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Gosport War Memorial Hospital

21 Jun


Gosport War Memorial Hospital


I work with elderly clients and their families, they are amazing people who have lived full and interesting lives and I struggle to understand how anyone could treat these amazing people unethically.  They are fabulous human beings!


After Harold Shipman was convicted in 2000, it is shocking that the Police did not reconsider the various complaints that had been made in earlier years. It was after Dr Shipman was convicted that a mass complaint by 90 families was made in 2000 and although investigated, no charges were brought.  This is one of those situations where the well-used phrase “never again” can be appropriately understood!


Opioids are used at major traumas to immediately relieve pain, such as car accidents and at painful end of life.  In the case of major trauma, the purpose is to relieve pain, whilst the process of recovery from the injury can be assessed and undertaken, such as surgery, after which a detailed pain assessment should be undertaken to ensure that appropriate pain relief is provided, with consideration given to the side effects of the proposed medication/s.  It is not intended for long term use, except in carefully controlled circumstances, due to the side effects.


As far as end of life situations, the clinical purpose is to ensure that the person dies pain free and it is known to have an effect on breathing and that this side effect is likely to shorten life, however not prescribing it will ensure that a dying person experiences excruciating pain.  Opioids is considered the least worse option, for obvious reasons since death is both close and inevitable!  I have first hand seen the effects of opioid end of life care and although the difficulty in breathing is challenging to both experience and watch, it is still clinically considered a better option.


When pain relief is constantly given, then often a tolerance is experienced, so the pain can seem to be worse.  There are pain clinics to help manage this in the NHS and many alternative therapies that can assist with pain, such as Bowen Therapy (a mind and body therapy), which I can first hand vouch for and can seem like magic in its effectiveness!  Other non-pharmaceutical therapies are available.


I want to express my concern over the Police response in 2000 and pass my best wishes to the families of the victims for the follow-on outcome from this report that will give them peace, whatever that may be.


And add my voice to the sentiment.  #NeverAgain


NHS Continuing Healthcare Funding

18 Jun


NHS Continuing Healthcare Funding (CHC)


What is it, how much is it and where does it come from?


It is funding granted by the NHS, which regionally means the local Clinical Commissioning Group.  It is granted following an assessment process to determine if the person has a “primary healthcare need”.  The amount awarded should cover the whole of the cost of the persons assessed needs, so how much they get depends on their needs, but if that person is in a care home, should cover the total cost of the care home fees.


With care home fees at approx £700-£1,000 per week, this is highly valuable and the process is complex.  It is not determined on any one condition, but rather how that condition presents and therefore how challenging it is to care for that person.  It takes into account how that person is managed by a professional carer, so commonly caring for a loved one at home can be harder, as their domestic home is not set up with all the professional equipment that a care home would be.  And a loving spouse or child as carer is not the same as a team of professional carers, who are able to work around the clock, although the loving spouse or child carer will no doubt do an incredible job because of the nature of that loving relationship.


The case law relating to the funding goes back to 1999, when a car accident survivor named Pam Coughlan, who lives in Exeter went to Court to secure the funding for her care.  The case was also about where she should live, as she was being asked to move when she had been promised a home for life.


Following the Coughlan case, the Parliamentary and Healthservice Ombudsman has produced a number of reports in relation to this funding, including that there should be a national criteria.  The first National Framework was produced in 2007, it was updated in 2009 and amended with the changes to the NHS in 2012.  It has meant that there have been a number of cut off dates, the most recent one being March 2012, so unless the case was submitted to the CCG prior to 31 March 2013, it cannot be considered for a period earlier than 31 March 2012.


With the last cut off date, nationally the NHS received an additional 54,000 cases, which is about 10 times the normal amount and the CCGs have been dealing with the backlog.  After they received all the submitted cases, they had to work through them all, make sure they had all the right forms and paperwork with authorities to act, so they could know how big the issue was, this took months.  Having done that, they went to the commissioners to ask for resources, as having a 20 year backlog is unreasonable, so they needed extra resources to work through the cases and once they had done that, would need extra resources to pay out any successful retrospective claims.  They are part way through that bit of the process and some of the cases are now being accepted and paid, so the case can be closed.


So where are we now?  You can still make a claim for CHC, you can make a retrospective claim, even if someone has died, but only back as far as 1 April 2012.  So if you are receiving care, whether in a care home or at home, then you can be assessed, funding is only granted if you have a “primary healthcare need”, ie you are very unwell and require a lot of skilled support from carers.  With the Care Act 2012, Social Services now have a duty to refer you if you may be eligible.


The process is complicated and can be distressing for family members, as they are already upset by their loved one being unwell, any additional stress on top of that is challenging.  Whenever I represent the person or family in an application for CHC, I never lose sight of the loved one at the centre of this or the upset that the whole family are coping with.