Thursday, 26 May 2011

Family Nursing and Home Care Cutbacks: A Comment

PATIENTS using Family Nursing and Home Care may soon have to buy their own medical products after the charity announced cuts to its service. In a letter sent to FNHC patients on Monday, the charity's finance director, Andy Cook, said that there were plans to get patients to purchase their own dressings from their local pharmacy. In the letter Mr Cook said that the range of dressings and other medical items distributed by FNHC district nurses would be reduced to 'conform to an agreed list of products between us and Health'. The move has been heavily criticised by Unite union official Nick Corbel, who has warned that patients will be put at risk.

What will happen in the future if you are one of those who require medical products that are currently supplied by Family Nursing & Home Care (FNHC) who have recently announced the closure of their outlet?

Currently you have to join FNHC and pay a membership fee of £50 upwards to be able to access this service, and the scheme includes the provisions of feeding tubes, dressings and incontinence pads for children three years and above. Dietary drinks are also medically required by the person/patient for their well-being (to keep them alive).. The change in policy means that members will no longer be receiving the service they have paid a membership fee for.

Financial assistance is currently provided to FNHC by Health & Social Services and Social Security Department fund, and there are free medical supplies to under five year olds. Families with children over five years pay 15% of FNHC retail price for the products.

According to the staff of FNHC stores, who received their redundancy notices on Easter Saturday, the outlet closes on the 1st July 2011. One of my correspondents commented that "The staff runs efficient and personal services which believe no private company would, or could provide."

The alternative will be purchasing items required from chemists or other outlets at full cost.

This reminded me very of the true story told by theologian Frances Young, in her book, "Face to Face", and this was about the NHS in England. Cuts there came in earlier than in Jersey, under the regime of Margaret Thatcher and the so-called policy "care in the community", which actually often simply meant State care on the cheap:

Arthur's incontinence has always been with us, and the way we have handled it has really been an extension of the babyhood practice of using nappies. We are geared up to it with suitable washing machines and drying arrangements. But plastic pants became a problem: he got too big for the typical baby-pairs you can get in chemists' shops. We heard from other parents about the supply of disposable rolls and plastic pants. I asked our social worker. She said I could call in at the Community Health centre and pick up what we needed. I could and did. There was a funny old man who would just take your word for it, fill a plastic sack with rolls, produce a couple of pairs of plastic holders and all was fine. We went about every three months. We only needed rolls for school.

Then came the cuts. So what did they do? They employed a secretary to check up on every issue from the Community Health stores. The secretary must have cost more than they saved. The informal arrangement no longer worked. A call from the social worker got us on the list, but then they would only give us a couple of rolls at a time, and we were lucky to get any plastic pants. There was no way we could call frequently enough to get enough rolls for school use. School kept pressing. Other parents were on the laundry service; they had a regular supply delivered every week. Why didn't we apply? Eventually I tracked down the District Nurse and a formal application was put in. We were put on a two year waiting list. Think of it - people coping with incontinent old people on a two year waiting list! They're likely to die before they get what they need

That is the trouble with removing a system that works. The alternatives usually require form filling, and bureaucrats checking, and replacing the front-line staff who know the people and their needs, decisions become bedded down with line managers checking decisions at a lower level; instead the whole enterprise, as I am sure will also happen in Jersey, becomes more formal, with forms to complete, assessments to check, before any alternative support is given to the needy.

They now will have to justify their need to clerical staff, rather than it being assessed on a common-sense basis by an organisation which can supply nurses to change dressings, for example, and who will know how people are coping. It is another burden, another hoop to jump through. As Frances Young says:

Professionals are always telling us to keep fighting for our rights, but we have got better uses of our time and energies. What concerns me is not our particular situation, but what it reveals about the stupidity of the whole set up, what it reveals about the hardships more vulnerable people must suffer. And this is supposed to be a caring society. Those who need the care are subject to suspicion and discouragement. They are exposed to unnecessary indignities - like the time my husband and I were sent separate bills to cover the parental contribution to Arthur's care. I hear people from disadvantaged backgrounds, immigrant groups, crying out at the way they are treated and saying this society is racist; I tell them it is not just those with the `wrong' colour skin who suffer in this way in our society. It should not simply be interpreted as racist. Granted that it is worse for them at times because of racist attitudes, it is still a fact that even people like us, white, Anglo-Saxon, Protestant, comfortable, middleclass and articulate, are subject to being treated as non-persons when we present our vulnerable face to officialdom.

There is something about the way state services are organized which creates an 'us' and `them' situation which is profoundly alienating. I am glad that I have experienced something of this, and can stand with at least a small measure of understanding alongside the real poor and inadequates in our society. It is time we realized just how uncaring and inhuman our institutions are. It is time Socialists realized that this is what their ideals have produced -- it has gone bad on them. It is time Conservatives realized that cuts have hurt the most vulnerable members of society whatever they say, and that stopping waste has created waste, and hardship .

And she notes what we will see in Jersey, that more expensive options will be available, and an extra financial burden placed on those who are struggling with enough burdens as it is:

It is since they came to power that supplies for incontinence have mushroomed in Boots and in chemists' shop windows. At last we can get what we need - by paying for it. Society may need handicap, but it will not bear the cost of handicap. The unfortunate are made to feel that they are to blame for their misfortune.

One of the comments on the JEP website is particularly pertinent in this respect:

Someone needs the Nurse opinion on this one as some patients, like my late father have leg ulcer problems and the amount and cost of dressings is extortionate to them. For the old its often a choice between food and electricity or changing dressings regularly. Looks like we'll be back to the old days when the patients had to rewash bandages.!!

"Face to Face", Frances Young, 1986


Anonymous said...

Thank you for bringing this to our attention Tony. This is a very serious situation and once again this is going to hit the most vulnerable people in our society. The States are out of control and they really don’t give a damn about the ordinary people in the street. I fear that this is only the beginning and sadly children and adults alike will needlessly suffer as a result!


Anonymous said...

We have seen this too, albeit from a mainland UK perspective.

My wife's eldest daughter suffers from a complex set of disabilities and a rare genetic syndrome. We have seen all the legislation describing "entitlements" - but the way it generally works is that one is entitled to be entitled, and the likelihood of you ever getting anything unless you fight for it (and often you have to fight dirty) is very low.

This has an impact well beyond the needs of the child. It transforms (perhaps deforms is not too strong a word) the personality of the parent and the siblings. The knowledge that your success is likely to ensure someone else who needs support fails to get it can leave you either with a deep sense of guilt or a failure of boundaries.

It shouldn't do. The measure of a civilised society (pace former Jurat Le Brocq) is the way that it treats those at its margins: the children, the sick, the prisoner, the disabled. On this measure Jersey is failing, and failing badly.

James McLaren