Welfare Reform on the Web (January 2009): Care of the elderly - UK

End of life care

National Audit Office

London: TSO, 2008 (House of Commons papers, session 2007/08: HC 1043)

The Department of Health has acknowledged that the priority given to end of life care within NHS and social care services has been relatively low, and has worked to raise its profile in recent years. In July 2008 the Department published its End of Life Care Strategy (the Strategy) which aims to improve the provision of care for all adults approaching the end of their life, including support for their families and carers. The Strategy centres on:

• improving the provision of community services by, for example, making rapid response community nursing services available in all areas 24 hours a day seven days a week, and improving coordination of care between local authorities and PCTs
• equipping health and social care staff at all levels with the necessary skills to communicate with, and deliver care to people approaching the end of life, and their carers
• developing specialist palliative care outreach services by encouraging PCTs and hospices to work together to provide appropriate support to all adults in the community, regardless of their condition.

The Department considers that the implementation of its Strategy should reduce inappropriate admissions to hospital and enable more people approaching the end of their life to live and die in the place of their choice. This report considers the scope for improving the pattern of care in light of the available evidence on the impact and appropriateness of existing provision. In preparing this report, the NAO drew on the knowledge and experiences of a wide range of health and social care staff involved in the delivery of end of life care and, most importantly, people approaching the end of their life and those caring for them. In addition to NAO's censuses of PCTs and independent and NHS hospices and its survey of care homes, three unique features of its methodology include a detailed examination of the patient records of 348 people who died in Sheffield in October 2007 to identify the potential for people to die in their preferred place of care; modelling of the provision of end of life care services to identify whether the quality of such services can be improved within existing resources; and detailed reviews of end of life care services provided by three PCTs.

The rise and fall of national minimum standards

J. Smith

Caring Times, Dec. 2008, p. 16-17

The days of the National Minimum Standards for care homes appear to be numbered and they are not expected to survive the replacement of the Commission for Social Care Inspection by the Care Quality Commission. The intention is to move to a regulatory system based on essential safety and quality requirements rather than desirable best practice standards. Under the new regime there will be three levels of legislation and guidance: primary legislation, regulations in secondary legislation, and compliance guidance. However, the proposed 'registration requirements' for care homes will in many ways play a role in the new regime similar to that of the current National Minimum Standards, with the important difference that they will have the force of law.

Spotlight on older people in the UK

Help the Aged

London: 2008 (Spotlight report; 2008)

This report looks at facts and figures on pensioner poverty, isolation, mobility and access to essential services, levels of satisfaction with quality of life, scarcity of employment and learning opportunities, and how society's attitudes to age have tacitly supported institutional ageism within the UK's health and social care system. As well as statistical indicators, each section of the report includes a commentary on the issues raised and direct quotes from older people.

Who will pay for better care?

S. Burke

Political Quarterly, vol.79, 2008, p. 628-636

The New Labour government has promised a radical rethink of how adult social care is funded, with a Green Paper due in early 2009. This article considers the options for funding long-term care for older people. It begins by looking at the collective funding of services through taxation, including income tax, council tax, social insurance and a 'care duty' linked to inheritance tax levied on estates when someone dies. The alternative to collective funding is to encourage individuals to cover the costs of their own care through equity release schemes, private insurance and pension funds. It is concluded that any solution to the care funding debate is likely to require a mix of public funding and private contributions, which may take the form of means-testing or a partnership approach. A partnership approach entails a universal state-funded care offer with individual top-ups.