Hello Everyone

I say everyone but really the answers I am looking for hopefully will come from either Steve or VM.

In the 1946 National Health Act at the very start of this act there is a very interesting and also puzzling section. Its odd because it seems to go against one of the core principles of this act.

(1)

General Duty To Provide Services

Section 1:

( 2 )

The services so provided shall be free of charge, except where any provision of this act expressely provides for the making and recovery of charges.

Keep in mind here that this is the original act ( 1946 ) and the active act when the NHS came into being in 1948 and the services were all totally free at the point of need ( including at home, but upon a doctors medical advice). So why the above?

Steve I dont have the full 1946 NHS act and you must have. My question to you; is there something almost hidden away in the pages of that act that would either ( a) allow future amendements or enactments to take place automatically, or ( b) does it relate to something within the act that wasnt free. Something like perhaps cosmetic surgery. I know that in the 50s people who suffered from varicose veins couldnt get surgical stockings free on the NHS because they were considered to be cosmetic in nature..

I find it hard to believe that a man so committed to the cause of a totally free NHS, like Bevan was, would have not seen through this and objected.

It almost seems to be predicting what was to come ( prescription charges ), or what might have to come in 1949:
THE POWER TO IMPOSE AND VARY PRESCRIPTION CHARGES BY REGULATION IS PROVIDED BY SECTION 16 OF THE NATIONAL HEALTH SERVICE AMMENDMENT ACT 1949.

Put in simple terms : is this the get-out clause that would allow them to make charges if they had to and given the economic climate of that time it would have made sense.

It does not stop there however, moving onto 1977 and the NHS Act of that year, the opening sections are the same give or take a word different, except in section 1 ( 2 ) where there has been a very important change:

( 2 )

the services so provided shall be free of charge, except in so far as the making and recovery of charges is expressely provided for, by or under any enactments whenever passed.

In the 2006 NHS Act the wording of this section is identical. In the new health bill to come where section 1 ie;the duty to provide is to be changed ( providing a action by a group of MPs and Lords doesnt come to pass and if it does then the original duty to provide ( as in 1946,1977,2006 will still be a part of the new bill ), section (2) remains the same.

This to my mind is a very clear contradiction to a free health service, it appears to give legal right to negate section 1 ie; the duty to provide free care. This has been in place since 1977. Critically it no longer mentions, like in the 1946 act,; where any provisions of this act etc.

It also raises the question in my mind how is enactments to be defined, do they as one would think, relate to the HEALTH ACT alone, or do they extend to other acts that interact in one way or another with the Health act.
Considering 1977 if the latter is correct then the enactments within act such as the Community Care Act would be taken into section 2 and also would negate section 1. This is a legal framework for charging for social care, even though it is actually mostly health-related social care which if section 1 ( of 1946,1977,2006 ) is interpreted correctly has it should be should be totally free at the point of need. Exactly in line with the core principle of the NHS and the Beveridge Report.

Opinions please.

Kind regards Ian

Ian,

In brief - but I'm sure Steve will provide further thoughts - it's an open door. A door is normally left open in most legislation for 'anything' ....

Meanwhile, if it's a bit of history you're looking for, here's a starter for 10 .....

http://tinyurl.com/82l4ckd

Don't forget to check out the footnotes.

You'll have to google for the original of that - because it ain't easily available without a good google. "You know how to google, don't you?!!!" You just ................ etc!

Or if that one doesn't suit - http://www.palgrave.com/pdfs/0333801121.pdf - and watch out for the invasions mentioned.

VM

Thank you VM for your link to Prescription Charging..underlines graphically the quote below...
Quote: Even when laws have been written down, they ought not always to remain unaltered. ARISTOTLE

NEXT.....

Hello VM

Thank you for those links; top class researching yet again.

I love the reference in the prescription charges document to the 2006 NHS act.

I rather think certain people are going to be upset again. Oh Dear!

Kind regards Ian

Ian - the original 1946 act can be purchased from TSO or any government bookshop and costs around a tenner. Most public libraries have a copy but they won't let you take it away - but useful if you only want to check the odd point! They soon introduced charges for prescriptions and dental treatment but as I keep saying they DO NOT charge for nursing care - and say so in their website and constitution. They avoid paying by shunting long term care costs on to social services and thus on to patients themselves via. mis-application of the National Assistance act. By simply redefining nursing care as so-called 'social care' - which the Appeal Court ruled in 'Coughlan' to be unlawful - they apply 'CRAG' thereby saving the NHS Billions! Steve.

Hello Steve

This is at the heart of the matter isnt it Steve. All nursing care is free by the law of the Health ACT Section 1 and my argument which from one of your posts appears to be the same, is that you can not separate social care needs that are related to health care needs, which have arisen by disease/illness or disability.

Indeed, it is only those cases where there is no obvious social care need related to a medical condition or disability that should fall within the remit of the social services and CRAG and other related National Assistance Acts.

In the Beveridge report along with the concept of free health care not based on ability to pay, there is a paragraph that I have used a couple of times already on this forum, so I may as well use it again.

Doing so I realise that this may not have actually made it through to the 1946 Health Act because not all proposed enactments make it into the final bill.

You might has well have the full section. Page 11 x1.

"" medical treatment covering all requirements will be provided for all citizens by a National Health Service, organised under The Health Departments and post medical rehabilitation will be provided for all persons capable of profitting by it. ""

That indicates long-term nursing care doesnt it Steve?

It appears to me if I may be so bold so make the suggestion where the class-action challenge should be aimed at.
On making legally clear this very definition. That all social care needs that are related to disease/illness or disability are medically created social care needs and as such are the full responsibility of the NHS and notthat of Social Services/Local authorities.





The various governments have already courted much adverse comments from the World Health Organisation, and the United Nations itself on the lack of social care responsibility. The United Nations protocol is a totality when it comes to the health and well-being of its member states.

You know like I do of the position in the States where dementia is considered to be a fatal disease of the brain;
THE World Health Organisation ( I am speaking here of doctors, such as DR.Greig Sachs,etc ).

I am not totally convinced that the NHS is fully the problem regarding CHC. I hold that it is the policies that goverments have made that is the main problem. There is a economic reality involved. The NHS has only got so much money it can use and that has to be spread around. We all know how the NHS wastes money, nice offices, free cars to certain employees,etc, but it is the governments that have played fair with funding.

They can spend billions when it suits them fighting wars that cant be won on somebody else orders. But they cant look after their own people. A simple increase in tax would resolve the all issue.
A measure of a real nation is that of how it cares for its own peoples.


Kind regards Ian

Hello Steve

Just spotted error in last but one paragraph. IT should read "" have not played fair"" Rather than "" played fair"".

Sorry about that.

Kind regards Ian

Ian...rehabilitation = restoring to health or normal life by training or therapy after illness...from habilitare "make able"

You are really working very hard to try and find solutions for us all....thank you. Keep at it

Ian "You know like I do of the position in the States where dementia is considered to be a fatal disease of the brain;
THE World Health Organisation ( I am speaking here of doctors, such as DR.Greig Sachs,etc ).

Thank you for this information Ian. I would be very interested in reading articles written by Dr Greig Sachs,etc....do you have a web link to this information please? I would be happy to provide you with my e-mail address via PM if it were possible for you to e-mail the research material to me....me being an ex musician and all I hope I am not breaking any rules in giving you my e-mail address......

Off now to the EMI home mother was resident in for 18 months...hoping to see results of some of the cognitive tests (I have been made aware of on this forum)available in her care notes..unlike Wales I have been allowed access to mother's care notes...in fact contributed to their construction...the Manager is a Qualified Mental Nurse...so her opinion should be of benefit to my claim for CHC...hopefully

ian wrote:" medical treatment covering all requirements will be provided for all citizens by a National Health Service, organised under The Health Departments and post medical rehabilitation will be provided for all persons capable of profitting by it. ""

That indicates long-term nursing care doesnt it Steve?

It appears to me if I may be so bold so make the suggestion where the class-action challenge should be aimed at.

Ian, I disagree.

Rehabilitation, to my way of thinking, means rebuilding someone's ability to do something, learning/teaching new skills to make possible something that has been rendered no longer possible, say, after an accident; recuperation; convalescence providing the rest required to regain skills - to name just a few. To profit from rehab implies that the rehab is curative, or problem-solving so as to enable.

I don't think rehabilitation means long-term nursing care. If anything, it means care provided to enable someone to regain the ability to be independent and to reach a state where they have no need for care - nursing is not required always to achieve that rebuilt state.

That's my PoV on it.

VM

Post no 8: I looked up the meaning of rehabilitation in the dictionary just to make sure my interpenetration was accurate. When I was nursing in the 60's a patient after surgery would commence rehabilitation (Recovery) the day following the operation and would be sent home after sutures were removed 7- 10 days... another 4-6 weeks would be spent at home rehabilitating before re-commencing work. Nursing care would only apply for the 7-10 days in hospital...probably for a shorter duration these days! There are conditions that require long term nursing care...severe burns etc but this would be in a hospital environment and fully funded by the NHS...rehabilitation carried out as an outpatient...resident at home....sick pay....so rehabilitation only applies where there is an expected recovery to good health...CHC funding is being currently refused to many with terminal conditions where there is no hope of rehabilitation. The Social Services picking up the bill at the behest of the NHS....AVOIDANCE....

Hello All
I am a new member to the forum, but have been following the forum threads for some time since 'finding' it and others when 'googling' for CHC information, which of course means that we are involved in the mire of the PCT and LA/SS mess.

Our experience to date from 2010 through to now, is within the current system and how it is interpreted by different people along the line, hospital, ss, pct, care home!, specifically re rehabilitation potential, is that 'rehabilitation' has many meanings but in health and social where 'elderly' are concerned it becomes a VERY moot point and a driver for playing down all needs, if they get away with it.

Rehabilitation, in our experience, we have learned, is to be 'considered' especially following STROKE / HEART problems .
BUT when it concerns the elderly ( over 65yrs ) the consideration of it is absolutely and totally embroiled within the funding/budgetary considerations FIRST and used to fob the patient off into social hands with the simple phrase ' has reached their full potential '.

This is the actual fact in our case, which we are sure will extrapolate across most pct's - la/ss now, especially when the hospitals want to discharge someone asap to social which is their everyday standard function and they do not want to be involved in the PCT/CHC complicated and time wasting paraphernalia.

I enclose a link to the royal college of nursing pdf re the rehabilitation nurse role which was published in 2007, and should have been reviewed in 2009, but no record of review so far, so this is the working document, it seems.

In our experience and direct knowledge, the services offered after the first acute hospital period is 'intermediate' care/treatment, (as stated in this document & is our experience) facility which is the full & absolute responsibility of the NHS within the 'free at the point of ......' concept, but it seems that now the opportunity is now regularly NOT provided to most dementia patients and swept under the carpet as 'has reached the full potential' to merely save costs and foist off to social asap, the reason being that the social model objective for MOST people is to 'maximize independence', which of course cannot be achieved at all with most people in middle to end stages of the various dementia syndromes.

Hope this 'take' on the subject, as it is now in 2011, our experience anyway, & being applied across many PCT's/Hospitals, is useful to someone.

HERE is a link BUT when trying to send, I am told I am not allowed to post links in full for 7 days, please put w w w. in from of this address rcn.org.uk/__data/assets/pdf_file/0017/111752/003178.pdf

Bernard

Got it Bernard....will start reading...thank you for this link In 1948 rehabilitation was very neccessary for a long period of time....60's surgical procceedured improved...rehablitation shortened.....now....very short or NO rehabilitation the norm......and as you say in terminal cases.....considered a social problem...this is what we are all trying to change!!!! WELCOME..Are you having any success with your involvement with the PCT/LASS mess?

Hello Mergymraeg100

Thanks for your post on rehabilitation and your request about Dr. Greig Sachs ( am also sending you a PM )

Quickest way google Dr.Greigsachs dementia. on the page that opens a long list of related items including one from the time.com called experts define dementia as a terminal disease.

Got distracted tonight with other issues on the debating chamber

Kind regards Ian.

ps Thanks also VM and Bernard for your welcomed and useful comments on rehabilitation.

Thank you Bernard for the link to rehabilitation. Apols. Have requested this in another thread - that's what comes from me reading from the bottom of the page upwards!