Our technical guys have told us that video is an outdated technology, and they’re not supporting it any longer, but I don’t know a better word for a new SCIE website (SCIE TV) that offers the chance to download video clips to use in your training; there’s lots of adult services content, personal stories from service users and particularly some interesting stuff on dementia and on personalisation.

There’s a video from the Minister, Phil No-hope, looking particularly cheerful as is his wont. Does a shiny gold tie go with a blue shirt? – your votes please. You can watch it if you want; I might change his name again to Phil Dontview. There’s also a promotional ‘animation’, which consists of lots of arrows swooping around, which my younger grandchildren liked. My 3 year old granddaughter prefers the old technology because she likes Bangers and Mash (two young monkeys who always got into trouble and used to appear on the telly, got on to VHS video, but haven’t made it on to DVD). SCIE might use these as  cautionary tales on child safeguarding (they’re always getting sent to bed, but obviously walloping was not on even in those days) or ASBOs and gain greater approval ratings.

The website: http://www.scie.org.uk/socialcaretv/default.asp

The British Humanist Association newsletter (it comes by email nowadays, so it thumps into the mailbox more regularly than when they printed it) is trying to get people to sign up to the petition on the No 10 website to get a commission on assisted dying. The BHA says:

Despite continued public support for a change in the law, Parliamentarians are reluctant to take a stand on assisted dying for fear of losing the support of a vocal minority of anti-choice campaigners.

It may be humanist to support allowing people to choose when and how they die, I’m not sure about that, but if this is code for ‘that religious lot’, there are a lot of people who are for and against assisted dying for all sorts of practical and principled reasons. Those who support choice because it sounds good have often not thought through all the implications, but they know what they think about the care they are likely to get in old age. For that reason a commission might be a good idea, because it might lead to a more informed debate, in which prejudice for or against ‘that religious lot’ is not the main issue.

Certainly, I can’t help thinking that if they want to get wider support, the campaigners against assisted dying are going to need more than supporters who have a committed religious view, because the social trends that are leading people to say ‘I don’t want to go there’ when they think about years of frailty in old age are still on the upswing. There was another couple in the papers today who were not terminally ill; they told their family they had had a good life and wanted to finish it off while it was still good. A lot of people think like that.

How far is this the product of not very good care services for older people? The legislative proposals are mainly about terminal illness, so they have engaged the interest of the palliative care lobbies, but I think many people might accept they will probably get good care if they have a major advanced illness, but they certainly don’t expect to get it if they are just frail for year after year. That is really what is fueling the demand for assisted dying.

The petition website (see if your friends have signed among the 3,000-odd): http://petitions.number10.gov.uk/Assisted-dying/

Lady Greengross, the former Age Concern director, asked an interesting question in the Lords; it resulted in a fascinating table: I have not reprduced the whole thing, but to show what it contains, I give the results for the five PCTs covered by St Christopher’s and for comparison the PCT with the highest proportion of people receiving continuing care funding.

Number receiving National Health Service continuing care in total and per 50,000 population, England Quarter 4, 2008-09

I was a bit surprised by this; I thought it would reflect the proportion of older people in the population, but I don;t think of Shropshire as particularly full of older people and I do think of Soutwark as particularly derpived, but they may not have the high proportion of older people that leads to a lot of use of continuing care. The next two biggest proportions of people getting continuing care are Bournemouth and Bexley. Readers might be interested to see what they think. Is this another sign of variable decision-making?

On the web: http://www.publications.parliament.uk/pa/ld200809/ldhansrd/text/91103w0003.htm#091103121000828

There was also a question on continuous deep sedation, controversial in some eyes because it connects up with assisted suicide.

Sedation

Dr. Iddon: To ask the Secretary of State for Health (1) what guidelines the NHS issues on the use of continuous deep sedation until death; [296149]

(2) what assessment he has made of the rate of prevalence of continuous deep sedation until death in England; what information he holds for benchmarking purposes on the rates in other EU member states; and if he will make a statement. [296150]

Gillian Merron: No central guidance on the use of sufficient medication to keep a patient sedated until their death, known as continuous deep sedation, has been issued. This is a matter for the relevant clinicians, using their professional judgment and taking into account the circumstances and wishes of the individual patient or, where a patient is considered incapable of decision-making, the views of the patient’s family on what he or she would wish. Data on the prevalence of continuous deep sedation in England, or in other European Union member states, are not held centrally.

On the web: http://services.parliament.uk/hansard/Commons/bydate/20091029/writtenanswers/part022.html#heading018

Minister of State, Phil No-hope (you will remember this is my name for him because of his invairiably bright and positive demeanour), answered a question about palliative care finance last week:

Palliative Care: Finance

Mr. Stephen O’Brien: To ask the Secretary of State for Health which primary care trusts have received a portion of the £286 million assigned by the Government for end-of-life care in the End of Life Care Strategy; and how much each has received. [295503]

Phil Hope: An additional £286 million revenue and capital funding is being made available over 2009-10 and 2010-11 to support the implementation of the End of Life Care Strategy. For 2010-11, this includes capital funding of £40 million for hospices. However, the majority of the funding is being allocated to primary care trusts (PCTs) through the 2009-10 and 2010-11 revenue allocations, so all PCTs will receive a portion of this funding.

The Department does not break down PCT allocations by policies at either national or local level. It is for PCTs to decide their priorities for investment locally, taking into account both local priorities and the NHS Operating Framework.

On the web: http://services.parliament.uk/hansard/Commons/bydate/20091029/writtenanswers/part022.html#heading014

So that’s all right then; we’ve allocated this money for the end of life care strategy, but we don’t care whether they actually spend it on that; that’s local freedom for you. Why do they bother to make allocations for policy purposes at all, then?

It seems that the Department of Health and the Charities Commission are having a row about NHS charities. A new international accounting standard for public bodies requires the accounts to be consolidated with the NHS accounts, whereas the Charities Commission thinks a charity’s accounts should never be part of a public body’s accounts.

Web information on the issue:

http://www.thirdsector.co.uk/News/DailyBulletin/948049/Charity-Commission-takes-stand-NHS-charities-accounts/63AA077707931EC526211C5DD9F168F7/?DCMP=EMC-DailyBulletin

Trust them to have an argument about the pointless end of the issue. This is a sign that NHS (and therefore public) bodies are controlling charities. You have to ask why? I realise that the history of this is that many of these are leftovers from when the healthcare system was turned from a largely charitable system to a public system (only 60 years ago, so of course we haven’t dealt with the problem yet). People gave charitable monies to (mainly) hospitals, so hospitals hung onto it; it gives them a bit of freedom of manoeuvre. What this means is that the historic NHS trusts, now mainly foundation trusts, have extra cash to do what they like with, instead of participating properly in local planning. This also gives an advantage to the richly endowed hospitals, in stead of spreading money around the country in accordance with needs.

What has this to do with social care and palliative care. It means that some hospitals can promote their internal palliative care without any concern for the planning of other local services, and advantage people where there is a rich inheritance when others might need it more. It’s time this source of inequality was ended and these charities floated off to be truly independent.

Another pic of the new St Christopher’s. You may think this is just like a commercial gym, and that’s the point of it. Patients visitng the new Anniversary Centre can book into this or take part in a regular physiotherapy programme; the fitter you are, the more you can combat your illness and its effects on you.