/ Health

Why is elderly care failing? Older people have human rights too

Images of person getting older

The Equality and Human Rights Commission (EHRC) has reported on care provided to older people in their own homes, and it doesn’t make pretty reading. Why is society allowing older people to be treated like this?

Examples emerged from EHRC’s report of people being denied basic rights, such as access to the toilet and the food in their own fridge. For those who have worked in the care sector, as I did for many years, this is sadly not altogether unexpected.

But it’s difficult to identify villains in a system that’s failing so many. Is it about care agencies and poorly-paid workers; is it about poor commissioning of care from private agencies by under-funded councils; or is it about could-do-better regulation?

Older people are human beings too

At first it seemed odd to me that this sort of inquiry came under the banner of ‘human rights’, but actually I now think it makes perfect sense.

Isn’t the real problem that – as a society – we’re prepared to let the social care system for older people bump along the bottom? It’s just about good enough, but it’s nowhere near the funding (or expectations we have) for younger people’s services.

We’ve become immune to care workers rushing in and out for 15-minute visits and driving at top speed to the next person, all because they’re not paid for their travelling time.

And our research shows that councils are increasingly rationing what they provide. In 2009 we found that 66% of councils met only critical and substantial needs. But our latest analysis for 2011-12 shows that 71% of councils are now excluding those with low or moderate needs.

Yes, there are bad home care agencies and poor commissioners, but I think the EHRC is right in bringing the debate back to the issue of treating older people like human beings.

The system is creaking at the seams

Until we admit as a society that we need to up our game on what care we give older people, we’ll never move away from a system that encourages care workers to prioritise a list of tasks, rather than thinking about what the human being in front of them really needs. Or ensure care workers are paid well so we routinely get well-trained, high calibre staff.

I’m not sure what the answer is, but I do think the system is creaking at the seams. The danger is that it could fall apart. And as the EHRC quite rightly showed, it is our elderly relatives bearing the brunt.


A few thoughts on some of the threads running through this Conversation [in no particular order or coherence] . . .

a. the situation today is so totally different from what prevailed in the 1940’s that what the NHS Act says should be done is now almost irrelevant. Longevity, medical services and treatments, the nature of hospitals, the availability of private care provision, costs and funding, the role of local authorities, and the attitudes and behaviour of society, have all changed out of all recognition over the last half-century.

b. the term ‘nursing care’ is open to interpretation. To my mind it ranges across a wide spectrum from intensive medical care as part of a programme of treatment for a patient’s condition through to observation, medication and auxiliary support as part of a residential care service. The NHS sees its role as to meet the first side of that continuum and probably tries to keep as far to the outer edge of that bandwidth as possible making no charge at the point of delivery but doing no more than is strictly necessary clinically. That leaves a very wide span of needs some of which used to be met by local authorities directly in their own establishments but, with few exceptions, is now generally contracted out to the private sector with the emphasis, so far as possible, on providing domiciliary support in people’s own homes and charging for it on the basis of assessments [“means tests”] – but not necessarily standardised across the country nor universal in provision. Additionally there is care home provision that is run entirely unsubsidised by the private sector at full charge to the residents but where certain medical and quasi-medical services might also be available at no direct cost.

c. The NHS has developed and funded extremely expensive advanced procedures, drugs and treatments that have had the consequence of prolonging life. It might be argued that this has come at the expense of routine care and ‘nursing’ for elderly people. I suspect there are very few elderly people in hospitals today who are not there for treating a specific injury, condition, or illness so that when that treatment is complete [made even quicker thanks to the modern medical techniques] they will be discharged and left in the hands of their GP and the domiciliary services.

d. The big problem is that the country can barely afford what is being done now yet there is a demographic time-bomb ticking away as my generation ages and the population expands. Due to age and infirmity many members of the post-war generation are now struggling to look after their own parents who are now in their upper-eighties and nineties.

e. At the risk of being extremely contoversial I can only suggest that we stop building and deploying intercontinental aircraft carriers and supersonic fighter aircraft but build-up the army to provide the kind of direct support and assistance [of the non-invasive kind I hasten to add] here and in other trouble spots where we have legitimate interests, and plough the savings into a balanced and dignified system of care for our elderly.

Gerald says:
3 March 2014

Dear John,
The Act lays down quite clearly that treatment must be free, this is NOT due to interpretation, recent court cases instigated by the Public against the NHS has confirmed this point of Law over and over but the NHS still ignores the Public. Just look at all the complaints and whistleblowing which the NHS is guilty of whitewashing and paying off etc. they really cannot seem to get it in their heads that they have massive problems. Hopefully now that the CQC has had their nuckles rapped for helping the cover up ,we might get real balanced inspections which might put the quality comparisons into perspective. Hve you ever wondered why the BBC or WHICH ? have never done surveys or under cover inspections in the NHS if they had listened to the relatives and whistleblowers maybe hundreds of people at Mid Staffs etc. would have been saved , you must admit there appears to be a disparrity here at least.

Gerald says:
3 March 2014

Dear John
” Nursing Care” and Nursing Homes” are NOT open to interpretation these terms are quite clearly defined in the Registered Homes Act and the definitions were regularly adhered to by all Medical Proffesionals when deciding type of Care requirements needed and therefore type of Care Home.
It is only since the Local Authorities have got involved that there has been this confusion introduced and Medical Pros have been replaced with Beurocrats and so called Care Managers or at best Occupational therapists.
The whole exercise is to save the “poor” NHS money (how many Billion Pounds does it cost the tax payer) they way this happens is they make now means tested instead of needs tested.Lets con the Public why don’t we .
You obviously haven,t been aware all of the bed blocking which is still going on in hospitals, inspite of there being numerous vacancies in Nursing Homes and Loads of eager GPs eager to earn their fees (fee for elderly person does not stop when person goes into hospital)
If you do not believe what I am saying check out the facts you will find the majority of elderly people are dying in Hospitals in spite of their personal prefernces ,if you think about this it really doesn’t make any sense whatsoever perhaps you could have a word with some of your friends for an explanation
All the Health Authorities have to do Manage efficiently their Core Business like the rest of us have to do and stop all the Political involvement (particularly of the Unions) .When one considers the fact that most of the Public Servants are in the same Union no matter what their role or their level I realise this will never happen and this is why ,if we are not very careful this marvellous institution called the NHS might bankrpt this Country (look what Communism did for Russia


As I think I said in another Conversation, the cost of Which? undertaking the kind of in-depth survey of NHS hospital care that you would like would be massive and the skilled resources needed to do it competently would be hard to find in sufficient numbers. Therefore it is probably unlikely that the Board of Which? would be willing to commit to such an exercise, especially since most subscribers would prefer it to concentrate on the day-to-day consumer issues for which it has both the expertise and the ability to make a difference.

I am not sure whether you have been consistently suggesting that what went on at the Mid Staffordshire Hospital is representative of practice in the NHS and would be uncovered elsewhere. Many people consider it to be an isolated example, deplorable though it was, that demonstrates that overall the NHS provides good care throughout its hundreds, possibly thousands, of establishments. Personally, I am not in a position to judge. I bear in mind that the NHS ventures into areas and conditions that no other organisation in the UK is willing or able to tackle.

So far as I am aware, the medical treatment of illnesses and conditions for anybody who presents at, or is brought to, an NHS facility is free of charge at the point of delivery. I believe some attempt is made to recover partial hospital costs from patients admitted as a result of certain incidents where there is compulsory insurance cover. Otherwise, ambulance services, medication, clinical treatment, nursing, post-operative care, and out-patient services are provided at no cost to the individual. The majority of medical prescriptions are also dispensed for exempt categories or people eligible for a ‘season ticket’ for repetitive dosage. As I suggested previously, there seems to be room for interpretation over nursing care since some of it cannot be pinned down as being exclusively the responsibility of the NHS. I should be surprised if the NHS was continuing to act in defiance of a ruling of the Court in a case that was identical to a previous one where the judgment had gone against the NHS; only the courts are competent to decide whether the first case is a precedent for others.

The paramount objective in embarking on any sort of investigation into, or action against, the NHS must be to identify any failings and bring about a good remedy. Unfortunately, in some people’s minds, the main issue seems to be to find somebody to blame and get them punished. For a minority [I hope] it is all about getting compensation. Not unnaturally, these cultures have given rise to a defensive posture in the NHS which is not conducive to good patient care or accountability. Ideally, we don’t want whistle-blowers and witch-hunts. I firmly believe there must be sanctions against managers and clinicians who have instigated or tolerated practices or behaviours that are harmful to patients’ well-being or threaten their lives. How we can secure that is not yet clear.

The work of the CQC is primarily preventive: to examine what goes on in hospitals and recommend improvements as necessary to raise their performance to the declared quality standard. If is is allowed and funded to do this job properly, the CQC is our best hope for achieving a satisfactory national health service.

In other walks of life, when things have gone wrong and people have unfortunately died as a direct consequence, there is usually an inquest to establish the cause of death and, where appropriate, the Coroner can make recommendations to the authorities. Uniquely, when people have died while under the care of a medical practitioner [in a hospital, for instance], a death certificate may be signed by a medical practitioner and no inquest is held. It is easy to see the intrinsic loophole in this arrangement. That situation would repay examination in my opinion.

Gerald says:
3 March 2014

Dear John,
Let me make it quite clear I do think what happened at the Mid Staffs Hospital is still happening else where and is only the tip of the iceberg, and there have already been many other examples which you appear to be conveniently forgetting.
I am to say the least very disappointed to read that you consider that people complain only when their loved ones die through obviouse neglect that there is only a financial consideration at the back of their minds, just remember the thousands of pounds that the NHS has paid out to silence whistleblowers actually working for them where are the ethics is this.
How do you condone the CQC cover up, where is the financial benefits involved here I wonder.
You seem to have a downer on the small guy (Care Homes) why is this I wonder ?
Just out of interest I strongly believe that a well run NHS would be a marvellous entity , but what we have falls considerbly short of this and desperately needs a major overhaul.
I do hope that the CQC have learnt a strong lesson from their bad choices of Senior Management and now employ more people that can carry out their inspectorate role without political biasness.Maybe a more balance staff make up (ex Public and ex Private might help)


I don’t see any reference to Private Medical Insurance in the conversation. I would like to know how and whether this is regulated. Has anyone visited a vet of late (sorry to use this analogy) and been landed with extortionate fees? They appear to be able to charge whatever they see fit especially if they know the Insurance Company will cough up and as a consequence up go the premiums and the consumer once again foots the bill. Who decides on patient fees when claiming remuneration?

Private Companies Gerald, whichever way you look at it just like all businesses have to make a profit or they close down sometimes to the detriment of their patients and staff.. Publicly funded patients in private care are under contract with NHS Trusts and I happen to know the costs they charge the NHS per patient are astronomical. What I have not been able to establish is how much of that funding goes to it`s shareholders.

There is still much work to be carried out by the Care Quality Commission I feel.

Gerald says:
3 March 2014

Hi Beryl,
Being in business for over 40 years now I think I am able to understand your point ,but you do not mention that in general you have to offer a product or service that the Public or other businesses find acceptable before they patronise you and this has be be offered at an acceptable price to make a profit .Only people who have tried this can fully understand how difficult this is.
The major Alternatives are State controlled entities which mainly existist with State funding and in most cases does not have consider the wishes or requirements of the Public at all.The past has proven on numerous occasions that the Private Sector delivers the Service that the Public Demands at a price that they are prepared to pay. Why do people find it so difficult to understand this simply fact of life.

If you know what the NHS pay the private sector Nursing Homes and you also know what they pay a TRUST why don’t you let us nkow so that we can compare real value for money