Thursday, January 14, 2010

Dementia sufferers being failed by NHS

Dementia patients are being failed by the NHS as doctors and nurses lack knowledge and training, a highly critical report by the National Audit Office has found. Improvements to dementia services are not being given priority in the NHS despite repeated assurances from officials. In addition £60m handed out to local organisations in the last year has disappeared, the NAO said in an interim report.

GPs knowledge of dementia has not improved in the last five years although family doctors are more confident in diagnosing the condition, the report said. There is no basic training in the care of patients with dementia even though three quarters of patients in hospital are over the age of 70 and cases of the condition are expected to double in the next 30 years to reach more than 1.2 million in England, largely fuelled by an ageing population.

Karen Taylor, director of health at the NAO, said: "In 2007 we found value for money for dementia services was poor. The Department of Health published the dementia strategy in February last year and whilst it was comprehensive and welcome, it was delayed and the response since then is that it has not been given the priority or addressed with the urgency that both we and the Public Accounts Committee was led to believe it would be." She said 'a couple of years at least' has been lost.

Mr Amyas Morse, head of the National Audit Office, said: “The action has not so far matched the rhetoric in terms of urgency. "At the moment this strategy lacks the mechanisms needed to bring about large scale improvements and without these mechanisms it is unlikely that the intended and much needed transformation of services will be delivered within the strategy’s five year time frame.” Dementia is set to cost the country £15.9 billion this year, rising to £34.8 billion by 2026, the report said.

The estimated £1.9 billion that the dementia strategy, which sets out objectives to improve care, will cost to implement over the next ten years is expected to come from efficiency savings in the NHS and social care but this is at risk because of a lack of co-ordination. Dementia care is likely to cost a lot more than estimated after recent court cases which mean many patients with the condition who were paying for their care home place, should be funded by the NHS, the report said. Savings could be made if people were supported to stay in their own homes for longer, the report said, as specialist dementia care home places could £1,000 a week, around double a normal place.

Local NHS organisations do not even know how much they currently spend on dementia services and have not mapped out future need in their areas so cannot plan effectively, the report said. The first £60m given to local NHS organisations to improve dementia services has been absorbed into their bottom line and it is not clear what it has been spent on, the report said.

Edward Leigh, chairman of the Committee of Public Accounts said: "The Department of Health is in danger of not being able to follow up on its dementia strategy which it announced nearly a year ago. Dementia has not been made a national priority. "Almost every doctor, nurse and care home worker will at some point look after people with dementia and still there is no basic training for staff; GPs knowledge of dementia has not improved in five years; and the speed with which people are diagnosed with dementia varies across the country and so many are mossing out on the care that they should be receiving."

Andrew Ketteringham, Director of External Affairs of Alzheimer’s Society said: "This influential report shows just how big the dementia crisis is. "Change can't come soon enough for the millions of families battling daily with this devastating condition. The strategy will transform lives but only if local health authorities are compelled to give dementia the priority it deserves. Millions depend on the Strategy succeeding. It's a race against time."

Phil Hope, Care Services Minister, said: “We welcome this report, however it is important to remember that the field work was done five months after the National Dementia Strategy was published. Our implementation plan is on track. “Improving the quality of care and treatment for people with dementia is fundamental to our work to improve the lives of those affected. We will give careful consideration to all the recommendations made in this report. “We are in the first year of our ambitious five year National Dementia Strategy - change will not happen immediately. There is still much more to be done and we are working hard to put the plans outlined in the strategy into place.


British councils trying hard to cut back care for the elderly

Council officials are attempting to force through plans to abolish round-the-clock wardens in housing for vulnerable elderly people despite the worst winter in decades. A High Court judge ordered Portsmouth City Council to restore 24 hour staffing for hundreds of residents of sheltered housing schemes after a landmark High Court case last month. Judge Milward Jarman QC said that there were “serious failings” in the cost-cutting plans to replace overnight wardens with a “mobile” team of just two people patrolling the city, covering seven separate housing blocks. But officials have now secured a temporary order allowing them to continue with the cheaper scheme while the council appeals last month’s decision.

Replacing the wardens with two-man teams is expected to cut costs by an estimated £365,000 a year. But residents said that they felt frightened and vulnerable without round-the-clock staffing and claimed that the cuts could lead to tragedy. “If they win and I hope and pray they do not we are going to have deaths on our hands, I can see it coming, especially with this weather,” said Ron Smith, one of the residents, in whose name the original legal challenge was brought. “Our own staff who used to do the nights knew the residents, knew what is wrong with them, what pills they need, everything like that."

Just under 350 residents, some aged in their 90s and others suffering from illnesses including cancer, were told last summer that overnight wardens were being withdrawn as part of a plan to “improve” the service. Almost half personally signed up to support judicial review proceedings brought by Yvonne Hossack, the campaigning solicitor, in a joint case which also challenged a similar scheme in Barnet, north London, supported by hundreds more residents. But although they won the case, the Portsmouth residents are now facing the prospect of a fresh attempt by the council to abolish 24-hour wardens.

With roads across the city blocked by snow, the council was forced to abandon its mobile teams last week, hiring in agency staff to temporarily restore overnight staffing during the extreme weather. But it plans to revert to the two-man teams as soon as possible while it prepares to appeal last year’s ruling. “We believe that this is an essential service it is a matter of life and death,” said Miss Hossack.

David Mearns, the council’s assistant housing manager said: “We have always maintained that the mobile night service provides a safe, effective service that meets residents’ needs. “To date, the service has run for 64 nights, and received very positive feedback from the residents who have requested their help. “This has been supported by scheme staff, who say the night service is working extremely well.”


Doubts linger about final passage of Democrats' health plan

Senate and House Democrats intend to pass a final health care bill by next month, but as they return to Congress, Democratic leaders face a barrage of criticism and outright opposition to the bill from lawmakers and important interest groups that could put passage in jeopardy. Democratic leadership aides in the House are insisting Congress can clear a health care bill by mid-February, but Senate leadership aides won't commit to a date. Sen. Christopher Dodd, D-Conn., who announced his retirement last week, went so far as to declare the bill's passage was "hanging by a thread."

Public opinion polls confirm a lack of support for the health care plan, with disapproval growing as time passes. "I think they know how unpopular this is," said Senate Minority Leader Mitch McConnell, R-Ky. "And so I have some hope that they will have difficulty ramming this ... down the throats of the American people."

Republicans highlight a string of reports questioning the cost savings claimed in the Democratic plan. The most recent report was released last month by the Health and Human Services Department. It found that the Senate-passed bill would not shrink health care costs as promised, but rather would increase them by .7 percent in the next decade. The report, issued by HHS's Center for Medicare and Medicaid Services, said the plan included potentially "unrealistic" policy changes needed to curb Medicare costs, and such reductions could lead to a loss of services for seniors. Democrats point out that the report shows that the bill would ultimately keep Medicare solvent by reducing costs associated with it.

House Democratic leaders will soon begin negotiating in earnest with their rank and file to reduce opposition to a final bill that will likely mirror legislation passed in the Senate. Many House Democrats oppose the Senate bill because it lacks a government-run insurance program and includes an excise tax on expensive insurance policies.

Interest groups on the Left and Right who don't like the bill's taxes and abortion language are also bearing down on lawmakers. On Tuesday, a coalition of business and union leaders sent a letter to Senate Majority Leader Harry Reid, D-Nev., demanding lawmakers to get rid of the excise tax, which will hit many union workers. "We urge you, instead, to choose alternative revenue-raisers that are less likely to undermine the objectives of reform," the letter says. "Viable options have been proposed."

If the House insists on any significant changes, such as substituting the excise tax with an income tax on the wealthy, Senate Democrats risk losing a vote, which will leave them shy of the 60-vote supermajority needed to block a Republican filibuster.

Brendan Daly, spokesman for House Speaker Nancy Pelosi, said these differences wouldn't block passage. "Congress will soon pass, and the president will sign, a bill that provides affordability for the middle class, accountability for the insurance companies and accessibility to many more people in our country to quality, affordable health care," Daly said.


Labor unions campaign Against Tax on Health Plans

Having failed to persuade President Obama to scrap a proposed tax on high-cost health insurance policies, labor leaders took their case Tuesday to Speaker Nancy Pelosi, and they said they received a more favorable response. “I love the House, and I love the speaker,” Andrew L. Stern, president of the Service Employees International Union, said after the meeting.

House and Senate Democrats are trying to iron out numerous differences in bills passed by the two chambers to expand coverage and rein in health costs. “We are not ready at this point to get a single bill that we can agree to,” said Representative Louise M. Slaughter, Democrat of New York, the chairwoman of the Rules Committee and a member of the speaker’s leadership team.

House Democrats held a caucus on Tuesday night to figure out how they could finish work on legislation to remake the health care system along the lines proposed by Mr. Obama. Having devoted much of 2008 to the legislation, senior House Democrats said it could be a political disaster if they failed to pass it in this election year. But House Democrats made clear on Tuesday that they would not simply accept the Senate’s positions on major issues.

House Democratic leaders said, for example, that they would insist on a single national insurance exchange, where many individuals, families and small businesses could shop for coverage. The Senate bill calls for dozens of state-based exchanges.

And House Democrats said they would also insist on eliminating the exemption from federal antitrust law that health insurance companies have long enjoyed. The House bill would revoke the exemption, while the Senate bill would maintain it. If the exemption is repealed, Democrats said, it would be easier for federal officials to take action against price-fixing or other anticompetitive practices in the health insurance industry.

Under the Senate bill, the federal government would impose a 40 percent tax on the value of employer-sponsored health coverage exceeding $8,500 a year for an individual and $23,000 for a family. The bill would make certain allowances for plans covering retirees 55 and older and workers in high-risk occupations.

Ms. Pelosi noted that the president wanted the tax. But Representative Jerrold Nadler, Democrat of New York, said: “The view of many progressives is that the tax is unacceptable. It would affect a lot of middle-income people.” Mr. Nadler said the politics of the tax should worry Democrats. In effect, he said, “the tax tells blue-collar workers that you should pay higher taxes and get lower benefits to help finance coverage for the uninsured.” The Congressional Budget Office estimates that the tax would raise $149 billion over 10 years.

The House bill would not tax health benefits, and Representative Joe Courtney, Democrat of Connecticut, said that at least 190 House members had signed a letter opposing such a tax.

Mr. Stern, the union president, said that many workers with plans costing more than $23,000 a year did not have luxurious coverage. At a White House meeting on Monday, he said, labor leaders told Mr. Obama that some workers with rather ordinary health plans had to pay very high premiums because insurance companies faced little competition. Mr. Stern said that many union leaders were concerned more about the formula that would be used to increase the tax thresholds in the future than about the initial thresholds of $8,500 and $23,000. Union leaders said they feared that under the formula in the Senate bill, the tax would hit more and more health plans, which would pass on the cost to more and more workers.

Representative Charles B. Rangel, Democrat of New York and chairman of the Ways and Means Committee, said it would be difficult to win support in the House for the proposed tax on high-cost plans. “That’s going to be a problem,” he said.

Some Democrats had assumed that the House would yield to the Senate on many issues because any changes in the Senate bill could imperil the 60-vote majority needed to overcome opposition from Republican senators. But Ms. Slaughter said, “It is as hard for us to find 218 votes in the House as for the Senate to find 60.”

At their caucus, House Democrats said, they felt pressure to make concessions to get a deal on health care. “A lot of people think we have a gun to our head and don’t like it very much,” said Representative Anthony Weiner, Democrat of New York.

Ms. Slaughter said “it is really critical” to have a single national insurance exchange managed by the federal government. “If you leave that up to the states,” she said, “some states will not do what we are asking them to do.”

The National Association of Insurance Commissioners took a different view. In a letter to Ms. Pelosi, the association said that states should retain primary responsibility for regulating insurance, and that insurance exchanges should be “established and administered at the state level, with the flexibility to meet the needs of our local markets and consumers.”

While Democrats tried to work out their differences on Tuesday, the Senate Republican leader, Mitch McConnell of Kentucky, said, “We are going to do everything we can to stop this bill.” “I have great hope that enough Democrats are going to wake up and say we should not thumb our noses at the American people and cram this down their throats, no matter what they think,” Mr. McConnell said. “It’s an act of incredible arrogance.”


Health bill may be lenient on employers

Democratic leaders negotiating a compromise health care bill appear likely to reject a House provision requiring employers to offer generous coverage to their workers or else pay a steep payroll tax, specialist say. The handful of moderate Senate Democrats who hold the political upper hand in shaping the final bill are expected to insist on hewing much closer to the Senate’s relatively lenient approach, which does not include a strong requirement that employers offer coverage. “I think that the House structure . . . will not fly in the Senate, given that they need 60 votes for the bill,’’ said Robert Greenstein, director of the Center on Budget and Policy Priorities.

Killing off the strong employer mandate in the House version would represent a substantial victory for business lobbies, who last year confronted the possibility that large Democratic majorities in the House and Senate could stick businesses with heavy regulations and fines.

Several influential business groups remain hostile to the Senate bill even so, but moderate Democrats have set their sights on at least keeping the Business Roundtable, a group representing large corporations, from not actively campaigning against the final bill. John Castellani, president of the Business Roundtable, called the Senate employer regulations “a much better approach.’’ He said they would give firms more flexibility in what kind of insurance they offer. “You don’t want to lose the ability to be creative and innovative, to drive better care, and to lower the cost trajectory,’’ he said.

But liberals and union leaders warn that the Senate’s approach would not strengthen coverage for many Americans who already have insurance, because unlike the House bill it would not set minimum standards for health benefits for large employers with more than 100 workers. Americans will want to know, “Is it going to stop this trend where employers are charging me higher premiums for skimpier coverage, or is it going to allow it to continue?’’ said Richard Kirsch, director of Health Care for America Now, a coalition of liberal groups.

In the coming weeks House and Senate leaders will meet to reconcile the differences between the health bills that each chamber passed last year. The employer responsibility issue has been overshadowed by noisier debates over abortion, taxes, and the public option. While the final product will require most individuals to obtain insurance, Democrats must now decide what employers’ obligations should be. A spokesman for House Speaker Nancy Pelosi had no comment on the negotiations.

About 56 percent of private firms offered coverage to employees in 2008, according to the Kaiser Family Foundation. Under the House bill, all firms with more than 50 workers would have to make substantial contributions toward relatively generous insurance for employees - including part-time workers, adjusted for hours worked - or face stiff financial penalties of up to 8 percent of payroll.

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