Life Game” to help people learn more about malnutrition in older people and the actions they can take to help prevent/manage it.
Launched on the 3 October 2018, the game aims to help retailers, professionals, volunteers and other members of the community who work with and live alongside older people to understand how to help the older generation remain ‘food secure’. You can find out more about the game at the following website: