APPENDIX 6
Memorandum by English Community Care Association
(GP07)
The English Community Care Association (ECCA)
welcomes the opportunity to submit evidence to the Health Select
Committee's enquiry into GP out-of-hours services.
The English Community Care Association (ECCA)
is the largest representative body for community care in England.
It speaks with a single unified voice on behalf of its members
and the sector to create an environment in which providers can
continue to deliver care that communities require and deserve.
ECCA works to ensure that care services are
commissioned fairly, efficiently and on a properly funded basis
to meet the true costs of providing appropriate care. ECCA also
works to promote and protect the standards of health care within
the independent sector. Adhering to high standards and acting
as beacon for quality are central to ECCA's existence.
Members of ECCA are drawn from the independent
sector and include voluntary, charity, mutual, not-for-profit
organisations, private, single care homes and major corporations
with services nationwide.
Members provide a variety of services including
services for older people, people with long-term conditions, people
with learning disabilities, people with mental health and palliative
care.
ECCA strongly believes that residential and
nursing homes (in their present and evolving states) are the foundation
upon which the NHS and Social Services depend. Longer life expectancy
may bring more complex needs which despite the progress of modern
medicines and advances in "smart" technology may need
continual nursing and care. There is no substitute for direct
human contact on offer 24-hours a day 365 days a year.
ECCA would like to highlight a number of issues
pertinent to the enquiry and would be delighted to provide more
detailed information or oral evidence if required.
1. RESPONSIVENESS
ECCA is concerned that GP out-of-hours systems
may not be adequately responsive to guarantee the health and well
being of care home residents. Members of ECCA strive to deliver
the highest quality of care. If the appropriate medical staff
are not available 24-hours a day, 365 days a year there may be
substantial barriers to quality. A care home is first and foremost
a resident's home and certain standards must be adhered to.
2. ADEQUATE STAFFING
It is essential that an out-of-hours system
has enough staff on duty to guarantee reliable and efficient treatment
and diagnosis. It may be quicker to call an ambulance than wait
for the GP on call to come to the care home.
Despite difficulties in staff recruitment and
retention, care homes try and maintain continuity of care so that
residents are not bewildered by unfamiliar faces. Whilst ECCA
accepts that the same GP cannot always be expected to be called
out late at night there should be some thought to the continuity
of care to help all parties concerned. Residents with complex
conditions, or long term conditions, value the relationship they
have with their GP. In depth knowledge of patient history often
means that consultation times can be cut down.
3. INAPPROPRIATE
USE OF
ACCIDENT AND
EMERGENCY SERVICES
If the out-of-hours system is not (a) adequately
responsive (b) adequately staffed there is a danger that care
homes will develop a reliance on accident and emergency services.
This would be contrary to government policy to reduce hospital
admissions and put in place preventative measures. Given the correct
infrastructure care homes are an excellent means of preventing
hospital admissions and are a much preferable and less intrusive
setting than hospital.
4. CERTIFICATION
OF DEATH
Care homes try to deal with death in the most
dignified and efficient manner possible. Currently nurses can
confirm the fact of death in certain circumstances, but a doctor
has to certify the cause of death. In general the GP who has last
treated the resident should certify their death and thus be alert
to any abuse that may have taken place. Your committee's latest
report on Elder Abuse highlighted the need for well defined
procedures to be put in place to guard against abuse especially
in the instance where a GP owns a care home. ECCA is concerned
that GP out-of-hours schemes may cause problems in certifying
death and increase bureaucracy between stakeholders including
relatives, CSCI, PCTs and coroners.
ECCA would also welcome a specific guidance
on who will have the power to authorise the removal of the remains
once the fact of death has been confirmed. Delays in doing so
can cause unnecessary distress.
ECCA advocates joined up thinking across all
the stakeholders involved in caring for residents in care homes.
If adequate procedures and systems are not put in place for the
patient's journey, the care home should not bear the sole blame.
It is therefore essential for adequate and accessible medical
staffing to be in place at all times.
June 2004
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