Police vs women in their 90s

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Fishnut
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Police vs women in their 90s

Post by Fishnut » Tue May 30, 2023 1:43 pm

Two stories in a matter of weeks about police being called out to manage situations involving aggressive elderly women and being completely incapable of de-escalating the situation.

The first occurred in New South Wales. A 95 year old woman was wandering around her care home with a steak knife in the early hours of the morning. She suffered from dementia and I'm in no way underestimating the risk that an armed dementia patient can pose to people but I'm surprised that a nursing home that "specializes in residents with higher care needs including dementia" doesn't ensure its staff the training to manage these situations (and doesn't have systems in place to prevent them from occurring in the first place). But they didn't, so they called the police and two officers turned up.

Rather than trying to de-escalate the situation - or even do the old 'look over here' trick to allow someone to grab the knife off her - they taser her. She fell (unsurprisingly). She hit her head (unsurprisingly). And then after a few days in hospital, she passed away.

Investigations are taking place and the officer who tasered her has been suspended and charged with assault occasioning actual bodily harm, common assault and recklessly causing grievous bodily harm. I'm not sure if those charges have been updated now she's died.

I don't think that the police are the right people to call in this situation (though I also recognise there's not really any other option) but they were and they handled the situation appallingly.

Tragic, but a one off.

Or so I thought.

Then I saw this story today. It's the good ol' Met again. They were called out to deal with a "disturbance between a woman and her carer". The woman was 90. Most articles are virtually identical, suggesting they're all repeating the same press release or agency reporting. The Sun (bastion of investigative reporting, I know, so take with a pinch of salt but it does sound lke they've actually spoken to neighbours unlike the rest of the press) says that he had dementia.
The panic-stricken elderly woman is said to have started ranting at police, spat at one officer and also threw cups of coffee before “extreme measures” were taken to bring her under control.

She was handcuffed behind her back and then the tightly-meshed sack-like spit hood was thrown over the pensioner’s head.

One officer then withdrew a Taser and flicked on the electric stun gun’s switch to aim a red dot on the petrified mother-of-three, but did not discharge the weapon.

The elderly woman – described as small and thin - was carried away afterwards by police while tied down on a stretcher and taken to a local hospital. She was not arrested.
Fortunately the taser wasn't discharged in this situation but it really concerns me how easily it could have been. Tasers are risky, even on seemingly healthy people. There's no way they should be even considered as an option when dealing with frail elderly people.

It's why I actually agree with Mark Rowley's decision to stop Met police from attending mental health incidents. Police simply aren't trained to deal with them (given what I've read in the Casey review and elsewhere I'd argue they aren't trained to deal with crime either) and their presence is putting people at risk of serious harm.

One woman is dead and another injured and likely traumatised because police have been turned into mental health first responders without being given the appropriate training. We need alternatives.
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Re: Police vs women in their 90s

Post by IvanV » Tue May 30, 2023 2:46 pm

The police are the legally responsible emergency responders when someone having a mental health crisis has the potential to cause a danger to others or to themselves. There is no one else who has anything like the preparation, equipment and readiness necessary to handle such a situation.

The Met are not recusing themselves from dealing with this type of situation. Since they are legally required to deal with it, they can't. And the Met said they would continue to handle this kind of situation, when making their announcement. The Met are only recusing themselves when there isn't an immediate threat to safety. Probably they only turn up in these other cases because no one else does.

I don't think it is practical to have a separate emergency response team for this situation, for the reason I gave in the first paragraph. And whoever else might do it is probably a lot more underfunded than the police. So the proportionate response is for the police's emergency responders to be better trained. Meanwhile, the likely effect of the police failing to turn up for mental health situations which they recuse themselves from is that often no one turns up, or only very late. So many situations which need some kind of a response are just going to get left to get worse.

The ultimate problem with all of these things is that everyone in the public sector is underfunded, and can't do a proper job any more, while expectations on them and legal requirements on them grow. They can't even get the staff even if they had the money to pay for them. So it's not all there, and crap happens more and more often. And our present government has no intention of doing anything about it. And I'm not convinced Labour has the guts to address any of this properly either, as there is only one place enough money to pay for this stuff can come from - the tax system.

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Re: Police vs women in their 90s

Post by jimbob » Tue May 30, 2023 6:25 pm

Fishnut wrote:
Tue May 30, 2023 1:43 pm
Two stories in a matter of weeks about police being called out to manage situations involving aggressive elderly women and being completely incapable of de-escalating the situation.

The first occurred in New South Wales. A 95 year old woman was wandering around her care home with a steak knife in the early hours of the morning. She suffered from dementia and I'm in no way underestimating the risk that an armed dementia patient can pose to people but I'm surprised that a nursing home that "specializes in residents with higher care needs including dementia" doesn't ensure its staff the training to manage these situations (and doesn't have systems in place to prevent them from occurring in the first place). But they didn't, so they called the police and two officers turned up.

Rather than trying to de-escalate the situation - or even do the old 'look over here' trick to allow someone to grab the knife off her - they taser her. She fell (unsurprisingly). She hit her head (unsurprisingly). And then after a few days in hospital, she passed away.

Investigations are taking place and the officer who tasered her has been suspended and charged with assault occasioning actual bodily harm, common assault and recklessly causing grievous bodily harm. I'm not sure if those charges have been updated now she's died.

I don't think that the police are the right people to call in this situation (though I also recognise there's not really any other option) but they were and they handled the situation appallingly.

Tragic, but a one off.

Or so I thought.

Then I saw this story today. It's the good ol' Met again. They were called out to deal with a "disturbance between a woman and her carer". The woman was 90. Most articles are virtually identical, suggesting they're all repeating the same press release or agency reporting. The Sun (bastion of investigative reporting, I know, so take with a pinch of salt but it does sound lke they've actually spoken to neighbours unlike the rest of the press) says that he had dementia.
The panic-stricken elderly woman is said to have started ranting at police, spat at one officer and also threw cups of coffee before “extreme measures” were taken to bring her under control.

She was handcuffed behind her back and then the tightly-meshed sack-like spit hood was thrown over the pensioner’s head.

One officer then withdrew a Taser and flicked on the electric stun gun’s switch to aim a red dot on the petrified mother-of-three, but did not discharge the weapon.

The elderly woman – described as small and thin - was carried away afterwards by police while tied down on a stretcher and taken to a local hospital. She was not arrested.
Fortunately the taser wasn't discharged in this situation but it really concerns me how easily it could have been. Tasers are risky, even on seemingly healthy people. There's no way they should be even considered as an option when dealing with frail elderly people.

It's why I actually agree with Mark Rowley's decision to stop Met police from attending mental health incidents. Police simply aren't trained to deal with them (given what I've read in the Casey review and elsewhere I'd argue they aren't trained to deal with crime either) and their presence is putting people at risk of serious harm.

One woman is dead and another injured and likely traumatised because police have been turned into mental health first responders without being given the appropriate training. We need alternatives.
Article in the Guardian about Hull having done something similar

https://www.theguardian.com/uk-news/202 ... dApp_Other
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Re: Police vs women in their 90s

Post by Fishnut » Tue May 30, 2023 6:36 pm

jimbob wrote:
Tue May 30, 2023 6:25 pm
Article in the Guardian about Hull having done something similar

https://www.theguardian.com/uk-news/202 ... dApp_Other
I just came to post that! I'd really like to know more about the impact of Humberside's approach. From a policing perspective it sounds like it's been positive, and they say that resources were found to ensure that the people they didn't attend to were still helped, but I'd really like to know more about that side of things. Have outcomes improved, stayed the same or got worse? Have those additional resources been maintained or was it a one-off boost that's been lost in later budgets?

I want it to work, I think it needs to work, but it should be something that gets properly resourced and thought-out rather than the mad scramble that it feels it's going to be in London. I'd like to know why Rawley felt he only needed to give a 90 day notice when Humberside - a much smaller force - allowed a year for other organisations to prepare.
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Re: Police vs women in their 90s

Post by Sciolus » Tue May 30, 2023 7:25 pm

IvanV wrote:
Tue May 30, 2023 2:46 pm
I don't think it is practical to have a separate emergency response team for this situation, for the reason I gave in the first paragraph. And whoever else might do it is probably a lot more underfunded than the police. So the proportionate response is for the police's emergency responders to be better trained. Meanwhile, the likely effect of the police failing to turn up for mental health situations which they recuse themselves from is that often no one turns up, or only very late. So many situations which need some kind of a response are just going to get left to get worse.
We already have a separate emergency response team for this situation, one which should be better trained and qualified to deal with it than the police. But funding and resources...
The ultimate problem with all of these things is that everyone in the public sector is underfunded, and can't do a proper job any more, while expectations on them and legal requirements on them grow. They can't even get the staff even if they had the money to pay for them. So it's not all there, and crap happens more and more often. And our present government has no intention of doing anything about it. And I'm not convinced Labour has the guts to address any of this properly either, as there is only one place enough money to pay for this stuff can come from - the tax system.
The medium term solution is to not f.ck up the economy so badly that it is utterly stagnant for 15 years. Whether Labour can manage that remains to be seen, but they surely can't be worse.

The longer term solution, as LPM points out regularly, involves the much harder realisation that we are going to have to devote something like half of our entire economy -- including its workforce -- to health and social care over the next few decades.

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Re: Police vs women in their 90s

Post by Woodchopper » Tue May 30, 2023 8:59 pm

The police appear to have acted with excessive force and I hope that the book gets thrown at them.

But in terms of the wider debate, speaking as a former union rep and a current health and safety rep it seems to me that ordinary care home staff shouldn't have to deal with situations like what are in fishnut's post. In both, someone intervening would have been at risk of injury and employers shouldn't expect that from employees who haven't been specially trained, equipped and recruited for such a role.

As far as I'm aware in the UK at least an entry level care home positions are not highly skilled. A care assistant would have a diploma that they got after study for some months, and they are not paid well at all. As has been mentioned, by all means have specialist rapid response units to deal with people with mental health problems. But if they are not available maybe not a good idea to expect people with little training and who weren't hired for such a role to deal with violent or potentially violent situations.

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Re: Police vs women in their 90s

Post by Woodchopper » Tue May 30, 2023 9:03 pm

Sciolus wrote:
Tue May 30, 2023 7:25 pm
The longer term solution, as LPM points out regularly, involves the much harder realisation that we are going to have to devote something like half of our entire economy -- including its workforce -- to health and social care over the next few decades.
My wife happens to work on helathcare personnel planning. Its her view that dramatic increases in healthcare personnel in developed countries simply isn't feasible. Instead, we're all going to have to come to the realization that people will have to accept much lower standards of care.

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Re: Police vs women in their 90s

Post by Fishnut » Tue May 30, 2023 9:19 pm

Woodchopper wrote:
Tue May 30, 2023 8:59 pm
The police appear to have acted with excessive force and I hope that the book gets thrown at them.

But in terms of the wider debate, speaking as a former union rep and a current health and safety rep it seems to me that ordinary care home staff shouldn't have to deal with situations like what are in fishnut's post. In both, someone intervening would have been at risk of injury and employers shouldn't expect that from employees who haven't been specially trained, equipped and recruited for such a role.

As far as I'm aware in the UK at least an entry level care home positions are not highly skilled. A care assistant would have a diploma that they got after study for some months, and they are not paid well at all. As has been mentioned, by all means have specialist rapid response units to deal with people with mental health problems. But if they are not available maybe not a good idea to expect people with little training and who weren't hired for such a role to deal with violent or potentially violent situations.
I agree that ordinary care home staff shouldn't be having to deal with situations where patients are violent, but from what little I know about dementia, violence is an occasional unfortunate side-effect and the patient in Australia was in a specialist home for patients with higher care needs including dementia. I wouldn't be surprised if the night cover is done by people with less training in the expectation that most will be asleep. That said, I find it concerning that she was even able to get her hands on a steak knife in the middle of the night and it suggests that failures occurred before the police were even called.

I also agree that this is a bigger issue than just police use of excessive force. People are living longer and that leads to inevitable health declines. I don't know how we provide a level of care that is humane and gives people dignity but it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
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Re: Police vs women in their 90s

Post by bolo » Tue May 30, 2023 9:30 pm

Fishnut wrote:
Tue May 30, 2023 9:19 pm
it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
Methinks you underestimate the ability of governments to keep ignoring things and fobbing them off to others to deal with.

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Re: Police vs women in their 90s

Post by Fishnut » Tue May 30, 2023 9:49 pm

bolo wrote:
Tue May 30, 2023 9:30 pm
Fishnut wrote:
Tue May 30, 2023 9:19 pm
it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
Methinks you underestimate the ability of governments to keep ignoring things and fobbing them off to others to deal with.
You're right. I should rephrase, it's an issue they shouldn't keep ignoring.
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Re: Police vs women in their 90s

Post by Woodchopper » Wed May 31, 2023 8:14 am

Fishnut wrote:
Tue May 30, 2023 9:19 pm
Woodchopper wrote:
Tue May 30, 2023 8:59 pm
The police appear to have acted with excessive force and I hope that the book gets thrown at them.

But in terms of the wider debate, speaking as a former union rep and a current health and safety rep it seems to me that ordinary care home staff shouldn't have to deal with situations like what are in fishnut's post. In both, someone intervening would have been at risk of injury and employers shouldn't expect that from employees who haven't been specially trained, equipped and recruited for such a role.

As far as I'm aware in the UK at least an entry level care home positions are not highly skilled. A care assistant would have a diploma that they got after study for some months, and they are not paid well at all. As has been mentioned, by all means have specialist rapid response units to deal with people with mental health problems. But if they are not available maybe not a good idea to expect people with little training and who weren't hired for such a role to deal with violent or potentially violent situations.
I agree that ordinary care home staff shouldn't be having to deal with situations where patients are violent, but from what little I know about dementia, violence is an occasional unfortunate side-effect and the patient in Australia was in a specialist home for patients with higher care needs including dementia.
Having spent a bit of time in care homes I doubt that even in a place that specializes in care for people with dementia the staff would be in a position to deal alone with the kind of incidents described in this thread. In any case the employer has a duty of care toward the employees, and procedures should emphasize that employees should avoid risks to themselves and call the police or other specialist back up in any incident involving risk of injury.
Fishnut wrote:
Tue May 30, 2023 9:19 pm
I wouldn't be surprised if the night cover is done by people with less training in the expectation that most will be asleep. That said, I find it concerning that she was even able to get her hands on a steak knife in the middle of the night and it suggests that failures occurred before the police were even called.
Yes, there was a clear failure there.
Fishnut wrote:
Tue May 30, 2023 9:19 pm
I also agree that this is a bigger issue than just police use of excessive force. People are living longer and that leads to inevitable health declines. I don't know how we provide a level of care that is humane and gives people dignity but it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
Certainly, and the things outlined in the article on Humberside were all non-violent incidents - eg checking up on someone who had been out of touch. They should all be done by others in the care system. It looks like the police were being expected to cover for lack of capacity in the social care system. Leaving aside all the other issues that is a huge waste of resources. But a line is crossed when someone is or is likely to be violent.

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Re: Police vs women in their 90s

Post by IvanV » Wed May 31, 2023 9:09 am

Sciolus wrote:
Tue May 30, 2023 7:25 pm
Woodchopper wrote:
Tue May 30, 2023 9:03 pm
My wife happens to work on helathcare personnel planning. Its her view that dramatic increases in healthcare personnel in developed countries simply isn't feasible. Instead, we're all going to have to come to the realization that people will have to accept much lower standards of care.
The longer term solution, as LPM points out regularly, involves the much harder realisation that we are going to have to devote something like half of our entire economy -- including its workforce -- to health and social care over the next few decades.
From a report by IFS about 5 years ago:
Health spending alone was £149.2 billion in 2016–17, with an additional £31.1 billion spent on social care and £48.3 billion on benefit payments to support individuals with disabilities and health conditions. Taken together, this constitutes 29.6% of public spending.
At that date, public spending was about 40% of the economy, so that's about 12% of GDP on health, social care, and benefits to people with disabilities, at that date. (Public spending has been up since with Covid and increased interest payments on debt). Healthcare costs have gone up a bit since, in reaction to Covid etc, and apparently the productivity of the NHS has fallen as an after-effect of that.

So 50% gdp on health and social care is clearly not the right ballpark. But 50% gdp on total public spending is plausible, not uncommon in Europe, and would give room to make substantial increases in various areas of public spending. But there are so many.

Woody mentions reduced standards of care. Our standards of care are already poor. The ambulances don't turn up in time for heart attacks and people die. That's not the kind of standard that should be reduced and it needs restoring. It's basic, not something that we should fall below. So how do we square the circle - get standards back to necessary standards, with a population needing more health and social care?

It's hard to see the NHS replaced by a co-funded system, like many continental countries have, without fighting on the streets in Britain. But what might be helpful would be if there was a reduced scope of what is free. Your teeth and your eyes aren't free, but you can get them at a standard price "on the NHS". That's seen as "regular maintenance" that you pay for yourself, not through the insurance system of the NHS. And you can pay a private charge instead, if you want nicer looking teeth or, sadly, a better dentist in many cases. We probably need a bit more of the scope to be seen as either regular maintenance or top-ups, so that the total public expenditure is contained as it grows. Yes, and we need more tax as well.

Someone mentioned economic growth. The difficulty is that health and social care are labour-intensive, and the cost of provision goes up as the economy grows. And people's expectations of the standard of buildings, etc, also pushes up the overheads, and labour costs ultimately drive the overheads too to some degree. So I don't think growth in the economy enables you to get the proportion of gdp you spend on health to go down, while achieving the equivalent output, very much. Though if you grow the economy without it reaching wages, except of the very rich indeed, well you could achieve the illusion of it.

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Re: Police vs women in their 90s

Post by Chris Preston » Wed May 31, 2023 9:48 am

Fishnut wrote:
Tue May 30, 2023 1:43 pm
I'm surprised that a nursing home that "specializes in residents with higher care needs including dementia" doesn't ensure its staff the training to manage these situation
Nursing home staff are trained, but that training consists of how to keep themselves, other patients and other staff safe, until emergency services arrive. It would be similar to the training that I get, which specifically states that I should not attempt to resolve incidents myself, but to wait for the appropriate responders to arrive.

The police response in Cooma was disproportionate and that is the focus of the investigation. No doubt failings on the part of the nursing home will also come up.
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Re: Police vs women in their 90s

Post by lpm » Wed May 31, 2023 10:28 am

IvanV wrote:
Wed May 31, 2023 9:09 am
Sciolus wrote:
Tue May 30, 2023 7:25 pm
Woodchopper wrote:
Tue May 30, 2023 9:03 pm
My wife happens to work on helathcare personnel planning. Its her view that dramatic increases in healthcare personnel in developed countries simply isn't feasible. Instead, we're all going to have to come to the realization that people will have to accept much lower standards of care.
The longer term solution, as LPM points out regularly, involves the much harder realisation that we are going to have to devote something like half of our entire economy -- including its workforce -- to health and social care over the next few decades.
From a report by IFS about 5 years ago:
Health spending alone was £149.2 billion in 2016–17, with an additional £31.1 billion spent on social care and £48.3 billion on benefit payments to support individuals with disabilities and health conditions. Taken together, this constitutes 29.6% of public spending.
At that date, public spending was about 40% of the economy, so that's about 12% of GDP on health, social care, and benefits to people with disabilities, at that date. (Public spending has been up since with Covid and increased interest payments on debt). Healthcare costs have gone up a bit since, in reaction to Covid etc, and apparently the productivity of the NHS has fallen as an after-effect of that.

So 50% gdp on health and social care is clearly not the right ballpark. But 50% gdp on total public spending is plausible, not uncommon in Europe, and would give room to make substantial increases in various areas of public spending. But there are so many.

Woody mentions reduced standards of care. Our standards of care are already poor. The ambulances don't turn up in time for heart attacks and people die. That's not the kind of standard that should be reduced and it needs restoring. It's basic, not something that we should fall below. So how do we square the circle - get standards back to necessary standards, with a population needing more health and social care?

It's hard to see the NHS replaced by a co-funded system, like many continental countries have, without fighting on the streets in Britain. But what might be helpful would be if there was a reduced scope of what is free. Your teeth and your eyes aren't free, but you can get them at a standard price "on the NHS". That's seen as "regular maintenance" that you pay for yourself, not through the insurance system of the NHS. And you can pay a private charge instead, if you want nicer looking teeth or, sadly, a better dentist in many cases. We probably need a bit more of the scope to be seen as either regular maintenance or top-ups, so that the total public expenditure is contained as it grows. Yes, and we need more tax as well.

Someone mentioned economic growth. The difficulty is that health and social care are labour-intensive, and the cost of provision goes up as the economy grows. And people's expectations of the standard of buildings, etc, also pushes up the overheads, and labour costs ultimately drive the overheads too to some degree. So I don't think growth in the economy enables you to get the proportion of gdp you spend on health to go down, while achieving the equivalent output, very much. Though if you grow the economy without it reaching wages, except of the very rich indeed, well you could achieve the illusion of it.
I forget where we got to in terms of numbers. But it was unachievable. GDP growth can never match healthcare growth due to cold hard demographics.

Standards will be binary and it will be elderly care where the difference shows through. Basic public care is already bad, it will become worse. Paid care will be as good as rich people want to pay for.

This sort of issue needs to be handled at the nursing home level. There should never be emergency call outs to worse-trained police or even ambulances. Nursing home staff need to carry the risk of injury, they need to be equipped for those risks, and they need to recruited with the full role in mind. Specialist dementia homes should recruit people who can deal with every situation in-house, or with an external back-up service covering the region.

We need to recruit police who are good at policing tasks, which we're failing at, without adding the mess that is recruiting police for dementia incidents or mental health management. Police recruitment should focus on finding people who are good at sending abusive whatsapps, shooting dogs and assaulting women preventing domestic violence, street violence and organised crime.
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Re: Police vs women in their 90s

Post by IvanV » Wed May 31, 2023 10:55 am

lpm wrote:
Wed May 31, 2023 10:28 am
I forget where we got to in terms of numbers. But it was unachievable. GDP growth can never match healthcare growth due to cold hard demographics.

Standards will be binary and it will be elderly care where the difference shows through. Basic public care is already bad, it will become worse. Paid care will be as good as rich people want to pay for.

This sort of issue needs to be handled at the nursing home level. There should never be emergency call outs to worse-trained police or even ambulances. Nursing home staff need to carry the risk of injury, they need to be equipped for those risks, and they need to recruited with the full role in mind. Specialist dementia homes should recruit people who can deal with every situation in-house, or with an external back-up service covering the region.

We need to recruit police who are good at policing tasks, which we're failing at, without adding the mess that is recruiting police for dementia incidents or mental health management. Police recruitment should focus on finding people who are good at sending abusive whatsapps, shooting dogs and assaulting women preventing domestic violence, street violence and organised crime.
I do agree in the longer run demand growth means we can't expand the spending to deliver the scope and standard of care we had 10 years ago. But our peer nations spend more than us, and have higher taxes. So there is some scope to increase spending in the shorter run, and rescue ourselves from some of the catastrophic standards of care we have blundered that cynical underfunding by a right-wing government has pushed us into.

But our peers are all finding their health services stretched, and they have less scope than us to increase spending and taxes. I was talking to a Canadian from BC the other day, and it sounds like the crisis in their health service is even worse than ours, though it varies by province. Across all these countries, they will have to reduce the scope of what is routinely provided, through some prioritisation, as money gets tighter to supply it. But we do need to get the most important bits of health care, the priority bits, back to some kind of fit-for-purpose standard. And the rest we need to be honest about. If the state doesn't provide, or only to the less well-off, well create a system so the rest of us know what to do.

The recruitment problem in the police occurs for similar reasons to recruitment problems in all social services, growing under-funding. Over the years, what various authorities are required to provide has grown, and what it costs to provide grows, and demand grows. Again, the only way we can hold things together, and do things in a responsible way, as demand grows, is to reprioritise and do some things properly, and be honest about what we can't afford. Because the present approach of trying to do it all on a grossly insufficient budget just doesn't work.
Last edited by IvanV on Wed May 31, 2023 10:56 am, edited 1 time in total.

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Re: Police vs women in their 90s

Post by dyqik » Wed May 31, 2023 10:56 am

IvanV wrote:
Wed May 31, 2023 9:09 am

It's hard to see the NHS replaced by a co-funded system, like many continental countries have, without fighting on the streets in Britain. But what might be helpful would be if there was a reduced scope of what is free. Your teeth and your eyes aren't free, but you can get them at a standard price "on the NHS". That's seen as "regular maintenance" that you pay for yourself, not through the insurance system of the NHS. And you can pay a private charge instead, if you want nicer looking teeth or, sadly, a better dentist in many cases. We probably need a bit more of the scope to be seen as either regular maintenance or top-ups, so that the total public expenditure is contained as it grows. Yes, and we need more tax as well.
The "regular maintenance" things are very things that should be completely free at the point of use, including eye tests, replacement lenses for glasses (including UV blocking coatings), dental checkups and cleanings, and annual physicals and tests and basic "feeling ill" doctor visits.

This is because this is primary opportunity for early and preventative interventions that make much more expensive treatments much cheaper or unnecessary. It's how you help prevent macular degeneration and cataracts, reduce the need for root canals and dental implants and reduce the incidence of heart disease, distribute vaccines, and detect cancers early.

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Re: Police vs women in their 90s

Post by dyqik » Wed May 31, 2023 11:06 am

dyqik wrote:
Wed May 31, 2023 10:56 am
IvanV wrote:
Wed May 31, 2023 9:09 am

It's hard to see the NHS replaced by a co-funded system, like many continental countries have, without fighting on the streets in Britain. But what might be helpful would be if there was a reduced scope of what is free. Your teeth and your eyes aren't free, but you can get them at a standard price "on the NHS". That's seen as "regular maintenance" that you pay for yourself, not through the insurance system of the NHS. And you can pay a private charge instead, if you want nicer looking teeth or, sadly, a better dentist in many cases. We probably need a bit more of the scope to be seen as either regular maintenance or top-ups, so that the total public expenditure is contained as it grows. Yes, and we need more tax as well.
The "regular maintenance" things are very things that should be completely free at the point of use, including eye tests, replacement lenses for glasses (including UV blocking coatings), dental checkups and cleanings, and annual physicals and tests and basic "feeling ill" doctor visits.

This is because this is primary opportunity for early and preventative interventions that make much more expensive treatments much cheaper or unnecessary. It's how you help prevent macular degeneration and cataracts, reduce the need for root canals and dental implants and reduce the incidence of heart disease, distribute vaccines, and detect cancers early.
The pricing model that Obamacare introduced for deductible and copays does reflect this for medical services (separate from dental and vision) - preventative medical expenses are largely zero out of pocket cost.

That's a separate consideration to high deductibles/co-pays and cost of base insurance.

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Re: Police vs women in their 90s

Post by IvanV » Wed May 31, 2023 11:21 am

dyqik wrote:
Wed May 31, 2023 10:56 am
IvanV wrote:
Wed May 31, 2023 9:09 am
It's hard to see the NHS replaced by a co-funded system, like many continental countries have, without fighting on the streets in Britain. But what might be helpful would be if there was a reduced scope of what is free. Your teeth and your eyes aren't free, but you can get them at a standard price "on the NHS". That's seen as "regular maintenance" that you pay for yourself, not through the insurance system of the NHS. And you can pay a private charge instead, if you want nicer looking teeth or, sadly, a better dentist in many cases. We probably need a bit more of the scope to be seen as either regular maintenance or top-ups, so that the total public expenditure is contained as it grows. Yes, and we need more tax as well.
The "regular maintenance" things are very things that should be completely free at the point of use, including eye tests, replacement lenses for glasses (including UV blocking coatings), dental checkups and cleanings, and annual physicals and tests and basic "feeling ill" doctor visits.

This is because this is primary opportunity for early and preventative interventions that make much more expensive treatments much cheaper or unnecessary. It's how you help prevent macular degeneration and cataracts, reduce the need for root canals and dental implants and reduce the incidence of heart disease, distribute vaccines, and detect cancers early.
I understand just what you are saying and why. And the point is well made.

But there is another economic principle which operates. That is that insurance is for the expensive stuff. Free at point of delivery funded by taxes is like being insured for it. Even formal insurance systems have an excess, because when it comes to insuring small losses it's cheaper just to pay for them and so avoid the admin costs of an insurance system. Most of us would be better off with higher excesses, and not bothering insurances for the cheap stuff. It's why selling insurance in white goods stores is such a con - the loss risk is too small for most people to need to be insured for losses on fridges, etc. You can pay for routine dental care on an insurance system, so that the cost is fixed, like paying it through taxes would be. But it's like the white goods insurance, it isn't good value, because most of the costs are too small. In dentistry most things that are expensive are optional, which makes it difficult for insurance to operate.

So how do we reconcile these two conflicting points? Like all trade-offs, it's difficult. For most of us there isn't an affordability issue over the small stuff, but for the less well off there can be. At least there needs to be a safety net for the less well off, so they aren't put off by cost from getting a basic level of care. And the idea that the old are all poor needs to be revisited. But for the rest of us, it's more effective just to pay for the little stuff, and have a choice over the standard of service we require and are willing to pay for.

In your subsequent post you make a good point about some of the basic preventative stuff being free. So perhaps there can be some basic levels of service that are not charged for. Now I'm 60, when I had my eye-test recently, there was a standard part that was free (which just seems wrong, that it becomes free because I'm 60, but there you are). But the detailed scans that led to them sending a referral to my GP were a quite expensive option on top, and the specific reason I presented myself to the optician to get those. Then you get to the difficult question of whether the state can afford to give everyone those scans.

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Re: Police vs women in their 90s

Post by Woodchopper » Wed May 31, 2023 11:29 am

Looks like we may have a derail, but anyway, in response to Ivan's earlier post.

I keep going on about this but the main long term problem in healthcare is a lack of people. Its not a problem that can easily be solved by money. Switzerland has loads of cash and and a healthcare crisis due to lack of personnel. The same applies in other countries with high social spending (eg Denmark, Norway, Canada).

Its likely that there will be a world wide shortage of healthcare workers.

Certainly, Britain could do a lot to get to the state that Switzerland is in. But that's moving from from one long term crisis to another long term crisis that is a bit less severe.

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Re: Police vs women in their 90s

Post by lpm » Wed May 31, 2023 11:32 am

I think there's a young person's perspective gap going on, where young person in this instance means under 60.

We don't grasp how vast the requirements of the elderly are relative to our own needs. We think in terms of childbirth/infancy care, plus minor problems, plus very rare early cancers or heart problems. We might look at what healthcare we've needed in our first 60 years and think it adds up to a lot - but it doesn't. 60 years of being born and vaccines and eye tests and physicals are nothing compared to the resources needed from 60 years old to x years old.

Approx 25% of us are going to die from cancer, 25% from heart, 25% from head, and the other 25% from respiratory illnesses. Cancer will cost the NHS £30k, heart surgery will cost £30k, a stroke will cost £30k. With luck most of us will survive Death's first attempt to get us and will go on to have further expensive events. And that's on top of all the cataracts and hip replacements and mobility aids and in-home care. The only cheap option is to die of flu or Covid in your 60s.

When I was a child all the old people in the family lived in terrible poverty. Huddled under blankets with the curtains drawn to keep in heat. We've started the process of raising state pensions. But in a few years children will see all the old people in the family trying to cope with terrible healthcare.

This isn't really a derail, because the opening post is basically about how nursing homes already can't cope. The next stop is that the nursing staff will be the ones with the tasers.
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Re: Police vs women in their 90s

Post by Woodchopper » Wed May 31, 2023 11:40 am

lpm wrote:
Wed May 31, 2023 10:28 am
This sort of issue needs to be handled at the nursing home level. There should never be emergency call outs to worse-trained police or even ambulances. Nursing home staff need to carry the risk of injury, they need to be equipped for those risks, and they need to recruited with the full role in mind. Specialist dementia homes should recruit people who can deal with every situation in-house, or with an external back-up service covering the region.
I'm not sure that's possible. I don't know the numbers but many people would be traumatized by being violently injured at their workplace. One of the things that the police and armed forces do is select people who are less likely to have that response, and try to mitigate it through things like training and an esprit de corps. But even then they experience high levels of PTSD.

I'd need some convincing that the kind of people who want to work as care assistants would normally be able to shrug off having to deal with violent incidents.

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Re: Police vs women in their 90s

Post by Woodchopper » Wed May 31, 2023 11:44 am

Fishnut wrote:
Tue May 30, 2023 9:49 pm
bolo wrote:
Tue May 30, 2023 9:30 pm
Fishnut wrote:
Tue May 30, 2023 9:19 pm
it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
Methinks you underestimate the ability of governments to keep ignoring things and fobbing them off to others to deal with.
You're right. I should rephrase, it's an issue they shouldn't keep ignoring.
I expect that if the problems aren't solved then much of the population will move to co-payment in kind. That's how it works in most of the rest of the world, and did in Britain before the 1950s. The fortunate amongst the elderly would be cared for by their children or other family members.

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Re: Police vs women in their 90s

Post by bob sterman » Wed May 31, 2023 5:42 pm

IvanV wrote:
Tue May 30, 2023 2:46 pm
The police are the legally responsible emergency responders when someone having a mental health crisis has the potential to cause a danger to others or to themselves. There is no one else who has anything like the preparation, equipment and readiness necessary to handle such a situation.

The Met are not recusing themselves from dealing with this type of situation. Since they are legally required to deal with it, they can't. And the Met said they would continue to handle this kind of situation, when making their announcement. The Met are only recusing themselves when there isn't an immediate threat to safety. Probably they only turn up in these other cases because no one else does.
They have said they are going to stop attending unless there is an "immediate threat to life" - a somewhat higher threshold than an "immediate threat to safety".

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Re: Police vs women in their 90s

Post by Millennie Al » Thu Jun 01, 2023 1:44 am

IvanV wrote:
Wed May 31, 2023 10:55 am
Again, the only way we can hold things together, and do things in a responsible way, as demand grows, is to reprioritise and do some things properly, and be honest about what we can't afford. Because the present approach of trying to do it all on a grossly insufficient budget just doesn't work.
There are things that could be done, but I cannot see there being the political will to do them.
  1. Make it unfashionable to use public services which have private alternatives. People should feel that it is beneath them to use a publicly funded service when they could buy it privately for themselves. This would allow their taxes to be used to cover other people. For things like healthcare, the private service could add extra, unnecessary frills. People are perfectly happy to spend lots of money on clothes and shoes which are no better functionally than very cheap versions. You could get teeth, glasses, wheechairs, etc from the NHS which are perfectly functional, but look boring and plain. Make people feel that they should send their children to a school they pay for, rather than a state-funded school.
  2. Abolish lots of rules whih have the effect of making people live longer to the point where they need huge amounts of care. Tax on tobacco should merely be sufficient to ensure that the smokers pay more than they will cost in healthcare - not a level intended to stop them smoking.
  3. Abolish very expensive ineffective rules which attempt to prevent people taking recreational drugs. These rules cost society a huge amount, both finacially and socially, yet don't actually work. Make the most restrictive rule be no more than we currently have for alcohol, so people can buy herion, cocaine etc in the supermarket.
  4. Allow assisted suicide. Currently we effectively torture those who are unfortunate enough to both want to die and are unable to kill themselves. While the free availability of recreational drugs may make quite a few want to stay living, there will still be some who would prefer to die. And overall I expect that this group are expensive to keep alive, so even if your morality makes you want to force people to live when they don't, consider the money saved.
  5. Stop borrowing so much. The interest on the national debt is now over £100 billion - more than half the spending on NHS England. It may be painful to spend less today, but nothing like as painful as paying the interest forever on the debt.
  6. Abolish limits on immigration. A person born here needs support for 16-18 years before they can contribute financially to society, while an adult immigrant can start immediately. And we save the costs of being really nasty to foreigners at the border and we get cheap labour.
  7. Simplify taxation. There should be no case where earning £X gets you taxed at a higher rate than earning a pound more. There should be no strange exceptions that make people waste time and effort unproductively avoiding tax.
  8. Frack! It is nonsense to suggest that refraining from drilling for oil and gas will help the environment. There is plenty of coal still being burned for energy which is more harmful than oil and gas, so we should be (globally) replacing coal and only reducing oil and gas once there is no longer any need for coal. Selling British oil to a country to replace its coal both helps the environment and makes us richer.

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Re: Police vs women in their 90s

Post by Stephanie » Thu Jun 01, 2023 6:50 pm

Fishnut wrote:
Tue May 30, 2023 9:19 pm
Woodchopper wrote:
Tue May 30, 2023 8:59 pm
The police appear to have acted with excessive force and I hope that the book gets thrown at them.

But in terms of the wider debate, speaking as a former union rep and a current health and safety rep it seems to me that ordinary care home staff shouldn't have to deal with situations like what are in fishnut's post. In both, someone intervening would have been at risk of injury and employers shouldn't expect that from employees who haven't been specially trained, equipped and recruited for such a role.

As far as I'm aware in the UK at least an entry level care home positions are not highly skilled. A care assistant would have a diploma that they got after study for some months, and they are not paid well at all. As has been mentioned, by all means have specialist rapid response units to deal with people with mental health problems. But if they are not available maybe not a good idea to expect people with little training and who weren't hired for such a role to deal with violent or potentially violent situations.
I agree that ordinary care home staff shouldn't be having to deal with situations where patients are violent, but from what little I know about dementia, violence is an occasional unfortunate side-effect and the patient in Australia was in a specialist home for patients with higher care needs including dementia. I wouldn't be surprised if the night cover is done by people with less training in the expectation that most will be asleep. That said, I find it concerning that she was even able to get her hands on a steak knife in the middle of the night and it suggests that failures occurred before the police were even called.

I also agree that this is a bigger issue than just police use of excessive force. People are living longer and that leads to inevitable health declines. I don't know how we provide a level of care that is humane and gives people dignity but it's an issue that our government can't keep ignoring. And they certainly can't keep fobbing it off to the police to deal with.
They don't get any extra training for physical violence in dementia specific care homes as far as I'm aware
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