U-turn

[bluemonday]

Clicky

Schadenfreude, no teares

[Cret]

Schadenfreude, no teares

 

Excellent word. I remember that from an old Rover advert where it had some smug guy taking pleasure in the fact someone else had paid more for a non-rover car than he paid for his rover. As if to suggest it was a good car. Yuck yuck!

[GD4ELI]

Clicky

Schadenfreude, no teares

 

It's anything but Schadenfreude, rather a minister admitting he was wrong and taking action. I maintain that Eddie Teare is one of the finest politicians on the Island.

[triskelion]

It was never a measure he seemed very passionate about when questioned on it in the Keys/Tynwald.

[Gladys]

Having had quite close experience in these matters recently, I have to say I was a little dismayed at the decision. The vision of keeping elderly people in their own homes is fine, providing the necessary support is given. The support does seem to be an essential of the plan, but the real problem is identifying those who need help in their own homes and making sure it is delivered. In my own case, it really was only after quite some intervention on my part to get the necessary help that we got anywhere.

 

Having said that, once they moved into action, Social Services were excellent. I had raised the problems with them over a year before, but once they had put us in touch with Age Concern their interest then waned. (You would have thought that having become involved they would have kept a watching brief after the remedial action had been taken to ensure that they could assist if there was a further change in circumstances - the elderly rarely get better do they? - but, no, they 'signed' us off.)

 

It took further more recent pleas, making them understand that if I buckled under the strain they would not only have an elderly person to deal with, but also two children. Once they took that on board and understood the severity of the problems, things did move quickly and we managed to find a place in one of the Government residential homes for my parent just before the decision to stop long term admissions.

 

It was important to us to find a Government-run residential home as the privately run homes were gloomy, inactive places that I really did not want for my parent. The Government homes were bright and friendly, with plenty of staff who all seemed to be very happy in their jobs and keen to 'care'. Money was not the criterion as we were not eligible for any Government assistance, beyond the non-means tested attendance allowance and have to pay the full whack even in the Government home; it was more that the Government homes were just far better places.

 

So, I would agree with the proposed change in principal, providing there is a mechanism to monitor all elderly 'at risk' people so that any changes in their circumstances can be responded to. However, there still remains a need for Government run homes which offer the quality of care that is not so apparent in the private sector. Also, 'staying at home' should not mean 'care supplemented by relatives' as that can put an enormous strain on families, particularly those in work (this usually means working women, as this type of care, along with most others, usually falls to the female to provide).

 

The decision we took was not one we really wanted but, in the circumstances, there was pretty well no option. If the Government run homes had been closed to long term residents at the time, then I really do not know what we would have done.

[triskelion]

Maybe its time to find ways of establishing third-sector care homes?

[bluemonday]

Or indeed, maybe it's time to stop taking the piss out of family carers who keep people in their own homes.

Saving the Manx gov in each case a few hundred a week. For 50.55 a week for a minimum of 35 hours plus earning restrictions of around £90pw.

Clicky ( Last 4 paragraphs )

 

£50.55/35 = £1.44 an hour.

[triskelion]

Where will the financing for that come? The DHSS is strapped for cash as it is.

[Gladys]

Maybe its time to find ways of establishing third-sector care homes?

 

The Ellan Vannin is just such a place. Yes, there is a need for more.

[Keith]

...rather a minister admitting he was wrong and taking action. I maintain that Eddie Teare is one of the finest politicians on the Island.

 

If he is indeed a 'fine politician' put him in the Treasury where being a bank manager is a useful skill. Health & Social Care on this island is not in a good state, it's in a mess. We have a Minister who can count the pennies but not see the people and this is a good example of that. If measures were put in place before the shutting to admissions, there could have been a smooth transition that the public would have understood and indeed, welcomed. But that would cost money (investment). Instead an arbitrary decision was made that did not take in to account individual needs nor how alternative provision would be provided and accessed. Eddie Teare can see the pounds of "over spend" but is unable to argue with Treasury that some of it may actually be "under funded".

 

On a personal basis, I am awaiting an operation on my sinuses. By the time I get the operation it will be a three year wait, unless I go private. A friend in England's husband had exactly the same operation as I require. It took three months from the first GP visit to having it done. I'm convinced that "the finest politician on The Island" would rather I went private, indeed would advocate that if I can afford it I should go private so that our underfunded NHS had one less operation to deal with.

 

While league tables etc are a very crude instrument, we should be producing waiting times and other evidences of quality in a manner that is comparable with the UK. Only then will the population be in a position to make an informed decision regarding the state of our Health & Social Services and THEN decide if we have a decent Minister, rather than one who rushes in to a cost cutting decision instead of a planned move towards an increased quality of care.

[thesultanofsheight]

...rather a minister admitting he was wrong and taking action. I maintain that Eddie Teare is one of the finest politicians on the Island.

 

If he is indeed a 'fine politician' put him in the Treasury where being a bank manager is a useful skill. Health & Social Care on this island is not in a good state, it's in a mess.

 

And which of the current quality list of publically elected rocket scientists would you have in his place?

[triskelion]

What country do you live in Keith? The Isle of Man has a FANTASTIC standard of care, and its free at the point of delivery. Try moving to Australia or something where calling out an ambulance costs $800. Whilst I can sympathise with your three year wait and agree it is obscene, Eddie has actually only been minister for the DHSS for half of that, and was tasked with stemming the department's ever spiralling budget, which takes 60% of Government expenditure as it is.

 

You are confusing the issue somewhat: The problem with your sinuses is a matter for the Health Services Division. The issue of care homes falls under Social Services Division. Yes, they are both run by the DHSS, and funded out of the same budget, but the difference is important because you seek to use the UK as a comparison. The system there is quite different. Care homes are almost always either run by the private sector or by County Councils or Unitary Authorities. Hospitals, on the other hand, are run by Primary Care Trusts. As a result, there is no budgetary overlap, and no single minister forced to make decisions as to how to rob Peter to pay Paul. Accordingly, each is able to operate to its own targets and priorities, but I assure you the closing (or slae of LA-run care homes in the UK is a massive issue there to.

 

Gladys: Thanks for your informative reply. When listening to Keys/Tynwald questions relating to the issue, it seemed they were forgetting this option.

[Keith]

What country do you live in Keith? The Isle of Man has a FANTASTIC standard of care...

 

How do you know this? What are the waiting times? What are the quality outcomes? Without access to 'league tables' (which I've already acknowledged are a crude instrument, but better than nothing) how do we know that our Health Service is FANTASTIC, comparable or worse than the UK? I was talking to someone recently who has just returned from an operation carried out in the UK. He was told over here that 'nothing could be done'. He insisted on a second opinion and has been told by the specialist that the 'worst case scenario' is he'll get 90% use back but that it should be more. If he wasn't assertive or didn't know his rights, he'd have taken the first comment and put up with it.

 

You are confusing the issue somewhat: The problem with your sinuses is a matter for the Health Services Division. The issue of care homes falls under Social Services Division. Yes, they are both run by the DHSS, and funded out of the same budget, but the difference is important because you seek to use the UK as a comparison. The system there is quite different.

 

I seek to use the UK as a comparison because it is the best comparison to make as the system is closest to ours.

 

Care homes are almost always either run by the private sector or by County Councils or Unitary Authorities. Hospitals, on the other hand, are run by Primary Care Trusts. As a result, there is no budgetary overlap, and no single minister forced to make decisions as to how to rob Peter to pay Paul. Accordingly, each is able to operate to its own targets and priorities, but I assure you the closing (or slae of LA-run care homes in the UK is a massive issue there to.

 

For many people, community care is a better way forwards rather than institutional care. However, the move should be driven by an improvement in quality of life, not budget. To do this involves huge investment to begin with, so that demand for those care homes naturally declines. This involves increased support agencies, home help, meals on wheels, district nursing etc. It involves better housing (Aids & Adaptations budget?). It involves adequate provision of day care services. It involves improvements to respite care and access to that care provision.

 

I have worked in private health in the past. I certainly wouldn't invest my money in a nursing home now. Granted, there was a period of time when private health was a cash cow but it is actually not an easy business to run now, on current fee levels. Private health is MUCH cheaper than Public health equivalent. Obviously, it looks expensive because the burden falls largely upon the individual in private health and on the Department for public, but the over all cost of keeping someone in a public service is more than the private one. What is needed is a 'private health' mentality within the public services.

 

While you reasonably point out that I'm mixing Health & Social Services, as one department but two beasts, I will do so again. With some planning, here's how to sort out a huge amount of the budget over spend.

 

Firstly, let the unit/ward managers manage. If ward managers don't know and aren't responsible for their budgets, how can they meet them? Give them training, then get them to do a 'bottom up' budget. This should be broadly in line with their existing expenditure. The first year should be a learning exercise rather than actually implemented.

 

Secondly, when talking with ward managers, a common theme is "if we spend less, they'll take the money off us next year". That, coupled with "if we over spend, nothing is done" lead to a culture of spending because it doesn't matter. So, inform the manager that their budget will not be reduced if they underspend AND the saving will be placed to one side as 'Restricted Funds' which the unit themselves can decide to spend on anything that improves patient/client care/support. Year two, their budget remains and again, any underspend is added to the fund. Year three...

 

This has two effects. The unit staff have ownership of the fund. They can actually work towards a 'pet project', which is likely to be quite innovative. There is a positive outcome for meeting budgets that is tangible. Waste is reduced but so is the laissez-faire attitude. I spoke recently with someone at a 'lower management' level who commented upon who they had worked with that day. Another 'lower management' member of staff and the unit manager... On a Sunday! Three managers on together, on a Sunday? Won't anyone think of the budget?

 

While improving productivity and outcomes (team building etc) natural inflation will eat in to the over-spend, so it may take four or five years before we reach a point where efficiency is met. Government should see this as a medium to long term plan to change culture, not a slash & burn approach. Change culture slowly it stays changed, come in with a big stick and it changes only as long as the stick is visible. And acting without thinking things through... well that way madness lay...

 

Talking about madness, what about the Isle of Man's psychiatric services...

[Sparky]

Secondly, when talking with ward managers, a common theme is "if we spend less, they'll take the money off us next year". That, coupled with "if we over spend, nothing is done" lead to a culture of spending because it doesn't matter. So, inform the manager that their budget will not be reduced if they underspend AND the saving will be placed to one side as 'Restricted Funds' which the unit themselves can decide to spend on anything that improves patient/client care/support. Year two, their budget remains and again, any underspend is added to the fund. Year three...

 

Absolutely spot on. This attitude is not just restricted to th DHSS though it prevails throughout government, we have it so we have to spend it, there is no encouragement to come in under budget, in fact as you say it is quite the opposite. Even the treasury reports reflect this. If you run a project for the government and save 5%, treasury reports that it has underspent by 5% which in government is seen as a negative and not a positive, until this attitude changes we will always struggle for cash and therefore the delivery of quality services will be affected.

 

I agree with your comment, let the managers manage. However, this will involve them making mistakes, as long as these mistakes are learned from then this will only improve the management team, if however they are punished (unreasonably), then they will sit back, take the cash and accept no responsibility and our money will keep dripping away.

[bluemonday]

Where will the financing for that come? The DHSS is strapped for cash as it is.

Say a week in a home costs 500.

A week with a carers allowance costs 50.55.

ergo a saving pw of 449.50.

 

Few people I suspect, will be happy or even be capable of surviving on that; or indeed consider they want to give up work to do that,

so.

Make the allowance a more practical sum.

Say eg min wage - 6ph x 35 = 210pw

 

Cheaper than a week in a care home.

Cheaper than a DSS supplied care worker for 35 hours.

Certainly far cheaper than an agency supplied worker for 35 hours.