Nicholas Timmins: The shifting nature of the health and social care divide

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Nicholas Timmins

Should the settlement of health and social care in England be re-shaped? And if so, how? Nicholas Timmins looks at the shifting nature of the funding divide in England's health and social care systems, from pre-NHS to the current day.

Nicholas Timmins: The shifting nature of the health and social care funding divide

The Commission on the Future of Health and Social Care in England is keen to hear the views of patients, people with care and support needs, carers, policy experts and other stakeholders.

You have a real opportunity to help us to develop fresh ideas about how we might achieve a truly integrated health and care system that is fit for the 21st centruy.

Find out more about the Commission's call for evidence.


#40816 Dr Mike Smith
Acting Chairman.
Patients Association.

One in 4 people in an acute bed are not getting the care they need, which is community-based care - in their own home or a nursing/residential home. An acute bed costs £2400 per week, community care some £700 per week. The correct care at a third of the price.
The lack of community care (inc out of hours medical cover) is killing the A & E Departments and probably also acute trauma patients who really need to be there whereas many if not most of the largely elderly attending don't - they need to be seen by their GP or practice nurse. Easy to spell out difficult to `sell' to the authorities involved and their unions, known as the stakeholders (terrible word!) Best regards Mike

#40818 Paul Munim
Community Enterprise East London

Clearly changes are being driven by the need to make savings. We believe local community organisations should have a greater role as they can deliver community support better because of their closer links with communities. We have created a website which is a directory of community organisations. We created this website because we realised that many people were contacting the NHS when they could easily have contacted their local community organisations for advice, befriending or practical volunteer help. People's conditions are now much more longer term and requiring ongoing support that local community organisations can provide. Yet instead vulnerable people are being given personal budgets and told they are 'free' to manage their own care. Effectively professionals instead of resolving the funding divide they have come up with the solution of dumping the divide onto vulnerable people. Is this really an effective way to resolve the divide? passing the buck onto patients?

#40819 Margaret Millar
Patient Advocate
Alpha 1 Advocacy & Action

Alpha 1 Antitrypsin ATT Deficiency is a very long term metabolic condition we have from birth, it was discovered in 1966 and therapy has been used successfully in the USA for the last 25 years. We are stuck in a never ending cycle of therapy denial because NICE have a "do not do" recommendation on ATT augmentation therapy therefore the Named Patient Bases has never worked for any A1AD patient in 50 years. The pharma company's play cat and mouse one pulls out and another comes in with no EU license to supply therapy, so research & development can continue. Who in the NHS is willing to sort our predicament until England NHS takes the side of cherry picked patients and help them directly we are doomed.

#40820 Kay Anderson
Patient (A1AD)
Alpha One Advocacy and Action

I agree with Margaret Millars comments on the above and being a long suffering alpha one patient would hope to see swift change in the type of treatment , care plans and diagnosing of this life threating /shortening hereditary disease with a accompanying level of compassion and empathy with alpha one patients here in the UK. We are all awaiting a decision on the Therapy side which is long overdue us some 30 years by the USA standards and without this we are being expected to receive nothing more than a evaluation consultancy twice yearly, would this happen to a cancer patient? I fear not we are in dire need of the proper drugs and proper care a terminal condition like alpha one is not one to be ignored , exploited by ruthless trials and on-going ones and further we need to be respected by all governing medical bodies. This is appalling and frankly a blot on the landscape of the great institute we attribute as the award global NHS....where is our voice ?

#40827 DineshP
Mental Health Nurse

What was it like to live two centuries ago? of course I don't know, except for history. Generally though we'd class that era as backward in the context of sociopolitical & certainly 'Political correctness'. Certainly they were not 'socially-mobile' either . Then again was society grappled with such a dilemma for example 'care of the elderly'? or what about HAI's or even antibiotic resistant infections, today draining are scares resources? With so much advancement in technology and exponential growth in the medical research yet paradoxically we seem unable to master the most basic aspects of 'Care' for each other. We already have integrated health & social care services, click-of a button have access to up-to date health advice, 24-7 health care(still we're craving for more of the same) yet time- to time we hear about 'malnourished' elderly patient in acute hospital beds & nursing homes. Social services miserably failing our vulnerable young & old a like? What is the cause? is it a lack of staff- training, or technology to empower nurses? or a lack of state-of the art equipment or patient facilities? or underpaid staff?
How far are we willing to go to allow such suffering & waste of resources until we truly put are hearts & minds in identifying the true cause of our problems today & even to begin to address those issues to deliver truly effective & equitable health & social care?

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