/ 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.

Comments

Ariadne you may be right but one thing is for sure we can not afford this enormous public sector final wage pension scheme. To add insult to injury the public sector thanks to all their unions still are allowed to bow out much earlier on a full pension. If they want to bow out early, fine but we should not pay their pension until they are 67 like the rest of us have to wait to get paid. Still leaves the sore point of public sector worker getting a good pension based on their wages. In the case of teachers it is even more rediculous. I know some one who happened to have worked as a teacher for some 8 years but because he puts ex amount in per year is guaranteed a full pension when he is of the right age, this means the tax payer making up the difference to what he has paid in himself. I do not see this happening for Joe the plumber. These kind of practices do put an enormous strain on things. Yes I know the pension was set when life expectancy was not much beyond 70 or so but it was also set as a set amount not based on wages received before.

Ariadne says:
24 February 2014

I agree that the public sector is a problem – but, unless everyone takes a “hit”, then this will probably be done over the medium to long term. Those working in the public sector would respond that their wages are generally lower and that they have planned their lifestyles upon the basis of what has been promised to them.

If there is a solution, then it has to be fair to all. It will take time – but, most of all, it needs the political will to do it. This requires the electorate to be realistic – but who is going to vote for a candidate, who is promising to make your life worse?

This is why I believe a start has to be made within families. Once the true extent of the problem is recognised, then and only then might there be the beginning of a political will to actually deal with all the inter-linked issues such as pensions, NHS and caring arrangements.

Yes Ariadne exactly what I have been saying all along. It should be punishable for a politician to base his solutions on short term gain in which case we may see some lasting well thought out solutions.

Ariadne says:
24 February 2014

Two other theoretical options would be – give the politicians a longer period in power so that they are not so concerned about the next election or – forget about the politicians and let the civil servants or other professionals run the system!

Ariadne, the public sector are very well paid mostly, teachers, doctors, councillors etc and they do get a pension!!!! The private sector who pays for the public sector has no pension unless they take care of one themselves. Promises have been broken time and time again to those in private employment. It is obvious the private sector can not go on contributing to unfair pension arrangements in the public sector. So start with at least letting the public sector work the same years as the private sector or if they want to leave early no pension until they are 67. Cannot be fairer than that but of course the unions would not agree.

We seem to have deviated from the original topic – elderly care. I don’t think pensions will cover the cost of personal care we we become dependent. Should families be required to take more care of their parents? As far as care homes are concerned, one of the major problems seems to be, in some cases, a lack of care and compassion by inappropriate attitudes, just as happened in some hospitals. Money does not remedy this – choosing the right people, and getting rid of the wrong people, would. We fund the CQC, and yet they do not do their job, nor appear to be able to respond to individual complaints. Surely these basics need to be dealt with before we can move on.

Gerald says:
28 February 2014

Hi Malcolm,
Funding is the major problem, and there are Acts of parliament which are responsible for determining the State Funding, the main problem lately is that the criterion laid down in these Acts have been manipulated by the Local Government and the NHS, so that previously NHS funded patients are coming under the means tested system applied by the Councils.
I have tried to get information regards this system , with little success but it seems that it is all down to reducing costs in the NHS and making the Public pay privately, if this is the case, it is totally against the original concept of the NHS and there-fore illegal .
To fully understand the above one needs to look back at Residential Home placements (council funded) and Nursing Home Placements over the last 30 years.
Bye the way the CQC gets its funding from fees paid by Care home Operators (£4500 per year for a 40 bed Home based on bed numbers) and other establishments such as Hospitals (Private & NHS)
I agree that the CQC has had a rocky start a lot of this was due to using old Council staff.
If you look at the new people I think you will agree there is hope now for the future.

Hello again Gerald,
I generally agree. However times have changed and more people have wealth to help fund their care – although it is unpalatable to have to sell the family home when some others, who have not bothered to save for their care in later life, get the same treatment funded by the state. In times of austerity I think funds have to be targetted at the deserving and needy – money is limited so we need to make best use of it.
I still think there are improvements that money cannot buy – like getting rid of unsuitable staff (at all levels) who mistreat, or condone ill-treatment of, inmates. We should encourage people to complain about mis-treatment, ensure they have adequate support or evidence, and treat them in confidence while the investigation takes place. I hate the term “whistleblower” – reminds me of “snitch” – but unless people are prepared to stand up for what is right, how can we ever expose malpractice? Good luck to the reformed CQC.

Gerald says:
2 March 2014

Dear Malcolm

Are you referring to the recent cases of cover ups by the exec of CQC , if you are you might remember me referring to completely biased actions of the CQC for many years, this is also happening in other institutions such as the BBC,THE NHS,THE LOCAL COUNCILS,MINISTRY OF HEALTH ETC. if you check out the common denominator all all these is UNISON isn’t it ?? It seems as though the Public Sector is not so unbiased as they would like us to believe.

Hi Gerald, the problem is so enormous that it is difficult to see our way out of it. The Bank of International settlements (BIS) which is at the top of the banking tier is totally above the law and any taxes. They instruct the banks underneath them. The banking system has been sucking the life out of everything by loaning money to governments which was not real money, merely a ledger entry, but wanting real money back in return. Our previous government threw the money away at an alarming rate, including the gold and had to borrow some of this ‘money’ from the imf. The banking industry has the government in a strangle hold as the interest alone is costing beyond belief. Because of this UK PLC is unable to see itself clear to give the cash where needed and we all suffer. There are only 4 countries left in the world that are free of this banking system which is run by just a few families. What to do????????

ekc, if the UK had not been so reckless with borrowing money to fritter away our problem would be less. Close to home, look at the ridiculous costs of PFI that government used to avoid debt on the books. Look at NHS and Defence lack of control over procurement. Money wasted on useless computer systems. As examples.

Gerald says:
28 February 2014

Dear Malcolm,
It is all very clever to look at the grand view but I think that doing so totally takes peoples minds from the real issue which is that the Government (both parties) with the aid of Public officials are forcing the Public to pay for Care which was previously funded by the NHS ,if you refer to the NHS Act this is illegal , there has already been court cases which have acknowledge this and still this goes on .Most Councils and NHS PCTs have colluded in this .What I cannot understand why the Public has not been made aware.
For current conversations on this refer to other WHICH conversations.
It is not the Public’s fault as you say most of the blaim should go to the NHS Management for being totally inefficient and wasteful .This situation is appalling and like most things in the NHS people are gagged, paid off , and generally ignored.

Gerald says:
28 February 2014

Hi EKC
To complicated just deal with the main issue concentrate on getting the NHS to be efficient, at the moment it cna’t even be bothered to collect its debts from Private Payers from abroad (only running at approx £500,000,000 Five Hundred Million) yes £1/2 BIllION Pounds and then impose real purchasing directives between the PCTs and the TRUSTS.
Whilst I totally agree with everything you say regards the Banks I really think such a world wide problem is out of the scope of this conversation and could just rather cloud the issue.

Ariadne says:
28 February 2014

There is clearly a problem. I would like to know – what solution do you all propose?

Gerald says:
28 February 2014

Dear Ariadne,

With the existing Management structure of the NHS there isn’t a solution, I think that all the latest Governments have sort and obtained advice and non of them had have the guts to take on the problem.
Everyone seems to be blaiming the Banks for all our ills and to some extent I can see their point but Banks have been s******g everyone around the world for Centuries , the NHS only came into existence in the 1940 ‘s.
It is not the concept which is wrong it is the way it is being managed (what ‘s new?)

Hi Gerald,
Yes I know what you mean, the problem is, it filters down into everything as the government is no longer in control of its own spending really.
However getting back to the NHS, it is totally mismanaged with far too many management jobs created to manage the managers. Unfortunately Cameron committed the ultimate crime in selling of the one really good thing Labour created all those years ago i.e the NHS. We will be going the way of America if we don’t watch it.

Ariadne says:
28 February 2014

So – if either and/or both of the two of you were in power – what realistic and possible solution would either and/or both of you propose? It is no good just complaining – we have to move forward.

Gerald says:
1 March 2014

Dear Ariadne,
Encourage WHICH? to carry out a campaign against the Local Authorities and the NHS Rip off to stop them making Nursing Care “Means tested” .
Bring back the old system wherbye Doctors are responcible for determining medical needs for Care Home placements instead of Beurocrats .
Deal with the problem at hand , do not try to deal with World Wide problems as other are trying to do,this is totally confusing and unnecessary.Just a reminder for everyone what this conversation is
all about “Why is elderly care failing? Older people have human rights too” I suggest this is Everyones rights under the NHS Act where it states quite clearly treatment is free and now we also have a choice of “where” Why are we being means tested I ask, simple question requires simple answer !

ekc says:
1 March 2014

Yes Gerald you are right we did stray a bit. However the problem is that there is no money to go round which is why people are now being means tested. We can all scream and say but it should not but when there is no money because it was frittered away and the IMF stood there actively encouraging the UK to borrow, what do we do?? GP’s salaries went up far too high under labour which does not help. Once a wage goes up it is difficult to reduce it but it has a knock on effect. Yes we can bury our head in the sand and say but we need to talk about why the elderly care is failing and do not look beyond it. However the picture is much wider which is why we need to look further. It is all very complex. The biggest problem is however there is no money to go round any more and as usual the most vulnerable are hit first, in this case the elderly. So where do we take the money from?? Overpaid GP’s, too much management in the NHS, bureau cratic failure in collecting monies from overseas???

Gerald says:
2 March 2014

dear exc
Since nursing care is the responcibilty of the NHS why shouldn’t we make them responcible , why shouln;t we expect them to be efficient, why should we let them get away with murder.
why should we turn a blind eye to the failings of the NHS ???
THE nhs COSTS US ALL BILLIONS if you look at your stoppages in your wages or salaries you will find that the National Insurance costs more than all the PAYE put togther.
if one paid this amount of money to , say BUPA wouldn;t one expect good value for money or at least them to deliver a reasonable service ??

Surely that is the whole ethos of WHICH? CONSUMER, why don’t we apply it to thePUBLIC Sector and PRIVATE sector provivions alike.and stop being biased against the PRIVATE SECTOR

ekc = emma says:
2 March 2014

Hi Gerald,
There is absolutely no reason why we should not expect them to be efficient. The NHS is one of the best things achieved and we should expect it to be efficient. That is my whole point. It does cost us all a lot and since the employer is supposed to pay slightly more in contributions than the employee you are right it costs more than the payee put together. But as mentioned before when governments squander money on a lot of things in the NHS to cover up unemployment for one than this big machine gets too big to run efficiently. Creating jobs out of thin air, upping up the wages of GP’s by some 50% etc etc is costing us all dearly. It has a ripple effect that unfortunately is felt by the most vulnerable the hardest, the elderly in care homes.. My Father in Law went to a care home which had a committee of elderly residents and the home was run very well indeed. This a very good way of running them but they are very far and few between.
BTW I work in the private sector and feel biased against the public sector as they forever want more forgetting that the private sector will have to pay for it.

Gerald says:
2 March 2014

Dear Emma,
The NHS Act of Parliament states ” Nursing Costs are the responcibilty of the NHS” and should be FREE to all . I don’t think you appreciate that the NHS with the aid of the Council Officials are insiduously making the Public Pat for this care through “Means |Testing” this is illegal and numerous Court Cases have found them guilty already why do they still persist I wonder,

The Proproitors of all Care Homes are responcible (Good and Bad) for the running of their homes and surely the Public will penalise them if they don.t like what they are being givenby taking their custom elsrwhere this is what is the Public’s right under freedom of choice isn’t it Try and get this service from any Public Sector provision.

Bye the way I was refering to the National Insurance Taxes as opposed to the Pay as you earn Taxes TOTALs for the Country.

I an pleased to hear that you work in the Private Sector, be Proud of what you do, if you really compare qualities in the Publice and Private Sectors by listening to a broad spectre of clients over a long period you might find numerous people who consider we are doing a good job. Please do not listen to the knockers of this world, they have no intention of giving us n unbiased opinion

Just rember the Publice have voted with their feet and funds to come to the Private Sector in spite of all the efforts of our Public Servants to the contrary

Keep up the GOOD WORK

All Best wishes

Gerald

emma says:
2 March 2014

I totally agree with you Gerald. Means testing is a nasty thing but it goes on unfortunately. Unfortunately not all old people have the luxury to choose a private care home and it is those I feel sorry for. I am proud to be in the private sector and am sick to death of all the moaning done by our public workers. (we have to work till 67, they want to bow out as early as 55 in some cases for one).

This phrase ‘ there’s no money to go round anymore’ begs the question of who is to be sacrificed. There is no immutable law that says it has to be the most vulnerable, unless you mean that it might be the most politically rewarding
Why not take money from the rich? Answer – because they will exert financial and political pressure. Simple really. Old people are not politically organised. As long as they are seen to be the responsibility of their family there’s no political disadvantage in ignoring them. Get them cared for on the cheap and everyone else will be happy – heaven forbid that income tax should be raised
Apply a generous means test and support people who have worked hard all their lives so that they can have decent care without having to be dependent on aging children (in their 60’s) Just tax their capital gains on their houses when they die, in the normal way. Not all elderly people are rich , as some people seem to think so why should they be treated punitively once they reach retirement age?

I would like to hear of more care homes where the residents have a say in how things are run. In fact I would go further and ask why people approaching the time when they know they are going to need care don’t get together and set up their own homes, possibly with ‘start-up’ support from the government. That way they can be with their friends and not be bullied and ill-treated by under-paid, poorly trained staff. Care homes need not be profit-making companies, they could also be co-operatives and new forms of non-profits. Now is the time to be thinking about alternatives.

Hi Ariadne,
Well for a start of salvage what we can of the NHS before it all falls in the hands of private firms who will only have one goal which is to make the shareholders happy which means high costs of insuring oneself. (so short term gain for the politicians but long time suffering for all)
Secondly streamline it by getting rid of the burden of too many managers at a high cost.
Thirdly some of the managerial wages are astronomically high and need to come down which can be achieved by various means.
Fourthly stop closing down all hospitals that are not big enough and centralising everything, this may be easier for the consultant but costs more in the form of so many other things. Bigger is not better as they always seem to think.
Private patients from abroad have to pay upfront for treatment as we would if we go abroad.
These are just some of the top of my head, if I sit down I could think of a lot more, the way the food is run, the cleaning companies are run, the wards are run. The list is endless. It has been allowed to get out of hand by failings of the governments to keep a close look at it all.

I agree with cutting out wasteful managerial layers. We should also stop paying outrageous fees to doctors who perform an A&E shift. However I believe in centralised hospitals – the medical benefits of concentrating excellence in both staff and facilities on one site far outweigh the convenience of having a local hospital. Much of A&E could better be dealt with at one level by GP health centres. Uninformed view, of course.

Malcolm centralising for excellence is great, however an awful lot of hospital care is for routine stuff and can easily be dealt with locally thus avoiding the demolishing of local hospitals and creating ever bigger centralised ones. All this centralising leads to transport problems for a start of.

ekc, agreed. I was not against local general hospitals, but centralising specialist activities – e.g. heart, lung, cancer and the like.

The debate seems to have run full circle with some really disturbing accounts of elderly care. As we are all tending to live longer it automatically brings with it added problems. In previous times the responsibility of care usually fell on female offsprings but times have changed since most women in this country now have to work to meet family monetary demands. However there are always exceptions as we have seen and those fortunate enough to be able to afford to stay home should still take on some responsibility of care for their elderly.
There are other issues however which need to be addressed.
Elderly people can become very set in their ways and often are very reluctant to move closer to relatives who sometimes are themselves retired as has already been indicated which increases the burden on them.
Care homes are increasingly being sold off to the private sector which are not always as well regulated as the public sector. I have first hand experience of a disabled relative living in a public/privately run care home. The home is comfortable and clean and seemingly we’ll run but the standard of care leaves a lot to be desired with frequent staff changes, other staff would be better suited to working in the military, staff confined to offices working on computers instead of mingling with residents, other staff using company vehicles intended for residents transportation thereby saving on petrol costs. All these things are rarely picked up by the CQC as medical staff will always support each other and non medical staff are afraid of losing their jobs if they become whistleblowers. They usually decide to move on and so the situation persists.

Gerald says:
2 March 2014

Dear Beryl,
The question of who should or should not care for the elderly is left up to the Great British Public and should not be decided by Beurocrats after all we are supposed to be a Democrasy.
I have been in the business (and proud of it) for over 30 years, I have seen the Public making their choices (and paying as necessary) over this period of time and as you say the Public Sector Council run homes have been seriously lacking and nearfly all have been closed down in spite of many Councils subsidising them for years.The whole process is called freedom of choice which I would suggest is the Public prime motivator.
For an indicator of how ell the Public Sector regulates itself one only needs to look at the Mids StaffsHospital cover up by CQC and other childrens Hospitals where many children and old people died needlessly through further cover ups numerous wistle blowers inside and out were totally ighnored and harrased before someone listened, I can assure you ththat this abmissmal siuation would not have been condoned if it was the Private Sector. you really have got your assumptions the wrong way around.
Bye the way I really do not think the Cheif Exec, from a Private Company would have been given the lead role in the NHS (as happened to the Mid Staffs chappy) do you?

Beryl – Which has looked into care homes. Search for the Conversation: “Care homes are failing – but is it too hard to complain?” I think you are right to be concerned about the private sector too.

emma says:
2 March 2014

Hi Gerald,
Privately run homes can be much more efficient if the owner is not just in it for the money. Unfortunately a lot of them are, which goes at the cost of the people that need taking care of.
Publicly run homes have the problem of complete and utter inefficient bureaucratic leadership which means usually a badly run home.

I entirely agree with the majority of your response Gerald and understand your frustration and concerns but my “assumptions” are very much based on facts. Your views are quite correct in as much as we are a democratic society where freedom of choice is encouraged and respected.

Unfortunately in the real world there is always going to be people who for one reason or another (there is usually money involved) will take advantage of the sick and vulnerable (and incidentally their relatives!) As you know with your long experience this is a fact of life and nothing is entirely black or white.

The NHS is struggling financially with currently a third of hospitals millions in debt. Millions of £’s of taxpayers hard earned money is being spent on private care in privately run care homes. Do you know what % of this is being spent on patient care and what % lines the pockets of shareholders which could easily contribute towards our struggling NHS hospitals? We are not allowed this info as it comes within the remit of commercial confidentiality (similar to patient confidentiality as you can no doubt relate to working in the profession and restricts staff members in both the public and private sector blowing the whistle on negligence.) A large % of privately run hospitals are owned by foreign companies anyway, (many of them American.) Do we really want to revert to an American style health system?

Thank goodness as a result of The Mid Staffs debacle there have been changes made to the CQC Executive Committee who seem to be doing a much better job but I reiterate the onus is still on the patient or their relatives who have the unenviable task of challenging the system when mistakes are made. I too have had cause to complain to them in the past and have had partial satisfactory results but only through perseverance and persistence.
Let us hope that the CEO from the private company does a much better job ………….only time will tell!

Cheers for the info Wavechange. As a comparative latecomer to Which? conversation I missed out on the previous debate on Care Homes but will certainly search the “archives.”

Gerald, “I can assure you that this abysmal siuation would not have been condoned if it was the Private Sector”. As far as I am aware, Southern Cross, the Bristol care home and Whitstable as examples were in the private sector and mistreated their patients disgracefully? This seems to cut across both public and private sectors, so perhaps it is more related to bad people and management?

Absolutely. There is good and bad in both sectors. It would be interesting to know if Gerald has had any involvement with either.

Gerald says:
3 March 2014

Dear Malcolm,
The Southern Cross issue had nothing to do with Patient care ,this Group got into financial trouble because it didn’t make the large profits which everyone seems to think the Private Sector is guilty of. This was one of the largest groups in the Country and catered prodominately for State Funded clients, they had been asking the Local Authorities for realistic increases if fees for years and were continually ignored.
This Group were closed down in an efficient organised manor and its clients were assimilated into other Private Sector Care Homes with due care and attention.
Has the NHS closed down th Mid Staffs Hospital I wonder ? they have not gone bankrupt they just treated 100’s of people absolutely awful.It seems this is acceptable then, as long as one doesn,t make a profit ?? by the way has anyone actual compared what a NHS Trust gets paid for bed and breakfast with the Private Sector , I understand the NHS gets 4 times as much and still they can,t “make it Pay” Don’t tell me that the NHS is better, I really think that recent events disprove this

Gerald, I see this report as a patient care issue for Southern Cross: “Late in 2011, two staff at the company’s Orchid View care home in Copthorne, West Sussex, were arrested on suspicion of ill-treatment and neglect of residents.[19] The case had come to the notice of the authorities due to a whistleblower. A coroner’s ruling in 2013 found that 19 deaths at Orchid View were unexplained, but stated that under Southern Cross’ former management the home was “mismanaged and understaffed”, and rife with “institutionalised abuse”. Hardly an endorsement for the way the company operated. Assuming this entry in Wikipedia is accurate, of course.
As I said earlier, this kind of maltreatment seems independent of whether it is public or private. I cannot understand why we let it go on for so long without acting, and why we allow those responsible to go unpunished. If managers were held personally responsible for such “institutionalised abuse” perhaps they would take more care to see it didn’t happen – this includes directors who continue to rise up the public service ladder. They might then see it worthwhile putting in reporting systems to protect patients (and themselves) and not turning a blind eye.

emma says:
3 March 2014

Hi Gerald, you are right it does cost an absolute arm and leg to stay a night in an nhs hospital, equivalent to a 5 star hotel but of course not with the 5 star treatment and food you would expect.
Not sure how this can be justified.

Ariadne says:
3 March 2014

I wonder if the next-of-kin ever sue on behalf of their elderly relations. In other words, if the abuse is not being punished in the criminal courts, then why not raise it in the civil courts. If financial pockets were to be affected, then improvements might come faster!

emma says:
3 March 2014

Ultimately directors are already responsible for what goes on in a firm but unless one prosecutes they walk away scotfree. Getting health and safety in might be an option.

emma, presumably the cost lies in the staff and expensive medical facilities in the hospital – in case you need medical intervention.
I have had no recent experience of hospital food but did see some of James Martin’s programmes. These highlighted a number of hospitals where food was simply badly prepared, not controlled by dieticians and terribly wasteful. He showed how by preparing menus and food properly, nutritious and enjoyable food could easily be offered within budget.
Another report shows how unprofessional is the general purchasing in hospitals – no coordination, prices varying wildly for common items from hospital to hospital, and overpricing. I hope it is not endemic, but the impression created is that there are a lot of people doing jobs in the NHS who are unprofessional (and lack common sense). Is that an unfair comment?

Emma – The hospital has trained staff and facilities to cope with medical problems. The hotel will probably have a first aider with a first aid box on duty, maybe a defibrillator if you are lucky. It is not a useful comparison.

emma says:
3 March 2014

No that is a fair assumption Malcolm. The cleaning gets contracted out and there is nobody checking them. There used to be a matron on every ward and things ran well. Now there is a coming and going of people and most do not know each other or if they should even be there.

emma says:
3 March 2014

I know that Wavechan and if any are needed that cost goes on top of everything else. Ever seen a break down of costs?? It will show you so much for the use of a bed, so much for this medication and that, so much for an xray, so much for the use of the operating room, so much to see Dr so and so. The list goes on. I was only referring to the bed and breakfast aspect.

emma, I suspect the bed cost includes the “overheads” that a hospital involves – the availability of necessary facilities that have to be paid, separate from the extra cost if they are used. So you still need to provide a fully equipped operating theatre for example whether a patient uses it or not. I stand to be corrected.
Looking at NHS data, it seems like a bed cost is around £250/day – is that about right?

Gerald says:
3 March 2014

Dear Malcolm,
No Malcolm you are not correct the figure you quote is basic B& B and does not include operating facilities or staff whereas a Care Home figure is totally inclusive ( inc. GPs fees in some cases) and is less that one third.An easy way to check is to have a word with Nuffield Hospitals or BUPA they are very transparent on their charges when they contract from the NHS or private

Gerald, I suspect you misunderstand what I have said. I have not included the use of any facilities, but simply the fixed overheads. Like any business.

emma says:
3 March 2014

Hi Malcolm yes it is in some cases but it can be more which is where the confusion starts as it all falls under the nhs.
And yes all the facilities are there but they are also there in private hospitals and there you only pay for what you use. A bit like flying, the first class is there but you only get charged if you use it.

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

Gerald
To answer your question – just like you it is a matter of patient confidentiality.

Suffice to say if you can afford to pay for it you should expect the 5 star treatment on offer and that`s OK, but do not expect the taxpayer to line the pockets of your shareholders when our NHS hospitals are struggling to cope. I hope I never live to see the day when we say goodbye to our NHS and a return to a two tier system between the have`s and have not`s.

I wish you well.

Gerald says:
3 March 2014

Beryl,

These figures should be available on a general basis and surely do not have to be case specific.

with the pitance the NHS pay for Nursing Home Care in my kneck of the woods nobodies pockets are being lined , but if you accept that means testing is being applied it is the NHS doing the Ripping Off .The reason the NHS hospitals are struggling is simply that the present Government is no longer chucking money at them as they have realised that the NHS just waste it on Fat Cat Top Management wasnt one earning £1million a year and still not giving value for money
I have absolutely no wish to see the NHS disappear I would just like to see it giving value for money for all those billions it sends of our money. I have like many paid in a lot more than I have taken out, I even have a private Insurancewhich I pay for personally .
Just out of interest (maybe) I recently found out had postrate problems after being rushed into hospital (emergency) ,the hospital was brand new A& E was amazing ,after care was awful fou dont want to know the details ,thank goodness I could go to the Nuffield (same consultant in both cases) facilities in new hospital abmissmal for a place costing £50 million it took me 6 weeks of constant pressure to be responded to by PALS (NOT an apt name)