/ Health

Have you planned for care in later life?

Pensions savings

Only a small fraction of us are planning for care costs in later life, according to our new research. How concerned should we be?

As I plan my day to day spending, I don’t think much further than the next holiday. Even home improvements that are a year away seem too far in the future to save for.

So it doesn’t altogether surprise me that only one in ten adults aged 55 years or over say they have put aside money to pay for any care needs as they get older, according to our new research.

Like me, more than half of those over-55s say they are prioritising other things they want or need to do right now, over planning for potential care needs.

And this is backed up by behavioural research: even if we get good information and advice, we don’t want to think about ageing and needing care.


So how can the government help people like me – the non-planners? Well, rather than encouraging me to plan, a new policy report by Which? says it can improve the system to help me live at home for as long as possible in retirement.

When asked to think about what changes they may make if their health and mobility did deteriorate, nine in ten people aged 55 and over said they would be willing to make adaptations to their homes to aid mobility and a similar percentage said they would be willing to use mobility aids outside the home.

This resonates with me. My parents have installed a number of aids and adaptations to help them enjoy their home: the bath lift that allows them a well-earned soak, the riser-recliner chair that looks like a very superior addition to their furniture rather than something you’d find in a hospital, the very smart trolley that also serves as a walking aid.

Such equipment – more acceptable when it looks desirable – could cut falls needing medical treatment by a quarter, and save the NHS and social care services £500m each year, the Centre for Ageing Better estimates.

Info deficit

The key to planning is also good information, but our research tells us that less than half of people know where to look for information about care. This is where Which? Later Life Care can help, which provides information on all aspects of choosing care, including financing and housing options.

The GP is trusted to give good advice and support, along with friends and family, but is the already packed 10-minute GP consultation really the best place to get care information?

What’s needed to make sure people get the advice they need from the places – like the GP surgery – they turn to?

Would you plan for your care? Is it on your list of things to save for? And – as the government works towards an Autumn social care green paper – what do you think is needed to support older people in the best way we can, given that many people use the care system for the first time at a time of crisis?

Populus, on behalf of Which?, surveyed 2104 UK adults online between 11-12 June 2018. The data were weighted to be demographically representative of the population.


This may sum it up. Why should I believe what the Metro says?
There were no riots when we voted to leave the EU, nor when the Conservatives were re-elected in the general election. No riots when we were taken into a war with Iraq.

Do we really think that the remainers, or others, will riot? I find it hard to believe, unless some are misled once again as was tried before the referendum or more extreme factions try to stir up trouble.. But the general public? No, I think it will be a relief to get it over with.

However, I think if this discussion were to continue it would be better here: https://conversation.which.co.uk/money/brexit-white-paper-consumers/

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Back to Carolyn’s question, may I suggest you log onto: Which.co.uk – Inheritance Tax (Last updated Aug 2018).

If you have saved for your own care then in my opinion you deserve 5 star private treatment.. A star rating system (as previously posted) could incentivise more people to save for their later years and care homes to up their act lest they face closure from a low star rating and boycott from prospective residents.

I suggest that if care homes are given star ratings for different aspects of their service, this could include and be an extension of the CQC ratings: https://www.cqc.org.uk/what-we-do/how-we-do-our-job/ratings Other ratings could include assessment of outings arranged by care homes, and the views of those who live in these homes and those who visit.

A bit like TripAdvisor then.

Certainly not. Part of the information would come from the current CQC data and I envisage that the other ratings could be from proper research involving users of the home and their visitors.

I agree Wavechange, although I am not sure about the efficacy of a traffic lights system as opposed to stars,

For example, stars are more readily identifiable and accepted by the human psyche when searching for suitable hotel accommodation and are easily recognisable on all advertising material, whereas traffic lights are perhaps more appropriately displayed on the base of food packaging in your local supermarket.

All advertising material pertaining to elderly care should include the number of stars awarded by the CQC and not kept hidden away in online reports where they are most probably infrequently visited.

More transparency and availability of information is needed to enable consumers to make informed choices on how to spend their own money during their final years, and therefore to have more redress when things go wrong, for example when 5 star expectations don’t meet the required standard.

I was trying to support your suggestion, Beryl. Some bad apples in the care home sector seem to have raised a lot of concern in recent years and it’s enough of an upheaval moving into a care home without the worry of poor treatment at a high price.

However the information is presented the system would need to be regulated. In the food industry, some major manufacturers are still avoiding using the traffic light labels.

I have very much enjoyed your discussion about different ways to rate care homes. As John explained below the CQC gives an overall rating based on the ratings for five different areas in an inspection. These are:
1. Are they safe? You are protected from abuse and avoidable harm.
2. Are they effective? Your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.
3. Are they caring? Staff treat you with compassion, kindness, dignity and respect.
4. Are they responsive to people’s needs? Services are organised so that they meet your needs.
5. Are they well led? The leadership, management and governance of the organisation make sure it’s providing high-quality care that’s based around your individual needs. It encourages learning and innovation, and it promotes an open and fair culture.

The Scottish Care Inspectorate has a similar system, although no overall rating.

On the Elderly Care website we have a directory that includes the CQC ratings for all care homes and home care agencies together with a link to each of the full inspection reports.


In a few weeks’ time we’re launching a freshly designed, restructured and rebranded version of Elderly Care – to be called Later Life Care – and an upgraded directory will include the Scottish ratings. We’re also adding food hygiene ratings..

We’ve also been working with the CMA to encourage care homes to more obviously display their CQC ratings on their websites and in the home itself.

While the ratings don’t give a full picture of what a care home is like, it feels like at least there’s some guidance as a starting point for making a choice. Nothing can compare with visiting a home to get more of a feel for what it’s like, though. We’ve got more information about that on Elderly Care.


I agree a visit is essential to get more of a feel for what a care home is like, but before visiting, first and foremost, the focus needs to be on a care homes rating at the initial point of choice. For example when you receive those ads through your letter box or by reading those contained in your local freeby magazine, an
obligatory CQC star rating needs to be displayed on every advertisement as a guide to a care homes standard of care.

I am not sure whether a Red, Amber, or Green circle would have the same impact on an advertisement or even be altogether as popular or appropriate as a star rating, but it would be a useful guide at the point of visiting and asking those all important 5 questions put forward by the CQC.

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I agree Duncan. The problem is the CQC would have to take on more responsibilty if they were to commit to a star rating procedure, which I would assume, they would be reluctant to do without quite a lot public pressure.

graham adams says:
17 September 2018

Most people are struggling to pay their bills and if lucky saving some in a pension let alone saving for care in later life. what planet are people on!

Star ratings have already been tried (1=3 stars) use the star rating system when looking for a Hotel . This system did not work as no one was consulted with regards to what standards were applied for a particular rating ,even the present rating is vague and undefined and often misinterpreted .

I have suggested in the past that where a local authority places people in care homes, those in care and their main relative should be given an annual questionnaire to allow them to relay their experience of the home, in confidence, to the local authority. This should allow the LA to see whether the care they are funding is acceptable, or not, and give regular feedback to the CQC.

Good luck with that one, Malcolm.

Not something Which? could campaign for? It seems to me where a care home has a poor approach it remains undisclosed for far too long. Maybe the knowledge that their “customers” were going to give an annual assessment might result in socks being pulled up?

I am just dubious about anything that relies on the memory and comprehension of the care home residents. It is also not unknown for the relatives to have an axe to grind. Personally I think the CQC assessment should be sufficient although I feel the inspections need to be more frequent and certainly within a few months of any change of management or ownership. I support the idea of making the CQC’s ratings more accessible and helpful but am hesitant about simplifying them down to five stars or three traffic lights.

There are five service criteria in the CQC’s assessment and four ratings from Inadequate to Outstanding. It should be possible to construct an easily-assimilated and meaningful scoring protocol using those factors. Some criteria might have more significance for some residents than others depending on their care needs and plan. A ranking system needs to cope with such sensitivities and I don’t see none-to-five stars or red/green/amber being good enough for that.

It might be good idea for each establishment to furnish prospective residents with a copy of the summary and on request the full version of the CQC’s latest inspection report. Additionally, the local social services authority could provide an information service. They are under a duty of care to select the most appropriate facility for residents whom they place at full or partial public expense so it would be an extension of that role.

We have seen in these Convos people relating their experiences, bad and good, and while some may have an axe to grind (but you might ask why) I’m sure those analysing a number of questionnaires will be able to get a picture of the worth of the home. It might confirm a CQC view, or it might prompt the need for an earlier inspection than otherwise planned.

I see a star rating as a way of screening homes for further consideration, and the CQC already uses this approach. I hope that most people looking for a care home will study the full report or do this on behalf of someone who is not able to do this for themselves.

Not everyone in care homes is fit to contribute to assessment but as a visitor I have spoken to plenty of people who do have their wits about them and are there because their body rather than mind has let them down.

Anything that can be done to allow elderly people to continue to live in their home rather than going into sheltered accommodation or a care home has various benefits and modifications are likely to be cost effective. Fitting a stair lift at an early stage rather than waiting until someone has had a fall or near miss could be a very good investment.

Our house has been altered to be suitable for my husband’s complex medical needs, and I have been his sole carer of 10 years. The exhaustion nd stress of that care has contributed to my having a stroke in August, making it impossible for me to continue caring for him and he has had to move into the only home in our area with a vacancy. We were entirely unsuccessful in finding 24 hour care from private carers here. The ASC are says the home with a vacancy is over their budget, and they are reluctant to fund the fees over the financial cap. AND not at all until they have completed their long and complicated needs and financial assessments. Mean while the stroke rehabilitation team say that it is not safe for me to care for him. what safe alternative is there for us? We feel completely abandoned, and i have kept him out if a nursing home for ten years, ruining my health in the attempt. e are happy to pay a fair share, but the assessment process would have been difficult when i was well. the stroke mens that i am exhausted and not thinking well. where is the help in this difficult time?

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Graeme Murphy says:
13 September 2018

Given that Northumberland County Council has now stolen my inheritance (her house) to pay for my Mothers care costs at the rate of £2098 per month whilst those in care that lived in a council house and blew their money as soon as they got it get their care for free I shall ensure that all my money is spent should it look like I need to go into a care home in the future. Casino’s and horse race tracks can be useful places.

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graham adams says:
17 September 2018

All this talk about saving for care in later life is ridicules, most people are struggling to survive or if lucky saving some money in a pension for living costs in the hope that one day they might get to retire after a lifetime of hard work. If the current con servative government continues to run this country things will only get worse unless your extremely rich or a big corporate business. If your worried about your future you should vote for one of the other parties and kick this current government out

Iike a lot of people I can’t afford to save much for my care costs and my biggest fear is that the greedy care home providers will take it all very quickly and leave me with no savings and unable to pay for further care. maybe if the bankers stopped giving themselves huge bonuses and increased to rate on savings, then I and many like me would be able to afford to pay for our care for longer.

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Tom, assuming care costs £700 a week, £36 000 a year, you’d need £1.2 million of savings even if interest rates were 3 times the current if you wanted to fund care without using assets. So I don’t think we can blame interest rates. Using assets such as a house, if you have been fortunate enough to own one, is the biggest contributor – over many years that will have seen the best use of “savings” in a useful asset. Stocks and shares ISAs are another good way of saving, tax free dividends and, over the long term, tax free capital appreciation.

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Thanks for reminding us of that, Duncan. Unfortunately, as ever, enforcement is the key. It is one of the things that the CQC checks up on when it carries out an inspection.

I am hoping that the new adult social care policy that is due to be outlined in a Green Paper “in the autumn” might take up a suggestion that has been made in previous Conversations on this subject of establishing a College of Social Care as an organisation that will professionalise the service, define and set professional standards [lacking from the Regulations you have referenced], designate and approve training and qualification pathways and providers, lay down curriculum, examination and competency standards, be the sole recognised awarding body of relevant qualifications, supervise the profession with a registration scheme, exercise disciplinary and disqualification procedures, and have a statutory investigation function for allegations against personnel. I do not think Which? has shown much interest in this idea and its continuing failure to engage in any of the Conversations on this serious issue suggest that putting up these Conversations is just patronising tokenism.

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That is only my judgment, Duncan, and I can only base it on the low level of continuing interest from Which? in the serious comments about the care system posted by hundreds, indeed thousands, of people. I might be wrong but I cannot recall a single comment from Which? that in response to a posted comment offers any genuine help or consolation or even an intention to look into it further. I hope I shall be corrected. On the contrary, there have been a number of responses which, although sympathetic, I would regard as insincere or patronising or both. I acknowledge that Which? has garnered and submitted to the Competition & Markets Authority the comments they invited on people’s experiences and problems with care homes, but increasingly I feel that was a statistical campaign-serving exercise detached from any empathy with the situations reported.

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As John says, we need to ask what purpose Which? has in launching these socially-important topics when there is no evidence its staff engage in them, respond to comments nor seem to take any account of comments when they produce another version. Some of us think they don’t see them as a resource but more a way to collect adverse comments in support of a campaign, but not to project a balanced view.

Hi everyone,
Just returned from a visit to Scarborough Hospital where I was treated for Sepsis. Quite an experience, I must say (mostly good) .
I have been a member of Which for many years and in general I have found them diligent and dedicated in their tasks, but in this instance ,as John clearly outlines, the whole campaign is a complete fiasco based upon a completely useless survey of six low rated residential Care Homes (no Nursing Homes) out of thousands, carried out by people who had no idea of what they were doing. Dose this help the Public, I do not think so
John ,once again , seems to have grasped the situation very well and has put into words all the frustration and disappointment which this Campaign has caused me, Thanks John for having the oversight and the eloquence to express it.

Gerald – I cannot recall having commented on the quality or scope of Which?’s survey.

In my previous comment to this Conversation I was merely commenting on the lack of response by Which? to the many serious and valid concerns expressed by the contributors.

This Conversation is about the personal funding of adult social care rather than the standards of care provided.

Misunderstandings all round John, I was referring to the whole campaign as I thought you was, there are many instances in the conversations where many others have strayed from the current topic and gone into many and varied topics particularly of a Political nature , if I have upset someone at any time, I duly apologise .

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I’ve negated it duncan – no comment to support it. 🙂 Not all the private care home industry is bad; probably most of it is in fact decent. We tend to concentrate in most things on bad experiences.

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I agree duncan. War – whether civil or …..- seems to exemplify the flaw in many people that makes them ill treat others. This trait seems to come out in everyday life when circumstances allow. Is this something we all suffer from to some degree?

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As usual Duncan you are blinkered in your approach, if you were to point out the massive failings of the NHS ( over 600 people effected at Gosport and 400 at North Staffs by atrocious care of the Elderly) and balance these with the instances you highlight attributed to the Private Sector (Only profit making at that as you seem to exempt the , so called charities and housing associations). I might take you serious , as it is your blatantly bigoted approach just reminds me of the rampant communists such as Stalin. I read somewhere that you had been sanctioned for taking a similar stance in the past maybe you could enlighten us.

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The main organisation which I take notice of is the CQC and this Organisation has been set up by the Government to rectify the mess under the old system (Local Authority and NHS run) the new system has now been universally acknowledge as being fit for purpose and it is now responsible for ensuring staffing levels and training and that standards are adequate and the service promised is provided . The CQC is also responsible for inspecting The NHS Hospital Trusts, the Local Authority Care Homes ,the “non” profit Care Homes ,the Voluntary Sector Care Homes and even GPs . If you were to read the CQC’s reports etc. as well as all those “enlightened” unbiased newspapers you keep quoting, you might have a more balanced view point but I will not be holding my breath waiting for this to happen.

Can I suggest, if this exchange continues, some more of the facts about particular cases are referenced? I consider most of the NHS is good, and most of the private sector. However in each of those organisations there seem to be “rogue” units, and they are the ones that should be discussed. Clearly it is not right to condemn the whole system on the basis of delinquent operators. It bothers me that the “good” people in these poor-quality operations allow bad practice to continue.

The media has also dealt with Gosport Hospital and North Staffs Hospital over 1000 unnecessary deaths involved and you and others like you totally ignore them and try and hide this by slagging off Profit making Care Homes .By the way NHS trust are now being made to be held responsible at last.
As you say ” It isn’t ” all ” about money its about human beings being treated badly by a system supported by political dogma” well why in your world doesn’t this apply across the board or does this only apply to the minorities (£120 billion spent on the NHS and £2 billion on Care Homes of all persuasions) Most of the revenue for Care Homes is actually Privately Funded and as far as I am aware ,at the last count most of the clients were not leaving in droves and even the CQC is publishing that the large majority are obtaining a “Good” and a very small an “inadequate” a miniscule number actual have their registration revoked.

Totally agree Malcolm but haven’t you noticed the lack involvement from Which ? to deliver this form of discussion I have personally complained to Which? on more than one occasion with regards to their one sidedness on the issue of Care of the Elderly, they just appear to have no intention of taking a Holistic view over this matter, bearing in mind, in most matters Which ? do their best to look at products and services delivered by as many producers/providers as possible and then recommend ” the Best buy” this plainly has NOT happened in this instance.

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I think what Gerald is saying is something I have commented on a number of times. Which?, in my view, on some topics adopt a partisan position that colours the way they report. Banking scams, ATMs. care homes, car emissions, rail problems to mention a few. They are quite right to expose real wrongdoing but I’d like to see the whole picture, not just the bits that support a particular moan. And I’d also like to see thought-through and constructive proposals as to how situations might be remedied, developed to help make things better; not simply a “how bad it is” and “something must be done” that avoids the real work involved in making things better.

Gerald – I am glad to debate the issues on the basis of rogue service providers but you make this comment
” The main organisation which I take notice of is the CQC and this Organisation has been set up by the Government to rectify the mess under the old system (Local Authority and NHS run) the new system has now been universally acknowledge as being fit for purpose and it is now responsible for ensuring staffing levels and training and that standards are adequate and the service promised is provided . ”

I note you say NOW which I hope you mean that you accept for the vast majority of it’s existence it has been worse than a “paper tiger” as many many stories in Private Eye and media can attest to. We also have many whistleblowers who have suffered from believing in the CQC.

Any organisation that informed the subject when they were to be inspected, that re-registered each home when it “changed” its owner as acceptable seems to me to be simply hiding the problems.

If you mean changes in the last year or so are an improvement I would say it would not be difficult for there to be an improvement. However extending the CQC mantle far and wide concerns me and I feel it is too soon to say iit is good in action.

Surely the common theme for poorly performing sectors has been that whistleblowers are not adequately protected whether they work for the NHS, quangos, or commercial firms. Until staff feel that by bringing wrongs to light they and their families will not suffer badly then badly run or brutal enterprises can run unfettered.

P.S. The home care industry is alive with companies taking on big debt loadings and trying to be run to make a return on capital. Have we experienced before companies failing?

BUPA the leading mutual is selling off homes, two of the big providers are up for sale. There needs to be a fundamental rethink on the whole sector. Failing that listening to whistleblowers and taking action is our best hope to prevent horror stories.

The CQC have form

Patrick as you say the CQC has had it’s teething problems , but I honestly believe that under Mrs Sutcliffe (a Registered Nurse) they have made strides into delivering a fair and unbiased system.
Yes, large organisations (and you can’t get any larger than the NHS) are notorious at ignoring their clients complaints and they have terrible track records of intimidation and payoffs where whistleblowers are concerned, this system was rife pre CQC and has to be stopped. We must remember approx 80% of Care Homes are actually run by small family businesses who ignore the CQC at their peril, as it is comparatively easy for the CQC to deal with them the major problem for the CQC is the The large organisations and the largest being the NHS. With all the politics involved the CQC has no chance of bringing the NHS to task even Which ? would have a problem with this.
As an after thought… I understand Mrs Sutcliffe has now taken on the Chief Exec. role of the Nursing and midwifery Council maybe now she can give more credence to all the dedicated Nurses working tirelessly in our Care Homes.

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Instead of going on another tangent perhaps you would address my issues with regards to Gosport and North Staffs hospital or due you consider over 1000 unnecessary deaths not .worthy of your attention?

This Conversation is not a competition to see whether more premature or wrongful deaths occur in one sort of establishment than another, or whether privately or publicly run places are more likely to kill your relatives. Such generalisations and arguments don’t help.

I certainly don’t think it helps people to plan for the kind of social care they might need in later life to keep bringing up the possibly criminal behaviour that gave rise to hundreds of deaths at two NHS hospitals. In many cases the patients in the hospitals were in terminal stages of their lives and suffering badly. I don’t condone the way their lives were ended but those cases are now history. There are underlying issues with premature deaths in any care establishment that should not be allowed to characterise the whole system but they do need to be exposed and dealt with.

Unexpected deaths occur in social care homes for a variety of reasons, including maltreatment and brutality. There have been a number of comments in other Conversations about bad treatment leading to death, but two things have to be borne in mind: (1) most have not been recent, and (2) we have not been told the outcome of the Coroner’s inquest.

It is understandable that people grieving over the untimely and possibly questionable death of their elderly relative will recite their heart-rending accounts of the conditions in the care home, and I am not saying they are untrue or exaggerated, but we have only heard one side of the story in each case and do not know whether maltreatment was the cause of death. There do not seem to be many reports of such incidents today and I think changes in the operation, management and supervision or regulation of care homes have led to many improvements in care and treatment of the residents.

As I have said before, there is a strong case for professionalising the running of care homes, including the training and qualifications of the staff. I believe there are psychological issues to be dealt with among some staff”s attitude to the people under their care and to their own roles in the system. I think it is one of the most difficult and distressing jobs outside of any qualified occupation and it can take people to breaking point where anything could happen. Attracting suitable staff to work in homes must be a nightmare and it is widely believed that the local authority funding arrangements are largely responsible for the poor morale, lack of sensitivity, institutionalised regimes, and low expectations. Unfortunately the enforced low placement rates have an impact throughout the concept of care quality.

Until the government tackles the root causes of inadequate service delivery in adult social care provision, which almost entirely hinge on funding, then things will not improve very much and providers will close their accommodation or use it for something more remunerative. Local government cuts have made it virtually impossible for local social services authorities to operate their own care homes and until that changes then they will have to rely on the private sector where, because the funding is inadequate, the residents are not welcome and the culture of the establishment becomes unsupportive [possibly an understatement in some circumstances].

I suspect that the only care homes that make a reasonable trading surplus – sufficient to enable investment and to properly recognise the contribution of the staff – are those which have a financially-based selective policy towards residents. Those private care homes which have to accept local authority placements in order to survive will probably not survive very long because they are not making a real profit and will struggle to provide a decent quality of care and attract the right calibre of staff. It worries me that we are sleep-walking towards such a situation because we need more good quality adult social care places, not fewer.

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Thank you Duncan. Statistics are useful – especially if they show a trend – but I don’t think a “long list of private care homes where old folks have died prematurely from bad care” get’s us anywhere unless we know the Coroner’s decision or the inquest verdict in each case and whether or not anyone has been prosecuted. People can die prematurely at home and it would be easy to say it was due to bad care. I suspect that, pro rata to the number of places, there are similar mortality rates in local authority, housing association and charity-run care homes. If we don’t know, we cannot make much use of the numbers in just one sector.

P.S. Somebody seems determined to give you the thumbs down. I can’t see any justification for that. It would be good if they would explain themselves

Duncan, a thumbs up from me for your tenacity and perseverance. My close relative was rushed into the A &E on Thursday from the same privately run ‘care’ home mentioned in a previous comment with malnutrition so severe he almost died. Legal proceedings will inevitably follow so I am unable to comment further. Needless to say my family are all devastated but will not rest until this place is shut down for good and the people responsible are prosecuted.

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Thanks Duncan, by some miracle he is still alive to bear witness. Others have not been so fortunate.

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I’m still in favour of giving residents/their family a standardised annual survey to complete – online or paper – returned to the CQC rating care homes and giving space to list specific concerns. Who better to build a picture of a home’s standing?

Equally, there should be, and in other organisations, a means for “whistleblowers – horrible term – to raise their concerns in total confidence. The quantity and similarity of concerns should eliminate those with personal grievances and prompt an investigation to begin.

This would take time and money of course. As in other areas, such as the police, we have to decide where public money is best spent. Is it to come from, say, reduced defence and overseas aid to directly help UK citizens who need immediate help?

This is what I actually suggested to the Which? team, they have the organisation in place and are all ready carrying out surveys of this nature on Services and Products such as Cars and Banking etc.
The main people who might have a problem with responding to any sort of survey I believe is the NHS, they have a long record of not dealing with the Public’s complaints in a good way and have even been known to ignore much higher bodies.
Maybe that is why criticism is restricted to Care Homes ,they are the easy target and they will respond and I really believe that if matters are dealt with in a fair and professional manner , Care Homes will be better for it, there is always room for improvement as they say.

John, the money is there but as you say, it is not being directed to the Care Home Sector and many are going out of Business , these include all types : For Profit, non profit, Voluntary, Charities Housing Association etc.etc. they have all made representation to both party Government and all have been ignored and yet both parties have lavished funding on the NHS and yet none of this funding seems to get to the Elderly Care Wards and they are continually struggling the same way as Care Homes this results in bed blocking etc in other parts of the system.
I compare the two systems mainly to highlight a “Best Buy” scenario as Which? would normally do.
My main problem comes about when I try and get figures from the CCGs comparing the amounts the pay to both types of providers (NHS Trusts and Care Homes) I would have thought Which? could obtain this info if they were so inclined wouldn’t you ?
I would just like to remind everyone that the NHS Act states quite clearly that ” services are free irrespective of Domicile” this situation is changing all the time and means testing is now taking place in some areas.

Gerald – the covenant under the NHS that treatment shall be free at the point of delivery does not apply to the provision of adult social care services. People either have to make their own financial arrangements or, as a last resort, apply to their local social services authority where a means test will be applied. They might then receive complete or partial funding or none at all. If they do get a place in a home it will have to be within the local authority’s permitted cost allocation.

Any medical treatment received under the NHS by a care home resident will be free of charge including prescriptions if they are eligible [which most are, due to their age].

Well John, we have been receiving payments originally from the Dept. of Health and now from the CCGs now for at least 30 years ,its only since the Local Authorities have got involved that there is beginning to be this misinterpretation of the Act which you refer to,I have given you my opinion and I have proof of the payments to which I refer, I would respectfully suggest for the purpose of this Conversation that you take the trouble of looking into this matter in greater depth.
I realise in the minds of some people its only the Care Home Proprietors who are only money orientated , by the way the LA ombudsman awarded £8.5m fine against a LA for underpayment of fees to Care Homes only recently.

The NHS are also responsible for paying the total fee of the Care Home (with Nursing) including accommodation, meals etc. just the same as if they were in a Hospital Trust or a Hospice (another term for Nursing Home). As all NHS treatments ,the Client (patient) can decide where they reside and this service is not subject to means testing( I have recently read where the NHS is considering packages costing approx £9000 (nine Thousand per week) at some NHS Trusts, the highest I have heard is £2000 per week paid to the Abbeyfield Group.
Please do not confuse this system with residential Care Home packages which do not include any Nursing Care Provision. If you check out the CQC’s requirements you will find that any care home providing Nursing Care must be specifically registered to do so and all relevant extra requirements with regards to staffing, equipment,bedding and care staff training must be provided to the requirements of the individuals requiring Nursing treatments. If a Care Home has not been specifically registered for Nursing they are trading illegally (as detailed in the Registered Homes) and will be closed down by the CQC. Most of the todays clients are, in my opinion, needing some form of Nursing Care (trends have changed considerably in the last 30 years, unfortunately the LAs and the NHS seem to be hell bent on making everyone means tested ,this is an even changing game of mirrors ,the only loser being the general public.

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I agree with both your comments above, Gerald.

I hope I am not confusing nursing homes or nursing care with residential care homes; this Conversation – and those that preceded it – are generally about paid-for residential care homes in some of which the local authority social services department might be responsible, as a last resort, for placing people who can no longer manage to live in their own homes. But fundamentally this Conversation is about planning, especially financial planning, for care in later life including the entire range of financial provision from full or partial state-funding [through social services] to full self-funding by the resident [including supplemented or met fully by their family] and it does not exclude planning for adapting the home to prolong independence or to enable live-in help to be accommodated. It happens that most of this Conversation has concentrated on residential care homes with the alternatives left unexplored.

Where people cannot self-fund their residential requirements as assessed, a means test is applied to determine what, if any, contribution is required by the local authority from the resident. I have confined all my comments to the residential care home sector and made it clear throughout that adult residential care without nursing or treatment is not provided under the auspices of the NHS. It is therefore outside the terms of the NHS covenant on free treatment at the point of delivery.

Some residential care homes do also provide accommodation and nursing care for NHS patients and some or all of their fees might be paid by the NHS as you say. I have not made any comments on nursing homes or on any other form of NHS provision. I am fully aware of the CQC’s policies and requirements.

The social services departments are responsible through their assessment process for deciding whether a person is in continuing need of care by qualified nursing or medical professionals in which case the NHS should take over responsibility. If this is not happening then it needs to be addressed by the patient or their family, possibly with the support of the patient’s GP. Since most elderly people living in residential care homes only require personal support and assistance plus their meals and all the housework done for them, their essential needs are met satisfactorily in my opinion. The CQC will determine whether the provision is adequate and meets the set criteria. Providing an appropriate health care service for the remainder should not impose an excessive burden on the NHS but the issue is contentious and has been politicised.

Residents of care homes can still see their GP and obtain medication on prescription under the NHS. The administration of medication is not nursing although it does require a specific competency to be attained.

I see no reason why there should not be a means test for adult social care in later life which is a scarce and precious resource; there is not enough capacity for there to be a free-for-all. Moreover, a significant proportion of the elderly population have a good income and in many cases considerable personal assets. Take away the means test and there would be hardly any residential care accommodation at all because it is the local authority funding of a number of placements that keeps some residential care homes going. Perhaps you would explain how removing that provision would help the situation.

[This comment relates to Gerald’s starting “well John . . .”]

This Conversation is not about planning for the needs of patients requiring medical treatment, Gerald. Please see my longer comment that follows your second comment addressed to me..

Duncan – on funding local authorities’ adult social care provision –

Adult Social Care authorities in England & Wales [mainly county councils, unitary authorities and London or metropolitan borough councils] are permitted to supplement their council tax precept by up to 4.9% in order to increase their resources for adult social care and other public welfare services. This has been possible each year for some time now so cumulatively it has added a significant amount to their resources. The supplements are indeed capped at that percentage level as part of the government’s public expenditure controls.

I am sorry to disagree with you John , since the LAs and the NHS have been told to “work together” to provide a combined approach to Care of the Elderly this has been a massive fudgeing of lines with the effect that thousands of people who would have received funding from the NHS has now had to pay themselves.
As you stated the original system was monitored by Doctors and Nurses ,the new system is now controlled by Social Workers and Occupational Therapists . None of these people are medically qualified and in my opinion should not be involved in this ,very important task. Since this new system was introduced the eligibility criteria have been changed many times with the resultant being that more and more people are being means tested and made to pay for Care which was previously deemed the responsibility of the NHS all this without the involvement of any Doctors or Care Home (Nursing or Residential) Management.

All my comments have been based on what I understood to be the current position which you have here confirmed, Gerald.

I believe it is right that the assessment process should be carried out by the local social services authority and not by the NHS. However, medical evidence must be taken into account as part of that process and this would normally come from the person’s GP [if necessary after consultation with the hospital].

The responsibility for ensuring that a person who needs medical attention is placed in accommodation that will provide it is a serious one and must be exercised carefully, so I would expect there to be a high degree of diligence in making the assessment. If people need nursing care then they should either be in a hospital, a nursing home or a hospice where appropriately qualified staff are available, and not placed in a residential care home. So that judgment has to be made conscientiously and in those circumstances I would have expected the NHS to provide the funding.

If the judgment is that they do not need fully qualified nursing care but cannot live in their own home then it is right that a financial appraisal and a means test are applied and suitable arrangements are made for their continuing residential care. Each case can only be decided on its merits having regard to the individual circumstances.

It seems sensible to me to relieve the burden on the NHS for the ongoing care of patients who do not require nursing care or continuing medical attention, given that in a care home they will still be on a GP’s list and can be attended to when necessary, can have prescriptions for routine medication, and can have regular visits from domiciliary staff from their GP practice to change dressings, administer certain treatments, and observe their condition. Should their condition change and require more intensive medical support then it is important that this is organised and implemented which might require a change of residence. This where it is vital that the various agencies – NHS, Social services, GP practice, and other health or care workers – work together in the interests of the individual.

I am not going to debate whether social workers and occupational therapists are the right people to be involved in the assessment decisions other than to say that the ultimate responsibility lies with the Director of Social Services for the responsible local authority and that he or she will be accountable if a bad decision is made. You say that “more and more people are being means tested and made to pay for care which was previously deemed the responsibility of the NHS”. But the important issue is whether the decisions are correct in the vast majority of cases and if so then the change of policy was justified in my opinion. The means test will ensure that only people who can clearly afford it will be required to make a financial contribution. It also means that care home capacity is used more efficiently so that nursing homes and hospitals [which are under pressure] are not being used to accommodate people who could safely live in a residential care home. If the manager of a care home considers that the care and treatment of one of the residents requires a different approach then I am sure there is a mechanism for them to raise that with the placing local authority or the resident’s doctor.

Dear John, in essence everything you say makes sense and when this system was first introduced to us in 1996 we were assured of the Medical involvement to which you refer takes precedent in this system as for many years previous to this system it was only the GPs and the Hospital doctors who were considered competent to make such an important decision, these promises never materialised and for a short time Nurses were used,this system was strenuously opposed by GPs and Nursing Care Homes ,all opposition was ignored and subsequently even the Nurses were replaced by Occupational Therapist with a Social Worker making the initial assessment .No Doctors are now involved in this process. I hope that now you are aware of the real situation yo will understand when I say that,in my opinion this system is not fit for purpose.I leave for others to explain how this system has evolved and why it has evolved all I will say is that Nursing Homes and Doctors were not party to it.

I see your point, Gerald, but policies change for various reasons and this change was probably for economic reasons. But the important question is whether there have been any tragedies as a direct result of the change in assessment procedures. I don’t know the answer to that. Nobody has said there have been but perhaps you can enlighten us.

Without a doubt John there has been a change in policy and it is Economic as you have surmised. The simple fact is that the people who have paid for the NHS system are not now getting the service they now require free of charge from the NHS .The new system through a slight of hand paper trick is making the Public pay for NHS treatment.The main tragedies however have been recently reported in the NHS Trust Hospital of over 600 premature deaths ,the irony of this is that this “Care” was not means tested and was free.These facts have now been accepted by the Hospital but only after years of campaigning by the relatives .I only use the NHS because they are the largest provider of Care for the Elderly (I do not differentiate been Nursing and Residential Care as in my mind it is all part of the same system and I do accept that people who do not require Care should not be subsidised by the State) I had no complaint with the original system where GPs were mainly the arbitrators as I have in general found them unbiased and professional ( there is always the odd bad apple like Doctor Shipman in any system).

Three quick responses, Gerald –

1. The people who pay for the NHS are current taxpayers and the government believes it is essential constrain public expenditure to avoid having to increase NI, PAYE and VAT. Alternative governments were available. Patients’ previous contributions funded the NHS at the time they made them.

2. The tragic premature deaths at NHS hospitals were not as a result of a failure of the care assessment process and it is not a relevant factor in this Conversation in my opinion.

3. It is necessary to distinguish between medical treatment [an NHS responsibility] and adult social care [the responsibility of local social services auhorities] because the financial arrangements are completely different. I appreciate that you and many other people do not differentiate between them but the fact is they are entirely separate [but working in partnership] and run in completely different ways. I would reword one of your sentences as follows “people who only require care should not be subsidised by the state“: in other words state funding – collectively and predominantly paid by the working population – is for medical treatment.

Residential accommodation and domiciliary services [home helps etc] for which an assessment with means test applies are for the help which people need for continued living. It is the citizen’s responsibility to make financial provision for their personal living arrangements until the end of their life. The welfare state did not take away that responsibility.

This might read like a severe interpretation of the situation but I believe it is factual and accurate. It meets the basic needs of those in financial hardship and ensures that those who can afford it make a contribution. Those who want to expand the free provision to include social care for all need first to justify it and then explain where the money is coming from to pay for it, for once the system is opened up in that way demand will explode.

Nursing Homes (Care Homes with Nursing Care) have always been funded by the Health Authorities (CCGs) and were a replacement to the Geriatric Ward the fee has always included Full Board accommodation and under the new Homes Act can be integrated within the same premises as any other Care Home. The Act stipulates that any Care home providing Nursing Care must be registered to do so, and in the process of registration It is agreed what extra services etc are needed and this includes Nurses etc.
Surely this is within your definition of Adult Social Care ? I can understand if one looks at the Old System in which we had complete separation of these services in the Act and in practice with different rules and Authorities in control but now that the CQC is implementing the New Act things have changed .I suggest that not everyone is aware of all the ramifications of the new Act for instance there are quite a few Care Homes with patients who have Nursing requirements who are not registered for Nursing and who are subsequently not staffed or monitored for Nursing etc . I will leave it to others to explain how this is left unregulated and unmonitored but I would suggest that certain Authorities are once again trying to get things on the cheap.
Well John, I hope I have explained the reason for our misunderstand

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Hey Duncan,
You of all people should not complain about people expressing their viewpoints.

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How do we know who give thumbs down (thumb downs?).
However, I think it is best to keep comments to opinion and information on the topic, and on others’ comments, and not comment on the commenter.

Hi Gerald and Duncan,

I know this is a heated topic, so thanks for keeping the discussion civil.


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[This comment has been removed as it broke our community guidelines. Thanks, mods]

I think John is big enough to look after himself and doesn’t need or seek brownie points.
Duncan can we now stick to a constructive discussion on the topic in hand and try and look at matters from a wider perspective.No system is perfect and Care of the Elderly is no exception and certain aspects do need improvements, all I can say is that it is infinitely better than what we inherited, just ask the Public and all the Nursing staff from the old Geriatric Wards who have been the main stalwarts of the process of improvements in the Private Sector. You must also remember that the Local GPs are also actively involved in the Care of our residents on a daily basis and I can assure you that they are very diligent in their duties and would soon make their dissatisfaction known and expect action.
This is part of the British system (not American) where the NHS and the Private Sector is working in Harmony all anyone needs to do, if they are looking for a Good care home, is to refer to the Local GPs I have always found them to be unbiased .

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I never realised you had stopped Duncan. at least I restrict my comments to Care of the Elderly which happens to be what I have specialised in for the last 30 years if I am not qualified to make comments who is ? or don.t you realise that there are actual people working in the Private Sector in this Country as well as America (hundreds of thousands) someone has to put in a good word for them don’t you think ?

Hi both. Clearly some differences of opinion here, which is fine, but let’s please remain civil at all times. These issues can be debated, but let’s do it without any perceived accusations/anger please.

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There is no link to support the statement “Over 30 % of the NHS (England) is privatised “. This is a link to what the King’s Fund says: “https://www.kingsfund.org.uk/publications/articles/big-election-questions-nhs-privatised? Very different. clid=EAIaIQobChMI1YzY9Nqe3gIVbrHtCh0yaAWxEAAYASAAEgJ9m_D_BwE. It will depend on what services you include such as dentistry, optical, GPs but these have been in the private sector for a long time anyway.

As far as F35s and the NHS go, is the ambassador’s sales pitch the official US line that it is better to buy equipment to kill people than buy equipment to save life? I wonder how many in the UK would vote for that. Here is the missing link “https://www.thetimes.co.uk/article/put-defence-spending-before-nhs-says-american-envoy-7wp0nd6p8

“Privatisation” is a weasel word. I interpret it to mean “taken out of the control of the government” [except possibly by the provision of a regulator] like the gas and electricity utilities that were fully privatised and can do whatever they like subject to the relevant Acts of Parliament. The likelihood of anything like that happening to the NHS is so remote it’s a waste of time speculating about it.

As Malcolm has said, many professional services have been contracted out to specialists since day one – or were never included in the first place except as contractors [GP, dentists] and consultants [surgeons, radiographers].

If in this context “privatisation” means employing outside companies to undertake certain functions required by hospitals and surgeries then that is a matter of judgment for each NHS Trust, Clinical Commissioning Group, or Practice. This can include cleaning, catering, grounds maintenance, buildings maintenance, and all sorts of other non-clinical things and of which some might be incorporated in a PFI contract for the provision of a new hospital or clinic. It would not surprise me if that work amounted to 30% of the NHS’s non-personnel and non-loan repayment costs, but without definitions it is a meaningless figure. So long as the NHS organises this efficiently and economically, specifies it correctly, and supervises the execution of it properly, I see nothing to worry about. I can’t believe American companies are forming a line to take over those operations since there is little profit it in and they would be obliged from the outset to employ all the existing staff on pay and conditions of service no worse than previously.

I cannot see how any commercial company could be interested in actually carrying out the clinical functions of the NHS because there is absolutely no opportunity to make any profit since the provision of treatment has to be free at the point of delivery. That is the Welfare State covenant and no government will renege on it. There is also no way that any form of selection by wealth will be introduced into the NHS.

There is no restriction on foreign companies setting up private hospitals here and offering procedures and treatments at a profitable charge to their patients, as many companies already do, so if American ‘Big Medical’ want a slice of the action then they can do that – but I get the impression, judging by the amount of advertising by such hospitals, that the market is already saturated and that they are in fact allowing the NHS to take up spare capacity on favourable terms so that waiting lists can be reduced. Private health insurance is also widely available in the UK if people want to ensure they have the funds to have private medical treatment at a time to suit their convenience.

The other area where the NHS is open to external involvement is procurement – drugs, equipment, facilities, supplies and stores. There is no way the NHS could produce all its requirements in-house so external contracts are the logical and most economical way to do so – and again it needs to be organised efficiently and managed competently. This can be 100% of all its requirements and is an open market to all who can supply the goods and materials.

I believe the big gripe about potential privatisation is around the employees of private contractors not being on standard nationwide pay scales and conditions of service and a perceived loss of bargaining power and diminution of trade union influence and membership. This has been escalated into a projection of unsubstantiated fear that the NHS is going to be privatised and that people will have to pay for their hospital treatment.

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Worth reading the King’s Fund view.

As far as these links go, the proposed transferring of staff by these 3 trusts is hardly privatisation when the companies they will be employed by are wholly-owned subsidiaries of the NHS trust involved.

The Virgin Care contracts are presumably covered by this comment from the King’s Fund: “The Health and Social Care Act 2012 extended market-based approaches, emphasising a diverse provider market, competition and patient choice as ways of improving health care. There is evidence that this led to a large number of contracts being awarded to private providers, but it did not result in a significant increase in spending on the private sector. This was in part because these contracts tended to be smaller than those awarded to NHS providers.

They say “Total spending by NHS commissioners on non-NHS organisations (including the voluntary sector and local authorities as well as private providers) was £13.1 billion in 2017/18. This accounts for 10.9 per cent of total revenue spending, and is similar to the 10.9 per cent spend on non-NHS bodies in 2016/17.” I see nothing wrong with private organisations providing services to the NHS providing the tenders are properly constructed and the successful operator properly monitored.

I hasten to add that I have no expertise in this area, just interested in what different “authorities” have to say and report.

I was party to the original “tendering” process with the Local Authorities for L/A funded Residential Care and basically we were told what amount they would pay towards our fee and in most cases this was lower than we were charging. We were told to take it or leave it or go to the client for a “top up”.
Please remember these clients are the people who have obtained money under the “means testing scheme” . We asked the Council for a break down of this “one for all” figure but nothing was forthcoming. Every year the Government assured us that this anomaly would be rectified and each case would be assessed individually based on needs of the person and quality of the Provider and also cost of living increases would be included in any increase. Since the beginning of this scheme in 1993 there has been no individually assessed payments , the L/A has continually underpaid the officially agreed cost of living increases (inc. minimum wages) until recently when the Care Home Association took this desperate matter to the LA Ombudsman and got judgment against the L/A for £8.5 million which sounds a lot but it was shared by 100s of homes for years of underpayment.