A session with medical colleagues about our newly renegotiated arrangements for continuing care applications. Recently, we have talked with our pcts about their application processes for continuing care funding; they claim they are all consistent with the Greater London guidelines and all use the same forms. Part of the reason why this is not so is that they are thinking about outcomes, whereas our nurses and doctors are dealing with the process, and all the pcts have a different procedures, even if (which I think is also not right) their decisions would be the same. The real reason why the system is unsustainable is that the public does not understand why they must must must contribute to local authority community care, but are not not not allowed to contribute to NHS continuing care. Our doctors, like the public also do not understand why the everyday care needs that come from an illness or disability do not get continuing care, whereas an artificial concept ‘the primary health need’ which is not too different from being unable, say, to get up in the morning because of a disability, is the only basis for getting it.

Anyway, with yesterday’s budget all this is not going to continue for long; it will be one of the easy cuts to make in the decade of holding back the public sector. It does seem crazy that because of incompetence and greed in banking, we are going to have to put up with poor and deteriorating services in the public sector for ages, and when that period of retrenchment is over, we are going to get resurent bankers and private sector managers saying that their giant par packets should not be tweaked because they’re mopre important to the economy than being decent with our old people. No banker or manager is worth more than good care for our old and dying people.