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LETTERS


three months to get a data stick because my old laptop can’t be encrypted, and I can’t connect my own smartphone to our system for security reasons, though they won’t supply one that I can con- nect. Maybe they’re just afraid of negative press.


From: Catherine Dampney, NHS Wiltshire Subject: iPads


Has anyone looked at the cost of producing the traditional set of telephone directory sized Board Papers for each board?


We worked out we would have RoI in one year, not including the productivity lift in the mobile workforce. Plus it gives us a platform to get the security right on these devices, so we can move to a ‘Bring Your Own Device’ model and cut out a significant set of infrastructure costs including network and device costs.


From: Mat Cooke Subject: Plant-based diets advice


In 1983 we made a U-turn in our dietary advice:


From – Base your meals on fats.


To – Base your meals on starchy foods.


Guess what has happened since this time. Obesity has gone from 2.7% to 27%. Are you seriously advocating eating more carbohy- drates?


From: Lynda Steele, NHS


Herefordshire Subject: CQC inspections


The fact that CQC do not accept complaints about service deliv- ery as part of their review, or as a trigger for review is a weakness in my opinion. Complaints are a rich source of material which helped in the determination of the failures at Stafford and I find it inexplicable that they no longer have any role in the higher level management of complaints.


From: Tim Ellis Subject: Brompton viable story


I do not like the wording of your news on the Brompton.


Of course the Royal Brompton received minimal support in the Public Consultation – it was not one of the four configured options. In addition, the IPSOS poll was skewed/ worded by the JCPCT and was hardly independent.


Moreover, why would you relegate a world class service which ticked all the boxes of the Safe and Sus- tainable criteria? The whole review has been a sham and this indepen- dent panel is a desperate attempt by the Safe and Sustainable Team to cover their guilty tracks.


London was discriminated against by having three centres and the Brompton has been treated shab- bily.


From: Martyn Ayre (personal ca- pacity) Subject: Dilnot care proposals


Not quite strangled at birth but – probably fortuitously – Dilnot’s projected additional costs to the taxpayer will see these proposals failing to thrive, then eventually being dumped in a pauper’s grave, after the Treasury vultures have picked over them.


Parliamentary parties of all stripes are thus far demonstrating contin- uation of their decades-long and dishonourable record of abject cowardice – playing to the gallery of easy popularity with promises of ‘jam tomorrow’ when they know for sure that this particular ‘tomor- row’ won’t happen on their watch, but then brow-knitting, hand- wringing and advancing excuses of ‘further work on the detail’ when faced with making a decision. I


suspect the apparent willingness to look for ‘cross-party consensus’ arising from Dilnot is three par- ties trying to buy themselves some time, then pin the blame for failure to reach consensus on the other two – there is precedent from the last Parliament.


This, in my book, is just as well, as Dilnot’s proposals fall well short ofthe target he was set – ie, proposals for reforming the FUNDING of social care. The glaringly obvious approach of a mixture of state aid and compulsory and discretionary top-up insurance is barely touched upon. Interestingly, Dilnot seems intent on providing detailed answers to questions he was not tasked with addressing (information and advice; assessment – ie, the role of local government in managing demand) but by ducking looking in any detail at the relationship between social care funding and disability and care-related benefits (ie, matters that impinge on his Whitehall lords and masters’ historic shortcomings), he has failed to identify opportunities for improved value for public money through their better alignment and targeting.


Inevitably – and irrelevantly, in terms of funding the system – he curries favour with the carers lob- by with the time-worn, cliched call for ‘more rights’ – which means what, precisely? This sounds ter- ribly harsh, I know, but let us re- member that the great majority of those carers are also those who would stand to get much larger inheritances, thanks to the pub- lic purse increasing its subsidy to people with wealth and assets. This is at the nub of it – increased funding is needed in the system to meet swelling need, not increase the level of subsidy to the sons and daughters of some relatively wealthier people.


Presumably unwittingly, the pro- posals for the £100k asset cap cre- ate perverse incentives for those who can afford to self-fund to enter the residential care system earlier and become a public li- ability as a ‘wealth depleter’ even more quickly – this generates even greater demand. Dilnot entirely misses the issue, as far as I can tell, as to how self-funders gener- ate significant pressures for the publicly-funded system.


The local authority assess- ment, which he so readily con- demns, is the only lever in the sys- tem that can conceivably manage demand, now or in Dilnotland. I’m very loath to impinge on the rights of people to spend their money as they wish but it cannot be a fair and equitable system that allows this to continue. For places like Kent, this inequity, combined with punitive and unfair Ordinary Resi- dence rules, means it is even more unfair on local taxpayers.


Perhaps the greatest weakness of Dilnot’s proposals, given his brief to fix the system for decades ahead, is his reliance on the finan- cial services sector alone to come up with ideas about possible fu- ture financial products related to meeting care costs. Is it too cynical to suggest it is highly unlikely that the sector, with its track record, is going to promote anything that does not, first and foremost, make them a handsome profit, leaving the taxpayer to pick up the offset?


So, only 2 out of 10: not the required radical overhaul (which entails challenging, not kow-towing to, unsustainable public expectations), just a bungling, ham-fisted tweak of the current 70-year-old mess.


The two points are for having some integrity and suggesting eli- gible care needs are restricted to those deemed ‘substantial’ or ‘crit- ical’. When politicians of whatever stripe become sufficiently brave to challenge the public expectations they have been so keen to stoke up and argue that if you want more you pay for more, the luxury of meeting ‘moderate’ needs may become affordable again.


TELL US WHAT YOU THINK opinion@nationalhealthexecutive.com


national health executive Sep/Oct 11 | 15


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