The NHS Consultation: Give your feedback
Please MAKE YOUR VIEWS KNOWN. A questionnaire, feedback on your NHS experience, improvement ideas, opinions and feedback on the consultation.
Hello, Dear Reader. Thank you for spending some of your precious time reading this.
I’m Victoria, the author of Carer Mentor. You can read more about me and why I publish Carer Mentor here.
Over the last couple of weeks, between catching up on sleep during a short respite and medical appointments, I’ve been researching and sharing feedback with other carers on this NHS Consultation and Virtual Wards.
It was a rollercoaster: reading the questionnaire, sharing thoughts, and feeling despondent. Then, I saw the changes to the consultation site—free-form feedback, space for ideas, and the ability to see ideas from other people!
These are not directed prompts but free-form ideas you can “LIKE” and comment on. [it’s a great idea, but on Sunday, 17th Nov., the ability to comment on improvement ideas seems to be disabled 😳🙄]
This NHS consultation is important. I have no association with its authors or reason to promote this except the most obvious one—I want a better healthcare system as soon as possible.
A CALL TO ACTION
UK residents: click here or the image to provide feedback on the NHS.
NHS = The National Health Service1
Consultation opened on 21st October 2024 and says it’ll run for ‘several months’.
On the website, you’ll see a video from Wes Streeting, Secretary of State for Health and Social Care of the United Kingdom.
You’ll need to create an account and fill out the questionnaire. Once you’ve filled out the questionnaire, you can provide general feedback on your NHS experiences as a member of the public or as an organisation.
The website also provides space for your ideas for change and open feedback.
Dear US Based Readers, You may be interested to read this:
Honoring Rosalynn Carter’s Legacy by Prioritizing Caregivers
By Dr. Jennifer Olsen, CEO, Rosalynn Carter Institute for Caregivers (January 2024)
Today, RCI (Rosalynn Carter Institute) is a leading advocate promoting caregiver health and strength. As a Healthy People 2030 Champion, RCI takes action to transform the future of caregiving by building cross-sector partnerships, leading research projects and strategic initiatives, developing and implementing evidence-based programs, and advocating for systems-level policy change at the state and federal level.
Profiles in Caring
Behind this project to develop Profiles in Caring is the idea that caregivers’ needs and experiences must be centered more in conversations throughout a care journey. While recognizing that all caregivers have unique needs and experiences, we found that there are phases of caregiving to which many caregivers can relate.Using these phases, and the stressors and the goals associated with them, we were able to develop 9 unique profiles to help locate caregivers on the continuum of their care journey
I’m a little envious!
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Feel free to stop reading here. Alternatively, have a roam around these facts and references that I collated to try and get my head around the NHS, Social Care, the healthcare funding and what it all means for me as a caregiver AND as someone who will need care in the future (unless I move elsewhere).
The NHS UK Healthcare System Consultation
The rest of this article shares references with some commentary.
Essential Background information:
What's the difference between 'healthcare' and 'social care'?
What is Social Care in the UK. The Kings Fund Home Truths Report 2016
My Priority Three Concerns
The questionnaire highlights three ‘shifts’
Introducing the 3 shifts
The next questions relate to 3 ‘shifts’ – big changes to the way health and care services work – that doctors, nurses, patient charities, academics and politicians from all parties broadly agree are necessary to improve health and care services in England:
Shift 1: moving more care from hospitals to communities
Shift 2: making better use of technology in health and care
Shift 3: focussing on preventing sickness, not just treating it
Shift the care to whom exactly in communities?
As a caregiver, I’m concerned that a productivity culture will put more burden on caregivers before more resources, GPs, pharmacies, and social services are established in our communities. Based on my recent experience with the ‘Virtual Ward’ system.
Increased productivity can mean using Virtual Ward systems to pass the patient home with some equipment, and they have to report readings, reducing hospital time and costs. However, faster discharge can easily result in an unsafe discharge. Several carers I’ve interacted with have had unsafe discharges. Loved ones were discharged before fully recovered to free up a bed, and there was no support at home. Everyone feels pushed to leave. Carers are assumed to take on all the mental stress and clinical care and fight for support.
The recent Autumn Budget changes, set to start in April 2025, increase the National Living Wage, National Insurance Contributions, and Small Business Tax, impacting the operational feasibility of already struggling GP practices, care organisations, pharmacies, and in-community support services.
In the last few days, pharmacies have decided that in January 2025, they intend to reduce the number of hours they are open and stop home deliveries to reduce operational costs and respond to the Autumn Budget. Imagine the impact on those with chronic illnesses, immunocompromised patients and rural residents.
There’s an assumption that the NHS encompasses all care. It does not. The NHS is NOT Social care. They are separate. GPs, pharmacies, hospice care, and care organisations are privately owned and partially funded/contracted by the NHS/social care services. There is little/no available support outside a hospital.
A Patient is assessed in terms of their needs (basically, are the needs severe enough?) and in terms of their means do they have less than £23’250.2
BUT before talking about finance, the questions need to focus on the availability of care services. Local authorities contract private agencies and whatever is available. Availability, then finance, and somewhere, maybe, quality can come into the equation.
These are only three of my concerns!
Essential background information
Here’s what I’ve been wading through. Some key reference points
1. Link to the Darzi report:
Independent Investigation of the National Health Service in England by The Rt Hon. Professor the Lord Darzi of Denham OM KBE FRS FMedSci HonFREng (September 2024). HTML summary here.
2. A Lancet Publication in July 2017
Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study Guzman-Castillo, Maria et al.The Lancet Public Health, Volume 2, Issue 7, e307 - e313
‘The number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.’
I wanted to clearly delineate what the NHS is and what it doesn’t do, but if years and years of consultants and experts can’t, why did I think I could!
I got STUCK! The information is opaque. The jargon is alphabet soup.
In my inability to decipher the NHS versus social care. Scope of Work and Funding.
3. The NHS is one of the World’s largest employers
How it delivers services and is funded is taking me hours to decipher.
Source: US Department of Defense, NHS Digitial, World Bank. Taken from NHS Confederation
4. NHS 'FTE' workforce numbers Breakdown by roles
Taken from the NHS Confederation
Source: General practice workforce, NHS HCHS workforce statistics
ALL Staff:
!! Click on the image and take a look at the GP staff as a filter of the workforce numbers
5. How does the NHS in England work and how is it changing?
Do you understand who does what?
6. How funding flows in the NHS
NHS Funding is not the same as social care funding. Link to MIND's information 'It can sometimes be difficult to say whether a service you receive is health or social care. Healthcare is generally provided free under the NHS. Social care is provided by local authorities, who can charge for it.'
Availability, access and delivery of care resources and support are limited; some call it a ‘postcode lottery’. Quality is becoming a secondary consideration. Despite increases to NHS funding over the last 10 years, increases to social care funding have not kept pace and the care system is now relying ever more heavily on unpaid carers to prop it up. Vacancies and high-volume workloads, often overstretch existing staff.
Social care is funded by a combination of local government, people paying for their own care, and sometimes both.
Social care: Local authority social services departments (SSDs) are responsible for social care in England, Wales, and Scotland. This includes commissioning publicly funded social care services, such as residential care and services for people in their own homes.
NHS: The NHS is responsible for nursing, medical, and health care. The NHS may also employ social care workers for Continuing Healthcare, which is a national guidance framework for adults with a primary health need.
7. What's the difference between 'healthcare' and 'social care'?
A healthcare need is related to the treatment, control or prevention of a disease, illness, injury or disability. And the care or aftercare of a person with these needs.
A social care need is focused on providing assistance with:
The activities of daily living
Maintaining independence
Social interaction
Enabling you to play a fuller part in society
Protecting you in vulnerable situations
Helping you to manage complex relationships
In some circumstances, accessing a care home or other supported accommodation
It can sometimes be difficult to say whether a service you receive is health or social care. Healthcare is generally provided free under the NHS. Social care is provided by local authorities, who can charge for it.
8. What is Social Care in the UK. The Kings Fund Home Truths Report 2016
Timestamp 1:38 The number of people receiving formal care from the state has actually reduced over the past six years, despite this increase in need.
“26% Fewer people receive council support”
Timestamp 1:43 Our research shows that the social care system as it stands is struggling to meet the needs of older and disabled people.
9. The Kings Fund: How is social care paid for?
Many people are surprised to learn that social care is not free at the point of use in the way that NHS care is. Rather, social care is funded by people paying for their own care, by local government, or often a mixture of the two. Local government budget cuts have significantly increased pressures on the social care system, resulting in one of the most difficult policy challenges of our times. In this video we give an overview of how social care is funded.
Bottom Line
Please provide your feedback on the Department of Health and Social Care website.
I don’t have the time or energy to try and understand the whole system. There are too many people (in my humble opinion), many who are well intentioned and experts in their field…who are discussing things within the box of what’s happening.
Carers,and anyone in the UK, WE have an opportunity to put all that information aside, and tell people what we need and why!
I can’t tell you the number of times I’ve heard from someone in the hospital, ‘Yes, but I just need this bit of information’, or ‘that’s not my job, I just need to check this off.’ OR today, ‘I’m not clinical, I’m an assistant, I don’t know that we just do what the doctor has asked for.’
The transactional, single-action, tick box nature of the system means the right hand doesn’t know what the left is doing. It’s certainly not a whole body, holistic or long-term quality of life perspective.
The Kinds Fund Home Truths Report in 2016 highlighted that over 6 years [2010 to 2016] 26% fewer people receiving council support, despite the increasing need and demand for support. We all know about demographic shifts. So, how are these needs being met, if at all? Who’s having to do more care-giving, and what does this mean for the increased number of people needing more care?
Compounding these increased needs, carergivers are not recognised as the ONLY ones who have complete oversight of a patient’s needs and medical history. We’re not valued as knowing more than the person ticking boxes, we’re not paid, yet we have to repeat information at least 5 times during the course of an emergency admission.
I’ve curated relationships with our doctors and specialist nurses who have been and are amazing over the last four years. They know, I have a cheat-sheet of my mother’s medical history and have things organised (understatement). I count our blessings for these empathetic medics and nurses.
It’s really hard for me to feel confident and trust there will be timely action in hospital Emergency room and admission situations, after everything we’ve experienced.
I never assume the correct information has been received, and close every loop I can.
This year, Carers Rights Day is on Thursday 21 November 2024 – and this year’s theme is about raising awareness of the rights the UK’s 5.7 million unpaid carers are entitled to, and to help them get the support they need and the recognition they deserve.
Everyone can play their part in ensuring that the burden of care in communities does not automatically fall onto the already over burdened shoulders of Carers.
Everyone has an opportunity to share their experience, without the fear of backlash on the care for a loved one on a ward. (Experiences with Dad’s care 2018 and 2019).
Let’s Raise our Voices
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Wikipedia gets closer to defining the NHS!
The National Health Service (NHS) is the umbrella term for the publicly funded healthcare systems of the United Kingdom, comprising the NHS in England, NHS Scotland and NHS Wales. Health and Social Care in Northern Ireland was created separately and is often locally referred to as "the NHS".[2] The original three systems were established in 1948 (NHS Wales/GIG Cymru was founded in 1969) as part of major social reforms following the Second World War. The founding principles were that services should be comprehensive, universal and free at the point of delivery—a health service based on clinical need, not ability to pay.[3] Each service provides a comprehensive range of health services, provided without charge for residents of the United Kingdom apart from dental treatment and optical care.[4] In England, NHS patients have to pay prescription charges; some, such as those aged over 60, or those on certain state benefits, are exempt.[5]
Taken together, the four services in 2015–16 employed around 1.6 million people with a combined budget of £136.7 billion.[6] In 2024, the total health sector workforce across the United Kingdom was 1,499,368 making it the seventh largest employer and second largest non-military public organisation in the world.[7][8][9][10]
When purchasing consumables such as medications, the four healthcare services have significant market power that influences the global price, typically keeping prices lower.[11] A small number of products are procured jointly through contracts shared between services.[12] Several other countries either copy the United Kingdom's model or directly rely on Britain's assessments for their own decisions on state-financed drug reimbursements.[13]
Social care in a nutshell Social care is not free at the point of use. Anyone who requests publicly funded social care must undergo a needs assessment and a means test, and only those with the highest needs and the lowest financial assets are likely to receive support. Anyone with assets of more than £23,250 must pay for all social care themselves. Below this threshold, contributions are made by the person needing care and the government on a sliding scale. If the individuals requesting care have long-term complex health needs, the NHS may also contribute to funding.