Each year, the Government decides how much to raise benefits and tax allowances. The basis for these upratings is rarely debated, yet has major long-term consequences for the relative living standards of different groups and for public finances. The impact of benefit and tax uprating on incomes and poverty from the Joseph Rowntree Foundation considers the implications of present uprating policies, which mean that some parts of the tax and benefit system are uprated by earnings growth, other parts by prices and some not at all.

The impact of continuance of these polices over the newxt 20 years will be a doubling of the child poverty rate alongside a substantial gain to the public finances. Some of this budgetary gain may be needed to meet other demands – of an ageing population for example – but the cost falls disproportionately onto poorer groups and could be raised more fairly.

The Commissioner Volume 3 Issue 3 from the North West Primary Care Librarian’s Group was published today with its podcast ( Standard Podcasts [6:22m]) contents are:

• PBC: Personalise your Improvement with the No Delays Achiever

• Dental Commissioning and Contract Monitoring - Tendering, Procurement & Contracting

• Evaluation of One-Stop Shop (Oss) Models of Sexual Health Provision

• Improving Access to Psychological Therapies implementation plan

• National Infarct Angioplasty Project (NIAP) interim report

• Practice-based commissioning : tips for preparing and pitching a proposal

• Strategic commissioning for older people

• Apply for Beacon Status

• Other documents and conferences

Feed for Podcast

Standard Podcasts [6:22m]

‘Lost: low earners and the elderly care market’, from the think tank the Resolution Foundation looks at low earners and how they fare in the elderly care system. It identifies that social care for older people rarely receives the political attention it should. The Government’s recent commitment to a Green Paper on social care provides the opportunity for elderly care to become centre stage. Theis report establishes how low earners fare in the elderly care system.

It identifies that:

• Low earners tend to be older than average, and more likely to own their own homes. They also hold disproportionately more of their wealth in housing assets (as opposed to liquid savings) than other income groups.

• Are less likely that higher earners to prepare financially for retirement through
  pensions, and worry more than other income groups as to whether they will have sufficient assets to retire comfortably.

• Inclusion of housing assets when calculating care cost contributions is of critical importance to low earners – it renders the majority of them ineligible for subsidised care, and also most at risk of having to sell their homes or downsize in order to access their wealth to pay for care. This is in contrast to lower earners,who may not own their own homes and be eligible for subsidised care, and higher earners, who may have sufficient funds to pay for care from their liquid assets, such as savings or annuities, rather than their homes.

• Low earners feel the system to be unfair – in the very low level of means testing benchmarks which excludes the majority of low earners from any state funded care; in the inclusion of housing assets which penalises those who have saved

Key messages are:

• There is acceptance that increased elderly care costs cannot be met by the government alone. Low earners still believe only the very wealthy should pay for their care costs, and that the majority of people should receive government funded care or only make a small contribution.

• The number of self funders – i.e. those who either wholly or partially pay for their elderly care – is rising, and will continue to do so, because local authorities are adjusting their eligibility criteria so that only those with greater care needs are eligible for free home or residential care, leaving those with “lesser needs” (which are now nonetheless significant) to fund themselves, regardless of income.

• For those who cannot afford to self-fund formal care – which is likely to be a more common situation amongst low earners – informal care (i.e. care provided by friends or family free of charge) is crucially important. Estimates suggest that 70 per cent of the care provided in England and Wales is currently delivered by informal carers. Demography points to the fact that the numbers of low earners reaching an age where elderly care is required will increase substantially in the next 5 to 10 years, yet the increasing number of elderly living alone, not marrying and not having children will mean there will be fewer children and relatives for older people to rely on to provide them with informal care

• Finally, low earners are also more likely to be carers of relatives than the rest of the population. The age profile of this group, combined with these factors, suggests that a significant proportion of low earners may be shouldering a dual burden – they may be caring for their elderly parents, but also still supporting (financially and otherwise) their own children. This “squeezed” generation phenomenon, which affects women in particular, will be a significant factor affecting their quality of life, but may also have a longer lasting, intergenerational impact – people who give up work to care for relatives will not be contributing to their pensions.

Looking at social exclusion in the elderly Age Concern have produced  Out of sight, out of mind: Social exclusion behind closed doors sets a number of challenges across both local and central government and for voluntary groups to ensure that older people are socially included.  These are:

• Develpment of a cross-departmental government commitment to help the most disadvantaged older people.

• Central and local government strategies for tackling social exclusion and neighbourhood renewal must include older people.

• Local authorities should revisit A Sure Start to Later Life and re-model their services to ensure they are joined-up, user-friendly, rooted in the community and flexible enough to reach out to vulnerable older people.

The report recommends:

For people who are over 80 and living alone

• Consultation and involvement that is genuinely inclusive.

• Local policies and programmes to enhance social contact.

• Low-intensity home services.

• Thoughtful planning of local services and transport options to help promote independence.

For people who are recently bereaved

• Improved support for counselling and support services.

• Multi-agency initiatives to identify and follow-up on bereaved people at risk of exclusion.

For people who are living in unfit housing

• ‘Handyperson’ schemes available nationwide.

• Multi-agency promotion of home repair schemes and free home audits.

• Improvements to the Warm Front scheme.

• Improve access to suitable housing, by reforming planning rules, funding home adaptations, and matching’ people to accessible homes.

For people who have limited capacity to make their own decisions

• Improved support for independent advocacy.

• Services that sustain social contact and independence for as long as possible.

Thanks to Sue over at Lancashire Care for pointing out this one.

The new issue of Journal of Epidemiology and Community Health is now available online. If you want to access the full text of the journal you’ll need your Athens password from the NHS (at the moment you’ll need one from Cheshire and Merseyside but from April this resource will be available nationally. If you don’t have an Athens password and are eligible you can get one here). Full contents of the Journal of Epidemiology and Community Health 2008 62(2) February

In this issue
Carlos Alvarez-Dardet and John R Ashton, Joint Edit
J Epidemiol Community Health 2008; 62: 89. [Extract] [Full text] [PDF]

“If you always do…”
JRA
J Epidemiol Community Health 2008; 62: 90. [Extract] [Full text] [PDF]

The subtle trade-off between personal freedom and social responsibility
Francesco Zambon
J Epidemiol Community Health 2008; 62: 90. doi:10.1136/jech.2007.065847 [Extract] [Full text] [PDF]

Area deprivation and mortality in the provincial capital cities of Andalusia and Catalonia (Spain)
R Ocaña-Riola, C Saurina, A Fernández-Ajuria, A Lertxundi, C Sánchez-Cantalejo, M Saez, M Ruiz-Ramos, M A Barceló, J C March, J M Martínez, A Daponte, and J Benach
J Epidemiol Community Health 2008; 62: 147-152. doi:10.1136/jech.2006.053280 [Abstract] [Full text] [PDF]

Adult education and child nutrition: the role of family and community
H Moestue and S Huttly
J Epidemiol Community Health 2008; 62: 153-159. doi:10.1136/jech.2006.058578 [Abstract] [Full text] [PDF]

Is leg length a biomarker of childhood conditions in older Chinese women? The Guangzhou Biobank Cohort Study
C M Schooling, C Q Jiang, M Heys, W S Zhang, X Q Lao, P Adab, B J Cowling, G N Thomas, K K Cheng, T H Lam, and G M Leung
J Epidemiol Community Health 2008; 62: 160-166. doi:10.1136/jech.2006.058917 [Abstract] [Full text] [PDF]

Fetal and childhood growth and the risk of violent and non-violent suicide attempts: a cohort study of 318 953 men
E Mittendorfer-Rutz, D Wasserman, and F Rasmussen
J Epidemiol Community Health 2008; 62: 168-173. doi:10.1136/jech.2006.057133 [Abstract] [Full text] [PDF]

The epidemiology of fractures in England
L J Donaldson, I P Reckless, S Scholes, J S Mindell, and N J Shelton
J Epidemiol Community Health 2008; 62: 174-180. doi:10.1136/jech.2006.056622 [Abstract] [Full text] [PDF]

Explaining the social gradient in long-term sickness absence: a prospective study of Danish employees
Karl Bang Christensen, Merete Labriola, Thomas Lund, and Mika Kivimäki
J Epidemiol Community Health 2008; 62: 181-183. doi:10.1136/jech.2006.056135 [Abstract] [Full text] [PDF]

Living and health conditions of Palestinian refugees in an unofficial camp in the Lebanon: a cross-sectional survey
J E Zabaneh, G C M Watt, and C A O’Donnell
J Epidemiol Community Health 2008; 62: 91-97. doi:10.1136/jech.2006.054338 [Abstract] [Full text] [PDF]

Reducing ambient levels of fine particulates could substantially improve health: a mortality impact assessment for 26 European cities
Ferran Ballester, Sylvia Medina, Elena Boldo, Pat Goodman, Manfred Neuberger, Carmen Iñiguez, Nino Künzli, and on behalf of the Apheis network
J Epidemiol Community Health 2008; 62: 98-105. doi:10.1136/jech.2007.059857 [Abstract] [Full text] [PDF]

Perceived health change in the aftermath of a petrochemical accident: an examination of pre-accident, within-accident, and post-accident variables
M K Peek, M P Cutchin, D H Freeman, N A Perez, and J S Goodwin
J Epidemiol Community Health 2008; 62: 106-112. doi:10.1136/jech.2006.049858 [Abstract] [Full text] [PDF]

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa
J R Hargreaves, L A Morison, J C Kim, C P Bonell, J D H Porter, C Watts, J Busza, G Phetla, and P M Pronyk
J Epidemiol Community Health 2008; 62: 113-119. doi:10.1136/jech.2006.053827 [Abstract] [Full text] [PDF]

Iron but not folic acid supplementation reduces the risk of low birthweight in pregnant women without anaemia: a case–control study
S Palma, R Perez-Iglesias, D Prieto, R Pardo, J Llorca, and M Delgado-Rodriguez
J Epidemiol Community Health 2008; 62: 120-124. doi:10.1136/jech.2006.052985 [Abstract] [Full text] [PDF]

Prevalence of overweight and obesity in East and West German children in the decade after reunification: population-based series of cross-sectional studies
C J Apfelbacher, J Cairns, T Bruckner, M Möhrenschlager, H Behrendt, J Ring, and U Krämer
J Epidemiol Community Health 2008; 62: 125-130. doi:10.1136/jech.2007.062117 [Abstract] [Full text] [PDF]

Preventing disability through understanding international megatrends in Deaf bilingual education
I M Munoz-Baell, C Alvarez-Dardet, M T Ruiz, R Ortiz, M L Esteban, and E Ferreiro
J Epidemiol Community Health 2008; 62: 131-137. doi:10.1136/jech.2006.059378 [Abstract] [Full text] [PDF]

Medical illness, medication use and suicide in seniors: a population-based case–control study
D C Voaklander, B H Rowe, D M Dryden, J Pahal, P Saar, and K D Kelly
J Epidemiol Community Health 2008; 62: 138-146. doi:10.1136/jech.2006.055533 [Abstract] [Full text] [PDF]

Coronary heart disease epidemiology: from aetiology to public health, 2nd ednChildhood cancer in Britain
Alberto Izzotti
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2006.045831 [Extract] [Full text] [PDF]

Childhood cancer in Britain
Kathrine Carlsen
J Epidemiol Community Health 2008; 62: 184. doi:10.1136/jech.2007.064709 [Extract] [Full text] [PDF]

If you need any training in using this or any other electronic resource and you work for Liverpool PCT use the contact form below to contact the library.

To use this journal you’ll need your NHS Athens password from Liverpool PCT (You can register here to get one if you work for the PCT.  If you need any training for this or any other electronic resources and you work for the PCT use the contact form at the bottom of this post to request it.

Quality Lines
David P Stevens
Qual Saf Health Care 2008; 17: 1. [Extract] [Full text] [PDF]

Handovers and Debussy
D P Stevens
Qual Saf Health Care 2008; 17: 2-3. doi:10.1136/qshc.2007.025916 [Extract] [Full text] [PDF]

Structuring flexibility: the potential good, bad and ugly in standardisation of handovers
E S Patterson
Qual Saf Health Care 2008; 17: 4-5. doi:10.1136/qshc.2007.022772 [Extract] [Full text] [PDF]

Patient race/ethnicity, age, gender and education are not related to preference for or response to disclosure
C Hobgood, J H Tamayo-Sarver, and B Weiner
Qual Saf Health Care 2008; 17: 65-70. doi:10.1136/qshc.2006.021758 [Abstract] [Full text] [PDF]

Communication gaps and readmissions to hospital for patients aged 75 years and older: observational study
E M A Witherington, O M Pirzada, and A J Avery
Qual Saf Health Care 2008; 17: 71-75. doi:10.1136/qshc.2006.020842 [Abstract] [Full text] [PDF]

Effective interventions and implementation strategies to reduce adverse drug events in the Veterans Affairs (VA) system
P D Mills, J Neily, L M Kinney, J Bagian, and W B Weeks
Qual Saf Health Care 2008; 17: 37-46. doi:10.1136/qshc.2006.021816 [Abstract] [Full text] [PDF]

Adverse outcomes after discharge: occurrence, treatment and determinants
P J Marang-van de Mheen, N van Duijn-Bakker, and J Kievit
Qual Saf Health Care 2008; 17: 47-52. doi:10.1136/qshc.2007.023309 [Abstract] [Full text] [PDF]

Patient safety events reported in general practice: a taxonomy
M A B Makeham, S Stromer, C Bridges-Webb, M Mira, D C Saltman, C Cooper, and M R Kidd
Qual Saf Health Care 2008; 17: 53-57. doi:10.1136/qshc.2007.022491 [Abstract] [Full text] [PDF]

Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York
W B Weeks, A N West, A K Rosen, and J P Bagian
Qual Saf Health Care 2008; 17: 58-64. doi:10.1136/qshc.2006.020735 [Abstract] [Full text] [PDF]

Intensive care unit nurses’ perceptions of safety after a highly specific safety intervention
N C Elder, S M Brungs, M Nagy, I Kudel, and M L Render
Qual Saf Health Care 2008; 17: 25-30. doi:10.1136/qshc.2006.021949 [Abstract] [Full text] [PDF]

What is quality and how is it achieved? Practitioners’ views versus quality models
P Hudelson, A Cléopas, V Kolly, P Chopard, and T Perneger
Qual Saf Health Care 2008; 17: 31-36. doi:10.1136/qshc.2006.021311 [Abstract] [Full text] [PDF]

Adequacy of information transferred at resident sign-out (inhospital handover of care): a prospective survey
S M Borowitz, L A Waggoner-Fountain, E J Bass, and R M Sledd
Qual Saf Health Care 2008; 17: 6-10. doi:10.1136/qshc.2006.019273 [Abstract] [Full text] [PDF]

A theoretical framework and competency-based approach to improving handoffs
V M Arora, J K Johnson, D O Meltzer, and H J Humphrey
Qual Saf Health Care 2008; 17: 11-14. doi:10.1136/qshc.2006.018952 [Abstract] [Full text] [PDF]

Integrating the chronic-care model and the ACGME competencies: using shared medical appointments to focus on systems-based practice
S R Kirsh and D C Aron
Qual Saf Health Care 2008; 17: 15-19. doi:10.1136/qshc.2006.020925 [Extract] [Full text] [PDF]

Patient-actor perception of care: a comparison of obstetric emergency training using manikins and patient-actors
J F Crofts, C Bartlett, D Ellis, C Winter, F Donald, L P Hunt, and T J Draycott
Qual Saf Health Care 2008; 17: 20-24. doi:10.1136/qshc.2006.021873 [Abstract] [Full text] [PDF]

Homeopathy or regular medicine? Cook County Hospital, Chicago, Illinois, 1882–1887: evidence, politics, customer choice and provider perceptions at work
D Neuhauser and M Diaz
Qual Saf Health Care 2008; 17: 76-78. doi:10.1136/qshc.2007.023705 [Extract] [Full text] [PDF]

Practice guidelines for haemodialysis in Egypt
Qual Saf Health Care 2008; 17: 79. doi:10.1136/qshc.2007.023325 [Extract] [Full text] [PDF]

Impact of the European Working Time Directive on specialty training
Qual Saf Health Care 2008; 17: 79-80. doi:10.1136/qshc.2007.023234 [Extract] [Full text] [PDF]

Giving a comprehensive overview of the social care sector in England ‘The state of social care in England 2006-07 (Executive Summary)’ the Annual Report of the Commission for Social Care Inspection follows concerns raised by the Commission last year, and explores the experiences of people not deemed eligible for state-supported social care. It shows that many younger disabled people and frail older people are being ‘signposted’ to voluntary services. Many are forced to rely on help from family and informal arrangements which can break down at short notice. People unable to rely on families or friends and unable to pay for care services themselves are simply left to cope with everyday life, while some become virtually trapped in their own home.Local authorities are increasingly only helping those with ‘substantial’ or ‘critical’ needs. This despite the use of a national set of rules (called Fair Access to Care Services - FACS ) to decide who is eligible for support. However who does or doesn’t get help varies not only between but also within the same council. In practice the criteria can be interpreted in different ways by local staff.

The full report can be downloaded using the links below along with the evidence that informed it.

State of social care - foreword & overview

State of social care - context and focus

State of social care - part 1

State of social care - part 2

State of social care - appendices

Lost to the System? The Impact of Fair Access to Care

Self-funded social care for older people: an analysis of eligibility, variations and future projections

You can also download the mp3 audio summary Audio summary.

The Future of Care Funding: Time for a change is the outcome of the nationwide Caring Choices: Who will pay for long-term care? initiative which aims to help shape future policy on long-term care for older people. It draws on the views of 700 people, carers and others in consultation, as well as a survey of those who attended the events and input from web visitors.

It shows high levels of dissatisfaction with means testing and the “postcode lottery” over social care entitlements. Nine in ten respondents to the “Caring Choices” consultation thought everyone should be entitled to some funding from the government and most people thought the current system of means testing unfairly penalised people who had made provision for their old age.

However only one in five believed that personal care should be funded totally by the state and a key option favoured by respondents was for people to receive a baseline entitlement, regardless of their income and wealth, with the individual also paying a contribution.

Informal and private care is plugging a funding gap of £25k for every disabled person over the age of 65 in Britain today says A Charter for Change, a new report from the charity Counsel and Care. Coming ahead of a Green Paper on Social Care, it calls for 2008 to be ‘the year of the care debate’ and urges Government to adopt a radical new framework for the future of social care.

POPP is an initiative being led by the Department of Health, providing £60m funding to council-based partneships to set up innovative pilot projects to:

• Provide person-centred and integrated care for older people.
• Encourage investment in preventative approaches which promote health, well being and independence for older people.

The strategic aim of ‘Partnerships for Older People Projects’ is to test and evaluate innovative approaches that enable a sustained focus on prevention. It is expected that partnerships will demonstrate improved outcomes in:-

• Providing more low level care and support in the community with a view to preventing or delaying the need for higher intensity and more costly care
• Reducing avoidable emergency admissions to hospital
• Supporting more older people to live at home or in supported housing such as sheltered or Extra-care housing rather than in long-term residential care

Just published are interim reports on the projects progress.

• National Evaluation of Partnerships for Older People Projects: Interim report of progress
• National Evaluation of Partnerships for Older People Projects: Interim report of progress, Briefing paper: Cost-effectiveness, Measuring Effects: Emergency Bed-Day use

You can also check out the Mass Media Coverage 21/11/07 over on Fade the Blog.

Today is the UN International Day of Older Persons so have a good one!  To celebrate why not check out what Help the Aged are up to.

The Healthcare Commission is calling for NHS trusts to do more to ensure they consistently provide dignity in care to older people, including offering adequate nutrition and privacy. They have published Caring for dignity: A national report on dignity in care for older people while in hospital  a national report on dignity in care. It warns NHS trusts of further checks, including unannounced visits, where there are clusters of evidence suggesting a problem at a hospital or on a ward. It is asking patients, their carers and the public - and their representative bodies like Age Concern - to come forward and tell the Commission where they have reason for concern.