Gloucester study shows GP support in care homes reduces hospital admission.

http://www.integratedcaretoday.com/2015/03/25/gp-support-in-care-homes-reduces-unplanned-hospital-attendances-by-25/?utm_source=Integrated+Care+Today&utm_campaign=ea240692f5-25_03_2015_NL&utm_medium=email&utm_term=0_41bd49ae2b-ea240692f5-15853249

Are women and ethnic minorities getting protection against deprivation of their liberty in hospital and social care?

Older people should be interested in the Deprivation of Liberty Safeguards (DOLS), because most of the people affected by official decisions to deprive them of their liberty under the Mental Capacity Act 2005 are older people affected by dementia, as you can see from this chart, published in the annual report on DOLs by the Health and Social Care Information Centre.

What this bar chart also tells you is that the rates of application are the same for men and women (the rates are per 100,000 in the population), but I think they shouldn't be because most applications are about older people and most older people are women: are men getting a disproportionate amount of protection from being deprived of their liberty?

And if you look at ethnicity a lower rate of white people are  affected by applications than the total rate of all other ethnicities, when white people are massively predominant in the population. Are agencies more prepared to make applications for the depriving non-white people of their liberty?

The law on DOLS is a bit hazy and the procedures are confusing, so it's not surprising that DOLS applications are still not hitting the expected rates, even after several years of the Safeguards being in operation. Numbers of applications are going up every year, although the rate of increase has slowed. That suggests that there are probably quite a lot of people who are being deprived of their liberty (although restriction of liberty is OK, so long as it's not continuous and heavy - that's one of the confusing thing about the law), and who are not getting the protection of the assessments that the Safeguards require. You can get some clue to this, by looking at the reasons applications were not granted. By far the most common reason was that nobody had done an adequate best interests assessment, so health and social care agencies weren't really looking too carefully at the best interests of the people they are supposed to be caring for.

Most of the people affected will be in hospitals and care homes. The Safeguards require health and social care organisations, that are depriving people of their liberty as part of caring for them, to carry out an assessment of the decision (or lack of decision) to do this. Mostly this is hospitals and care homes preventing people from leaving or pursuing their normal lives, mainly because there are fears for their safety where people cannot make decisions for themselves. The Safeguards require a 'best interests' assessment to be made by the professionals involved (is it in someone's best interests to be derived of their liberty?) and an independent element in the decision-making.

It's obviously still not working too well, and I'd be worried about the covert reasons why a decision is made or not made to apply for a DOLS authorisation. On the one hand, I think care homes and hospitals get themselves into deprivation of liberty situations trying to do their best in caring for people without thinking too clearly about people's rights and liberty. The affects mainly older people often without a lot of support from friends and relatives. On the other hand, I think they may be choosing to make applications when they are worried about being criticised or gong through a bad time with a particular resident or patient, rather than consistently thinking through whether their care for someone actually deprives them of their liberty.

Link to the HSCIC Annual Report on DOLS.

How to steal someone's identity: read the widely available care home reports at your local hospital

My wife fell down the stairs, so we went to the Urgent Care Centre (what used to be called Accident and Emergency) at our local hospital. 

While waiting by her trolley, I read with interest a report left on the counter. It was from a care home, sent in with a previous patient, giving full details of his and his nearest relative’s name, address, date of birth and information that would allow me steal his identity. It included his medical details and symptoms of dementia, so you could probably steal his identity without his knowing.

I thought about mentioning this to the computer-users studiously avoiding any eye-contact with the rest of us in the room, but I didn’t because my wife and I have a policy of being nice to everyone involved in caring for us. This is the most likely tactic for getting good service from harassed professionals in the NHS. So they had no opportunity to cease revealing the personal details of one of their patients to all and sundry arriving at the counter because our ‘be nice’ policy prevented my handing the report back.

It’s an example, though, of how easy it is to be careless about making sure that patient information is not routinely left around for anyone to gawp at. It’s lucky I am a registered social worker who keeps things confidential and carefully forgot the things I saw; they might not be so lucky next time.

Balance autonomy & physical/psychological security for older people leaving hospital says study

An interesting article in the Scandinavian Journal of Caring Sciences, at least judging by the abstract, and here was me saying earlier, don't trust the summaries go to the originals). It's from Australia. They studied the difference between older people's views of discharge planning before anything happened, their relatives and healthcare professionals, using a vignette of a frail older person in hospital.

The older people went for the safe option - the care home and so on - for the person in the vignette, but not themselves. The younger people balanced autonomy with security, provided the older person was mentally capable. Discharge planners are advised to stress balancing autonomy with security when working on the issue, look at the ethics of balancing physical with psychological security and help middle-aged people to plan in advance. Sounds like good advice, but I can only see the abstract - this isn't a journal I get.

Linley A. Denson, Helen R. Winefield, Justin J Beilby Discharge-planning for long-term care needs: the values and priorities of older people, their younger relatives and health professionals. Article first published online: 13 APR 2012 DOI: 10.1111/j.1471-6712.2012.00987.x