Cost cutting puts thousands of elderly at risk

By Jayne Warren - 29/08/2008

Mature Times has discovered that many thousands of vulnerable people around the country are being put at risk because of cut backs in the service to provide them with flu vaccinations in their sheltered housing complexes and care homes.

One reader told us about the sudden withdrawal of flu vaccinations administered at her sheltered housing complex, whose residents are mainly in their 80s and 90s. With no explanation, they were simply told to go to their local GP surgery for vaccinations instead.

But the distance, their level of infirmity and lack of transport, made it impractical both physically and financially – while in previous years one district nurse had managed to vaccinate everyone in under two hours.

Our investigations show that this is also happening in other areas, with vulnerable residents caught in a “tennis match” between GP surgeries and local PCTs.

MT reader Sandra lives in sheltered housing in East Herts, and flu vaccinations were originally organised by the Warden. Sandra told us: “The system worked very well - especially as just about everyone is 80 and over. But when the flu vaccinations were stopped last year, only those who were very unwell or housebound got a home visit, and the rest had to struggle to the GP surgery instead, which caused them a lot of distress.

“Residents in their 90s had to rely on their children - most in their 60s - to take them there and back, which wasn't easy as many had to work and were only free on Saturdays."

When Sandra wrote to the GP to find out what had happened, she was told that it was the decision of the local PCT - but then the PCT told her it had been the GP's decision. "It was just like being in a tennis match,” she says. “No-one took responsibility for the decision, they just blamed each other all the time."

We spoke about the problem to Frank Ursell, Chief Executive of the Registered Nursing Home Association (RNHA) - and he wasn't surprised. "This whole area is a can of worms. It started to become a problem a few years ago, when there were difficulties with prescribing. This 'cost cutting' of services for the elderly is going on all over the country.

"But the PCT's blame the GPs, and vice-versa. The only people who can make any difference is the Department of Health, who issued the vaccination guidelines in the first place."

So we contacted the D of H to find out and were told that the national policy is that the influenza vaccine should be offered to all those aged 65 years and over and those living in long-stay residential care homes or other long-stay facilities “where rapid spread is likely to follow introduction of infection and cause high morbidity and mortality”.

The guidelines go on to say that “each PCT must operate or establish an Influenza and Pneumonoccal Immunisation Scheme … the PCT can decide what services should be delivered by whom, and to what standard using: existing primary medical services contractors, out of hours provider, district or community nursing, or any other local provider.”

Even Sandra's local PCT - East and North Hertfordshire Primary Care Trust - boldly states on their website that: "We hold the majority of the NHS budget locally. By actively caring for your health, we aim to reduce chronic disease, increase life expectancy and promote healthy living in our community. To do this over the next few years the PCT will be delivering radically changed services, closer to patients, in their homes, primary care practices, clinics and other settings. To provide equal care and more choice for all, these changes will be led by clinicians informed by patients and carers and commissioned in partnership between the PCTs and their linked clinicians.”

So, on paper, the local PCT appears to have the responsibility and the budget to decide were vulnerable members of the community should receive their vaccinations.

So why the “tennis match”?

The General Medical Council confirmed this for us: "Following the Chief Medical Officer's advice issued in March of this year, it is for local PCTs to decide how the flu jab is delivered in its area. The budget needed to reimburse contractors is already part of the PCT's Unified Allowances."

Armed with this information we contacted the Patient Advice Liaison Service at Sandra's local PCT, and asked them about flu vaccinations to patients in sheltered accommodation. They told us:  "Historically, district nurses in some parts of Hertfordshire have given flu vaccinations to patients who were not housebound, for example those living in sheltered accommodation.  

“Following the reorganisation of the PCTs in Hertfordshire, a review of district nursing services was carried out to ensure that all patients had equitable access to services and that district nursing services were consistent across the county.
 
"Part of the outcome of this review was the decision that, in line with the rest of the county, it should not be part of a district nurse's remit to vaccinate patients living in sheltered accommodation who are able to visit their GP surgery. Patients who are housebound will be able to have a vaccination in their place of residence - as they are now.  If not then the GP practice is responsible for giving the vaccination."
 
We checked the definition of "housebound". It is: "A patient is not housebound if she or he is able to leave their home environment with minimal assistance. Wherever possible mobile patients should be encouraged to attend a practice nurse in a health centre."

So what is “minimal assistance”? The definition of that phrase appears to be the basis on which the PCTs are devolving their responsibility to provide a service in a care or sheltered home, or forcing elderly people to make a potentially difficult journey.

Our final hope lies with Sandra's local MP, Oliver Heald. We sent him all the above information, and he has offered to chair a meeting between the two tennis players with Sandra in attendance. This story will be updated when we hear the result.

But apart from the apparent cruelty of making people attend, surely there is an argument being missed here. The overall cost to the NHS of sending a nurse to a home and conducting 10, 20, 30 or perhaps even more vaccinations in the course of an hour or two can surely be very little difference to the patients being seen in a surgery. It’s just coming out of a different “pot” of money.

The cost to society, and the people forced to make these journeys, however, is hugely different.

If YOU have experienced something similiar, or know of someone who has, please write to: Jayne Warren at editorial@maturetimes.co.uk.