Birmingham Law Centre closes

Birmingham Law Centre closed today due to changes in legal aid funding.  This is a tragic loss to the people of Birmingham.  Birmingham Law Centre had a 100 year history providing legal advice and support to people who could otherwise not afford it.  They advised on issues such as benefit rights and housing as well as immigration issues.  This and the cuts to Citizens Advice Bureau funding in Birmingham leaves many vulnerable people with no access to legal representation and advice.

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Its promising the Government is striving to achieve more integrated services, although I’m dubious about the suggestion to pay hospitals based on the feedback from patients…

Health and social care ‘join up’ plans unveiled

Minister announces proposals to integrate services by 2018 to stop people being passed around hospital and social care staff

, social affairs editor. The Guardian, Tuesday 14 May 2013

Hospital ward

Delayed discharges from hospital cost the NHS £370m each year, partly due to lack of co-ordination between medical and social care staff. Photograph: Glyn Allan/Alamy

The government has announced plans for “joined-up” health and social care by 2018, potentially imposing a financial penalty on services if they ask patients to retell their stories to different layers of professionals.

Under the proposals unveiled by health minister Norman Lamb, hospitals would also be paid based on how patients rate their experiences.

The government has asked the regulator and NHS England to come up with a system that would stop people being passed around between doctors in hospitals and community services.

The government aims to “make joined-up and co-ordinated health and care the norm by 2018” – in effect stealing a march on Ed Miliband who has made integration the cornerstone of Labour’s health policy.

NHS England, the quango running the health service, will have a budget of about £1bn to ensure there are integrated projects in every part of the country by 2015.

Lamb said this would help end patients suffering disjointed care and support. In a recent study a third of bereaved people said hospitals did not work well with GPs and other services.

The government also pointed out that patients were facing long waits in hospital before being discharged, in part because of inadequate co-ordination between hospital and social care staff. Delayed discharges cost the NHS £370m a year.

Lamb said that “people are falling through the cracks”. He said that he wanted to end the fact that people are “having to retell their story every time they encounter a new service”.

“It’s a crisis point really,” he said. “People not getting the support they need because different parts of the system don’t talk to each other; older people discharged from hospital to homes not adapted to their needs, only to deteriorate or fall and end up back in A&E. Cutting emergency readmissions will bring a much better experience for patients.”

Chris Ham, chief executive of the King’s Fund, said the government’s announcement was a step change in the debate. “Feedback from our work with local health and social care leaders indicates that some aspects of current policy and regulation are acting as barriers to delivering co-ordinated care,” he said. “This should be addressed by giving pioneer areas freedom and flexibility to overcome these restrictions when they are rolled out from September.”

The coalition is attempting to mollify critics of its health policy who claim hospitals will have to compete with each other rather than co-operate to provide patient care. They point out that GPs buying treatment from the NHS’s flagship “joined-up hospital” – Torbay’s pioneering integrated health organisation – are taking legal advice amid fears they can no longer buy care directly because of a legal requirement to competitively tender some services.

Lamb said he had met Torbay to discuss the problem. “I don’t think these will be a barrier at all. We are looking to measure patient experience along a care journey and pay [hospitals] for it. It is a move forward.”

The idea of paying hospitals on the basis of patients’ ratings has been lifted from President Obama’s healthcare programme. In the United States nearly $1bn (£630m) in payments to hospitals a year will be based partly on patient satisfaction. Patients will fill in a 27-question government survey and US hospitals with high scores will get a bonus payment. Those with low ones will lose money

The World According to Top Dog (link to blog)

A blog from a voice hearer’s voice?  That’s right.  Fascinating story, explained in this talk from psychologist Rufus May (in two parts)

Should we be listening to and having a dialogue with patient’s voices?  Its not something I want to get into straight away, I think I need some experience as a qualified nurse first, but when I’m qualified and a lot more experienced?  Its certainly something I’d give some thought to…but very carefully!

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GPS Tracking for people with Dementia

Debate about GPS for people with dementia needs to be based on fact

The National Pensioners Convention has done itself no favours in associating the tracking devices with Asbo


Guardian Professional, Thursday 9 May 2013 08.30 BST


Older woman on her own

New technology can support independence. Photograph: Christopher Thomond

News that Sussex police has become the first force in Britain to pay for GPS tracking devices for people with dementia is sure to start an intense debate. The idea is simple enough (and the model is in use in several local authorities as part of their care and support): a person withdementia is given a tracking device to wear that enables them to be located easily if they wander, get lost or become disoriented.

Arguably, it is the next stage on from the familiar pendant-style alarms worn by many people in their homes. However, the implications of using such devices can cause controversy and invoke the threat of “Big Brother” or worse.

Discussion of the Sussex example on the Today programme illustrated the intensity of emotions and unwillingness to consider any potential application with Dot Gibson, general secretary of the National Pensioners Convention, dismissing any use of the devices. Her view was that the scheme was tantamount to imposing an Asbo on people with dementia, and was “inhumane”, “barbaric” and flouted their human rights.

There are risks in using new technologies to substitute for care, but they can be important tools as part of a package of care and support. What is vital is that debate should be informed by the facts and not by knee-jerk alarmism and prejudice.

The scheme being piloted in Chichester (so far with just six people) appears to be achieving positive results. It is enabling people with dementia to maintain some independence in their daily lives, while providing safeguards and reassurance for family members and carers that they can be found if they wander off, without it becoming a major police operation or necessitating emergency response (families can log in from any PC and track the location of a GPS).

Brenda Jackson, manager of Chichester Careline, which is monitoring the scheme, described it as “the exact opposite of tagging” in that it is less about control and restriction and far more about supporting independence. The National Pensioners Convention is concerned that such schemes are no more than “a sticking plaster” for major problems of under-funding of social care, and that trackers will be used as a substitute for hands-on support and contact with people. That could happen, but it does not appear to be the situation with this pilot, which is using the devices to enlarge people’s worlds rather than restrict them.

As technology expands the potential applications of tracking devices, it is important that a debate about ethics takes place and that clear principles are established. However, it would be wrong to dismiss new approaches on the basis of ill-informed facts or misunderstanding of the actual application.

The National Pensioners Convention has probably done itself no favours in making the misleading association between such tracking devices and seeing people with dementia as if they had “committed a criminal act”. This does nothing to promote discussion and simply rejects the possibility of technology having an important role to play.

We are all far more familiar with mobile technology in our everyday lives and most people now carry a mobile phone. It is not such a big step from phones to trackers, and it need not signal the beginnings of a police state or anything like it if sufficient safeguards are established from the outset. Getting the balance right between providing care while continuing to support independence and enable people to exercise choice is always going to be difficult.

How best to integrate technology into care and support will be one of the largest but most exciting challenges in the years ahead. We need to embrace the possibilities and not regard them all as crude excuses for cost-cutting or as instruments of social control.


This just seems wrong to me! Despite the possible argued benefits, I really don’t like this idea. Surely as nurses we should be able to promote independence for our patients without having to turn to  in-humane and cold methods such as GPS tracking.  Who even thought of this? It’s worrying! As it’s the police who are paying for this, it makes me further question whether this has anything to do with care and compassion or whether it’s a way of cutting down on police time and costs that are associated with older adults with dementia who are reported missing. Unless a person has consented to having a GPS tracking device fitted whilst having capacity I wouldn’t feel comfortable using this as an intervention for people with dementia.