Wednesday, 25 July 2018 16:35

Hope

On a recent visit to a sick kids ward I had the pleasure to be engaged by a mesmerising smile, glinting eyes and affectionately happy communication which comprised of no words.

I was sucked in with an overwhelming sense of warmth, happiness and contentment that was coursing through my veins. Personal worries and stress lifted in an instance; life in perspective!

My experience makes me question the meaning of what is normal, what is a disability and more profoundly the role of society in pigeon holing people in to boxes of normal or not. Surely my experience tells us one thing that the young person without verbal communication managed to change my outlook, feelings and demeanour completely in a matter of seconds, quicker than words spoken or written and more enchanting and definitely longer lasting, writing this narrative 4-days later is proof.

If disability is being different, needing more support or challenging society and its views and stereotypes then I say let’s bring it on! What is more important is the breaking barriers, acceptance and making life a much more rewarding place for all. If some want to shape society in a fashion of their own making, please, it has to be one for all and not the few!

I hope for that young girl in a hospital bed that got in to my psyche so intensely in a fleeting moment is provided all the support and acceptance by you, me and society.

We have the responsibility to challenge but also to embrace all in our society that are different from ourselves, remembering being different is a good thing. It makes us human!

All individuals deserve the right to live independently if it is what they aspire to do. One of the challenges is always ensuring that appropriate care can be provided whether a couple of hours a week, a day or even more full time care provision.

For those individuals with Additional Support Needs the challenges can be a bit more complex or daunting but again if the individual want that independence the obstacles in many cases can be overcome.

Some individuals are also challenged by their childhood home is no longer available or suitable and in some cases family members are no longer available to provide the support that they need.

One company in Bolton, ICRIT Healthcare, has looked at this challenge from both the NHS perspective and also the individuals aspirations and would be well worth contacting if you live in the North West of England as they do have accommodation suitable for supporting these individuals.

We believe that providing the right accommodation solutions will give these individuals confidence and skills to cope with their disability and long term will have a reduced financial and resources drain on the NHS.

Contact ICRIT Healthcare to learn more.

 

One of the greatest pressures on the NHS is the integration of Social and Health Care and ensuring that individuals who have had a need to be in hospital can be released knowing that appropriate care is in place.

This is very evident when it is a homeless individual as how can the individual be cared for whilst living rough on the streets.  It is also highly likely that these individuals will be readmitted so the drain on resources is multiplied.

ICRIT Healthcare in Bolton have just launched a service which is designed to work with local hospitals and provide independent living but with care packages in place to support such individuals.

To find out more please visit https://icrithealthcare.co.uk/our-services/hospital-to-housing-support

Here are some of the supporting facts to demonstrat the importance of such a service.

RESEARCH AND BACKGROUND

Research has demonstrated that being homeless can have significant implications for the individual, including increasing the risk of long-term health problems. The Deloitte (2012) study found that up to 70 per cent of people who use homeless services suffer from mental ill health. There were also high levels of alcohol and drug dependency, which tended to exacerbate health problems. Due to a reduced access to normal healthcare services, many homeless people let their conditions deteriorate until a point where emergency care is required.

Research by CRISIS (2011) indicates that the average age of death for a homeless person is 47 years old, 30 years younger than that of the general population. In addition to the impact on individuals, research has started to focus on the cost of homelessness. Research by Homeless Link (2013) estimated that each homeless person represents a cost of £26,000 per year to the public fund. Therefore services that prevent homelessness and help a transition away from this situation will likely result in a saving to the public purse. Deloitte (2012) found that homeless people attend A&E up to six times as often as the general population, are admitted four times as often and once admitted tend to stay three times as long in hospital due to acute health issues and complex needs. Also, one in ten homeless people who do access A&E will do so at least once a month. DoH research in 2010 found that overall the total cost of hospital usage by homeless people is estimated to be £85.6 million per annum. This figure is around four times higher than the cost associated with a similar sized group of non-homeless people. The same DoH (2010) report found that inpatient costs represent the majority of the care provided to this client group, and are approximately eight times higher than for the comparison group, possibly because the homeless have an average length of stay in hospital three times as long as the general population. In total this equates to over £2,100 per person, compared with £525 for the general population (Deloitte, 2012). A joint report by Homeless Link and St Mungo’s in 2012 found that when homeless people finally leave hospital, more than 70 percent will be discharged straight back onto the streets without their housing issues being addressed, which will likely result in readmission due to the conditions being adverse to recuperation.

Despite the circumstances described above, the DoH (2010) report highlighted that in 2010 only 39 percent of Local Authorities indicated that they had specific policies dictating protocol for the admission and discharge of homeless people; furthermore only 27 percent of those who are classed as homeless received help with housing before being discharged. A report by the Centre for Health Service Economics & Organisation (CHSEO) in 2011 showed that projects and models which have been implemented to improve admission and discharge practice have demonstrated cost benefits in two different ways: firstly the average length of stay will change due to a reduction in ‘bed blocking’ as homeless people are more likely to be discharged sooner if their housing and next steps are adequately catered for (however some may stay longer if this is deemed necessary)6; and secondly if patients are discharged at a clinically appropriate time and to suitable accommodation they are in a position to more ably recover from an illness, and thus there are fewer emergency readmissions to hospital within 28 days. Previous interventions have demonstrated these potential cost savings in action.

For example, at the Arrowe Park Hospital in the Wirral, a link worker was hired to ensure that those who were homeless were accounted for in policy and supported during discharge. The DoH study in 2010 found that during the year there was a fall in the number of episodes (26%), admissions (18%) and bed days (26%). The amount of delayed discharges was also reduced, saving an estimated £45,000 in six months

How easy is this and could it be easier?

The answer it appears relatively straight forward or that is how it is positioned but the reality is do not expect it to be cheap, simple or quick and be prepared for some challenges in establishing the trust terms how you want them.  There are pitfalls along the way which as you are doing something for the first time and dealing with solicitors and cutting through the legal speak will always be a challenge.

Starting at the logical first point is the setting up of the Will in which you are leaving all or part of your estate to the trust.  At this stage you will define who the beneficiaries of the trust would be and imagine that you have two children and one (A) gets 50% and the other (B), who is disabled their share is to be put into trust. The first realisation is the trust is not purely for them and to avoid a tax burden and the monies being considered as part of their wealth multiple beneficiaries will be identified.  This is required based on the assumptions that the disabled person will most likely be on benefits and any monies purely in their name would be part of the means testing process. Therefore, what might be deemed a relatively small inheritance sum might have significant implications on the amount the individual is receiving in benefits and ultimately having to live on.

The Will in most cases will sit until the eventuality of someone dies at which point the executors will be instructed to set up a discretionary trust as part of the terms.  Be prepared that this means legal costs in establishing and registering the trust and then the added complication of setting up a bank account in the trust name so the monies can be deposited. 

What many would recommend is that the trust is set up in advance so that the heartache and pain of dealing with the solicitor and a bank is done when not coping with the tragic loss of a family member, yet there are downsides to this also.  Banks do not set up trust accounts on a daily basis and the counter staff do not understand.  It took a family 4 different banks before eventually getting one that understood the trust terms and then from an initial request it was over a month to get something that could operate how the trustees required.  If you have a few failed attempts in progressing getting the account set up it could result in three or four months of going back and forward, signing different forms and lengthy conversations.

So, what to look out for is that banks see trust accounts as possible tax avoidance schemes and typically have a small team in a head office that you will not get to speak to regardless of however many times you request it.  The people in the branch reassuringly will say it is simple and straightforward but the reality is the banks see it as complicated and you will experience a chain of Chinese whispers with ultimately restrictions on the account which are the banks position but in many cases, renders the account inoperable.  Many of the banks see the area of trusts for their few private banking clients and do not want to operate the service unless the sums are significant. Banks also have some difficulties with trusts and the arbitrary rules that they set sometimes do not accord with the law.

Given the complexity of just getting a bank account established the next consideration is once the trust is established you will need to register and do annual returns with HMRC.  These are relatively straight forward and typically good record keeping will keep you right in doing the return.

Going back to the consideration of setting up the trust in advance though one area to consider is that trusts can only generate income for a period of 21 years.  So, if you are planning ahead, you will need to have the trust making no money for the period up to the deaths of the individual leaving their inheritance.  Obviously if it is the Will executors who are setting up the trust then it is assumed the individual has died. 

Is it easy then, no. Could it be, yes.

The problem though is that both banks and the government have their guidelines on how they expect the trust should be established and managed, the law has clear guidelines on what can and cannot be in the trust so you will need to be clear and concise in your requirements but willing to accept further beneficiaries of the trust and some of the conditions about trusts are antiquated and have been challenged but remain conditions, such as the 21 years ruling.

The reality, and in conclusion is that the trust needs legal input and you should not try and establish a trust without it.  You might need to shop around for a bank to work with and do not be afraid to walk away and start setting up an account with another if they start to restrict the terms of operating the account.  Finally, we do recommend do it in advance of the death because it taking 2, 3 or even 6-months to set it up in advance is nothing like struggling to do it on someone else’s bequest when possibly grieving.

The answer is “Yes” but what needs to happen is a step change in the provision of services and embracing technology. 

We do not advocate removal of human intervention but enhancing it.  Technology should be used to remove paperwork and form filling at the nurse’s station.  Admissions on electronic forms that are extracted from a central database which then means it is a checking and correcting process not a completion task.  These are maybe minor activities but when you reflect these across a major hospital it very soon will save days if not weeks of activities across the year.

What happens with saved time?

Waiting lists are always positioned as targets either met or not, changed interpretation or figures reset.  Waiting lists are not the problem! The problem is the capacity of the hospital and its process management to churn more people in and more procedures carried out.

What about operations and the lack of consultants? 

The requirement to maximise theatre time is fundamental to the success of the hospital and what needs to happen in every hospital is the requirement to understand, plan and schedule procedures.  Operations should be carried out throughout the week and even at the weekends.  This means that the specialist consultants required would be 3 or 4 if one procedure could be carried out continually on a known demand basis.

The business analysis of the processes is fundamental and targets defined as to what is realistic and achievable.  Management must support this process of change and identify contingency.  The movement of staff utilising expensive equipment and procedures is important and joined up and partnering agreements with the neighbouring hospitals.

So, in summary the NHS is a massive company with complex processes and is often dragged down by the paper chase that is happening in the background.  Technology can remove most of this and free resources. The processes need to be reengineered, per hospital and then collectively across the sector.  Cash resources thrown into a pot which is funding the wrong areas is worrying as the return is never going to be achieved.

In a recent conversation referenced with a senior consultant over the question of Brexit and the impact of numbers coming in to the UK.  The answer was the issue is not the resources but the level of knowledge and command of English.  Assuming the numbers decrease from the EU it will allow the correct people to be screened and employed coming from non-EU countries.  The main consideration on this point is the terms trained and their command of English thus reducing management intervention and supervision.

Finally revisiting the initial question, hospitals need to change using technology to release staff resources and all this underpinned with processes to improve the throughput of people with hospital procedures carried out.  The right resources are needed but the processes need to be defined properly to identify the gaps. 

A hospital is a manufacturing, care and repair company and should operate as such!

Got your attention? 

Looking at the NHS, it is undeniably struggling in places and things will need to change to support an aging UK population and the expectations people seem to have when it comes to medicines and medical procedures. 

Some issues are less emotive and can be improved with transforming services within the NHS namely technology and business processes, recruitment and retainment, asset management and operational costs, etc.

If we consider the salary figures;

  1. A) A Consultant in a hospital mid-grade is on £90,000,
  2. B) Senior Consultant would earn more than £100,000,
  3. C) A GP practice partner around £80,000,
  4. D) A Nurse is on an average salary of £23,000 to £25,000 per year,
  5. E) A Nurse practitioner could be earning as much as £70,000 per year based on location.

Who is underpaid?  There are a lot people working for salaries well below those of nurses and managing family commitments and daily living expenses.  So, what is the problem?  Do we want to put our life in the hands of staff that are undertrained, not incentivised, or are lacking committed to their chosen profession?

Remember the NHS was designed for a population approximately 65% of the current UK levels.

Considering the cost of an agency member of staff where the figures above could be doubled easily, where an agency nurse could be earning more than £75,000 per year based on 40-weeks!  Doctors covering out of hours playing a system to get higher rates and therefore enhanced payments and fundamentally not available to cover daily workloads.

The reality of expectations being set by what earnings are possible when the NHS has staff shortages to deal with. When the service cannot be delivered unless relief personnel on inflated wage contracts are brought in you have two people trained within the NHS, one remining as an employee on £23,000 the other who left because knowing they will be contracted back on 3 times the salary on £75,000.  Is this a fair system? Or value for money?

Shortages also result in longer hours, more work pressures and strains on service delivery.

In conclusion, the one answer is that staff levels, retention, job satisfaction and the overall expectations are somewhat broken.  This can be fixed as a long-term commitment to the NHS without breaking the bank. 

More nurses, more doctors, improved job satisfaction and ultimate retention is a big part of the solution.  Restricting agency staff contracts. Resetting public expectations for pressure points such as A&E and out of hours GP consultancy.  The journey to the solution involves a change of systems and processes, using technology, reducing paperwork and improving completion times.  This means stronger management and controls and up to date patient records.  A cost of living increase at the lower salary scales narrows the gap and releases the short-term dissatisfaction but with a programme delivery to readdress the main issues around staff shortages and agency employment.

If the plan is to reform the NHS the realisation throwing money into it for increased salaries does not fix it.  It masks the underlying issues.  Money for new employment and fast tracking students through the system would be a start but investment in continued training and enhanced terms and conditions is the answer.

Politicians need to be brave and justify this transformation as the longer the status quo continues as a broken system the ability to fix it becomes harder each year that passes.

Saturday, 20 May 2017 09:36

Home Care versus Care Home?

Home Care versus Care Home?

We are often asked what is the cheaper, Home Care or Care Home support for either elderly or disabled people. The first thing we would always stress is that you need to make sure you are comparing like for like and also what your requirements are now or longer term. Consider the following Youth Hostel or 5 Star Hotel? Both have beds, both can provide catering, both have toilets and bathing facilities but you would not say they are the same.

Similarly when deciding on care provision especially for Live-In Care you start to see some fundamental differences that start to determine what is right for you.

Do you have a pet? Many Care Homes do not allow pets so keeping your dog or cat is an obvious consideration.

Do you like flexibility of when you eat, have cups of tea or socialise with friends? Many care homes have set times for activities and you will need to fit in with the schedule.

Is it just you or is it you and a partner or other family member? Live-In care will be a lot more cost effective when it is more than one as typically one Live-In personal care assistant can cover two people for a slight premium, unlike a Care Home wher it will be two fees.

Also consider the element of companionship and if you are looking for joint social activities and group activities then maybe a Care Home can provide you this more than staying in your own home. Alternatively if you have a local group of friends and existing social activities these might have to be sacrificed based on location.

Cost is the difficult one based on requirements and obviously funding will be available for both depending on the care assessment carried out but we in most cases see the monthly fee being less with Live-In Home Care subject to complexity of care needs.

Finally the most common feedback we get is that emotional attachment to your existing house, belongings and area in which you live and people want to spend the “autumn years” of their lives surrounded by what they feel most comfortable with.

To learn more about our Live-In services please follow the link of call us on 01204 325013 to discuss your specific requirements.

ICRIT Healthcare cover the whole of the UK, why not get in touch.

ICRIT Healthcare and Supporting Hospital Discharges

GREAT NEWS!

Your relative is ready to come home is really positive news. On further discussion the elation turns to despair on how you will be able to provide the care needed. This could be someone who already benefits from a care plan and this now needs to be increased or it might be someone who is now in need of support for the first time.

Typically as part of the discharge the care needed will be discussed in detail with all parties and the medical profession will detail what they will do which is clinical led care which may involve visits to attend to wounds, dressings, medication, etc. Personal care is where family will be expected to provide or make arrangements to supplement or compliment the medical care.

ICRIT Healthcare
Saturday, 20 May 2017 09:32

Support for Younger People

Support for Younger People

At ICRIT Healthcare we often get contacted to provide support for younger people enabling them to access the community, events and activities.  Typically these clients are in receipt of Direct Payments for a small number of hours a week.  The individuals often do not have complex needs but require that little bit of extra support in accessing society, need one to one companionship or play time, or just that watching eye whilst they engage with others.

Learn More

Saturday, 20 May 2017 09:31

Support for the Disabled

Support for the Disabled

At ICRIT Healthcare we understand that being disabled does not mean that you have restricted access to services, activities or the community and we will support individuals with appropriately trained staff who all have completed relevant in-house and national training for specific conditions.

Disabilities can be both physical and mental but equally they can be complex and combination of both.  Also some disabilities are more common in the elderly but although most commonly related to age the onset of Dementia or Alzheimer's may start occuring at an early age.  The ability stimulate both mind and body is important with the outcomes agreed as part of the care plan.  Visit http://icrithealthcare.co.uk/homepage/support-for-the-disabled to find out more about the sevices we offer.

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