Speech from the Chairman of the Community Care Committee, Dr Andrew Dearden
Thursday 3 July 2003
Just about all of us will work at some time or other with patients and sometimes family members who will need to use community care services, whether they be
- the half a million people living in care homes;
- the 600,000 people over 65 cared for in their own homes;
- the 15 per cent of people with mental illness;
- the 200,000 adults and children with learning disabilities;
- the 55,000 children looked after by local authorities; or
- the 6 million men, women and children who care for their relatives or friends, often continuously.
So the Committee on Community Care continues to have a vital role to play, in working to ensure that community care is “user friendly” for both doctors and patients alike.
We have had another busy and productive year with a number of particularly successful initiatives.
Following our well-received and profitable intermediate care conference last year, this May we held a second one, in partnership with Age Concern and Carers UK. Once again this proved to be very popular with all the places being taken. Delegates were able to take part in a wider variety of workshops with more chances for exchange of ideas and experience of running successful intermediate care schemes.
Continuing care funded by the NHS can be a source of tension between different parts of the health service and also between the NHS and social services. Despite many attempts over the years to improve the situation, there still remains a distinct lack of clarity as to just what services should be classified as continuing NHS care and whose responsibility it is to provide them. As a result there is even greater confusion around commissioning, leading to inadequate provision and support for patients who may be left without appropriate medical cover or access to specialist support. This situation is unsatisfactory for patients and doctors alike. The committee studied this in depth and has now made a number of recommendations to health departments around the UK on how the problems of commissioning could be overcome. A paper written by the committee and on which we consulted within the BMA is now available on the BMA Community Care website. We will continue to work actively to achieve improvements in this area.
The BMA has continued to pressure the government to revise its Mental Health Bill, to lessen the emphasis on compulsion and control and instead take a more balanced view with equal weight given to the care of people with mental health problems. We are very pleased by recent reports which suggest that this pressure has paid off and that the Bill is being redrafted, and we look forward to making more constructive comments on future recommendations.
Because of our concern about the patchiness of training and approval schemes for doctors working under section 12 of the existing Mental Health Act for England and Wales, committee representatives met with a Department of Health working group and formulated a list of recommendations in an effort to improve the system. The Department has since briefed strategic health authorities and primary care trusts about the processes and arrangements which need to apply now, and is committed to reviewing this issue again once the proposed new Mental Health Act is introduced.
Doctors and carers can have a mutually beneficial relationship. To help foster this we have up-dated our guidance for doctors on working with carers (special thanks), to include information about the Carers Allowance along with suggestions on developing a carer strategy, dealing with issues of patient confidentiality and so on.
Over the session I have met with representatives of many other professional groups and organisations involved in community care to explore ways of working together, both at the coalface and in lobbying governments for improvements for example in the area of distinguishing between personal and nursing care. I believe this is essential to consider collaborative working with other groups where our messages and concerns are the same, in an effort to effect real change.
I would like to thank the secretariat of the committee for their invaluable help over the past year. Special mention must go to Sophie Ayre (aka Markwick), and Barry Christie, Debbie Marshall and Kumi Patel who filled in marvellously while Sophie was away on maternity leave.
These and other projects have contributed to a fascinating year and I would like to thank committee members for their hard work. I look forward to building on our successes in the coming session.