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#LDnursechat - Life on budget

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#LDnursechat discussed life on budget - specifically personal budgets and personal health budgets, and how these will affect service delivery.

When I agreed to facilitate the second chat, I felt prepared for it. As an ‘experienced’ RNLD in a relatively stable role, I have felt for a while now that I need a new professional challenge. And these chats have provided exactly that, along with the exciting development of @LDnursechat and the LD specific chats.

On paper, the PB provides individual, bespoke tailored packages of care which empower the individual as employer and director. In my area of practice, some of the realities are somewhat removed from this, and I was interested to discover if this was a national issue or if some areas are leading the way in PBs and ensuring quality outcomes for PWLD.

As the great @WeNurses have taught us, the chats are referenced before they commence and various contributors could be credited for sending links pertinent to the topic. We also started with a reminder about the NMC guidelines for the use of social media.

There were some recurrent themes, which we explored in greater detail. Most of the contributors were more aware of PHBs, although some had experienced positive interactions and outcomes for patients when good quality Personal Assistants (PAs) were employed, either via PBs or PHBs.

An overriding theme was concern for quality monitoring and auditing. PWLD are amongst the most vulnerable in society, and yet there seems little way of auditing the competence and appropriateness of directly employed PAs.

@janeyskev tweeted ‘how do we ensure PAs are competent and safe when they are directly employed?’

There was also some concern that some PAs are family members, and while they may be the most appropriate carers, there is some work needed to reduce the risk of various forms of abuse. Some PWLD may view their PAs as friends and therefore wouldn’t feel comfortable asking them for certain things, or reporting them if things were going wrong.

This led the discussion to advocacy, possibly the most powerful tool in effective service delivery for PWLD. Advocacy was widely regarded as the key to ensuring quality PAs, providing support for PWLD to make the right decisions regarding their PBs, and reducing the risk of abuse.

There were lots of examples of how positive PBs have been for certain individuals, and one of the main points towards the end of the chat was focused on just that: when PBs work for a person, they increase autonomy and control, and massively improve the quality of life for PWLD.

The further development of PBs and PHBs will happen, and when they are more established, they could generate an even more diverse role for RNLDs - both as PAs and brokers in this exciting new care delivery system. There will be a need for strong governance, proper brokerage and professional advocacy for PBs to be successful in maintaining quality outcomes and fulfilled lives for PWLD.

One pertinent point raised by @dmarsden49 was that ‘choice and control can bring extra pressures, but with the right support it can be the path to freedom’ and I think this summarises nicely.

There are many pitfalls, stresses and possible failings in the PB/PHB delivery, but if we can improve LD awareness, encourage the development of professional advocacy, and maintain our RNLD status as being one of holism and individualised, person-centred focus, we can and should make PBs work for the PWLD in our care.

At the end of the chat I was exhausted and exhilarated. As LD practitioners we are diverse, adaptable, person- centred, and totally committed to improving the lives of the people we serve. Whilst I have never questioned my decision to take the path of LD nursing, this chat served to restore my faith and motivation in the bucket loads. I am already reading up for the next #ldnursechat, and thanking my lucky stars I linked in with @dmarsden49, @samabdulla and @ldstudentnurse.

Read the transcript of this chat and see the forthcoming #ldnursechat schedule here.

@LDnursechat owned and facilitated by Michelle Parker @LDstudentnurse, Daniel Marsden RNLD @dmarsden49, Sally Evans RNLD @salsa442, Sam Abdulla RNLD @samabdulla.

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