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Welfare reform on the Web (April 2007): Care of the elderly - UK

Assessing the registered nursing care contribution for older people in care homes: issues of reliability and validity

J. Reed, B. Watson and M. Cook

Health and Social Care in the Community, vol.15, 2007, p.136-145

The present paper describes some of the findings from a study undertaken to investigate the use of the Registered Nursing Care Contribution (RNCC) tool introduced by the UK government in 2001. This tool was designed to assist in calculating the type and amount of care residents of care homes required from a registered nurse. From this determination of banding into a high, medium or low RNCC category, the cost of registered nursing care to be paid for by the NHS would be calculated. Care plan data from 186 residents in participating care homes were assessed by multiple assessors using the RNCC tool. The Minimum Data Set (MDS) rating was used as a validated comparison. Findings indicate that there were disparities between the RNCC and MDS bandings and between different assessors, suggesting that more training of users is needed to ensure consistency and reliability.

Call for a new strategy to deal with UK's dementia time bomb

M. Samuel

Community Care, Mar. 1st-7th 2007, p. 16-17

The UK's population is ageing rapidly, with numbers of older people with dementia expected to rise from 680,000 today to 1.7 million in 2050. A new report from the Alzheimer's Society argues that health and social care services lamentably fail to support people with dementia and their families. It calls for a new national strategy for dementia, with specific targets, and which would recognise the need for significant extra expenditure.

How can we know how they feel?

R. Levenson and N. Joule

Mental Health Today, Mar. 2007, p. 32-34

Despite the high incidence of mental health problems among older people in the UK, these often go unrecognised, and, even if recognised, untreated. Consequently, older people with mental health problems are likely to be cared for by staff who do not have a specialist mental health background and who have little or no training in mental health care. This article reports the results of a study which looked at the training needs of the non-professional staff involved in the day-to-day care of older people. Staff asked for training in mental health awareness, management of challenging behaviour, and risk management.

Let's wind down the top-up

B. Ferguson

Caring Times, Mar. 2007, p. 20

Many state-funded residents of care homes, or their relatives, are forced to pay top-up fees to owners who use them to supplement the inadequate fees paid for places by local authorities. This unsavoury practice has been condoned by the regulator which has consistently failed to investigate collusion between private care home owners and local councils. It must cease.

Networks and governance: the case of intermediate care

J. Moore and others

Health and Social Care in the Community, vol.15, 2007, p. 155-164

This paper reports evidence from an evaluation of the implementation of intermediate care for older people in five localities in England. Intermediate care is a policy conceived as an application of "joined-up government" and its development was intended to dissolve the boundaries between health and social care services. This analysis suggests that the five sites were developing service configurations that facilitated transitions between health, social care and other services, and that individual needs were taken into account in the decisions made about which people transferred into which services. The results are consistent with the idea that joined-up government goes beyond partnership and involves the creation of integrated service networks.

The organisation, form and function of intermediate care services and systems in England: results from a national survey

G.P. Martin and others

Health and Social Care in the Community, vol.15, 2007, p. 146-154

As part of its modernisation of the NHS and its provision for older people, the British government introduced a new range of services aimed at preventing unnecessary hospital admissions, facilitating earlier discharges and reducing premature admission to long term care. This postal survey of 106 intermediate care co-ordinators provides a picture of the nature and spread of intermediate care "on the ground" and an idea of how the policy has been implemented in practice. Much provision seems to be concentrated in supported discharge services rather than admission avoidance, and particularly in residential forms of post-acute intermediate care. Supported discharge services tend to be found in residential settings, while admission avoidance provision tends to be non-residential in nature.

Palliative care for South Asians, Hindus, Muslims and Sikhs

R. Gatrad, A. Sheikh, and E. Brown (editors)

London: Quay Books, 2006

The book provides information for caregivers about death rites in different cultures. Its multidisciplinary approach, drawing on expertise from medical, nursing and community professionals, sets out a framework for ensuring that the varied and complex needs of different ethnic groups are appreciated. The book places an understanding of different religious attitudes to death at the core of palliative care, developing a broader understanding of how to treat patients at the end of their lives. It also makes a strong case for making palliative care available to non-cancer patients. Given that ethnic-minority communities typically have higher death rates from diseases other than cancer, this is also important in reducing inequality at the end of life.

Partnering through networks: can Scotland crack it?

B. Hudson

Journal of Integrated Care, vol.15, Feb. 2007, p.3-13

The Scottish approach to healthcare reform focuses on co-operation and collective action rather than on competition between providers. One of the key policy levers for working together is proving to be the development of networks, such as managed care pathways, managed clinical networks and managed care networks. This article looks at the growing interest in networks in Scotland, focusing on managed care networks in respect of services for older people, and proposes a framework for the evaluation of network effectiveness.

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