21st January 2016

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Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell

Birthday Present 
News and Comment from Roy Lilley
Once an experience has touched your life it is difficult to be impartial. 
Walking into a care home, given a clean bill of health by the CQC and smelling the stink of urine, somehow undermines your confidence in the care home and the regulator.
Everyone's first reaction; close it. But, that's the kind of knee-jerk thinking that got us into this mess. 
What happens to the 25 luckless souls whose lives are in the picture frames on the walls and the boxes in the wardrobes.  It might be a stinking dump, but it is home. 
The solution; send in a hit team to clean it, support and retrain the staff, show them what good looks like and then pick-apart the balance sheet, P&L, management accounts and see if the absence of money is at the root of this evil.  You can bet the farm it is.
Next question; can you do that in 10,000 care homes?  That's probably the size of the task.
The care home sector expanded, rapidly during the 80's.  Guaranteed income, low cost consumables, cheap staff. 
The boom in provision peaked at around 575,500 places in 1996 but has been declining ever since. It may be more than coincidental that these market shifts can be tracked to general elections, each bringing change and economic consequences.
Local authority provision fell from 60% in 1970 to about 18% in 2004.  Private, family-payers are now the biggest part of the market, subsidising the public sector.
The profile of care home residents has changed; nearly three quarters of residents need some form of nursing care that 'residential care homes' are ill equipped to provide.  Seventy percent of residents have some form of incontinence, often leading to tissue viability and infection issues.  Half will have mobility problems.
Forty percent, or more, will have a form of dementia, (over half of the dementia population live in care homes), 20% have suffered a stroke, one fifth depression and 5% Parkinson's disease.  The incidence of dementia is going up by about 30% a year.  Alzheimer's prescriptions are up 6-fold in 10 years.
Add to that; heart disease (21%), Arthritis (18%), Fractures (12%), Osteoporosis (9%), Lung or chest disease (8%) and Cancer (7%).
Diabetes alone has increased from 8% in 2003 and 9% in 2006 to 14% in 2009.  Today's number?  Your guess is as good as mine.
An interesting Bupa census, back in 2011, but probably not wildly inaccurate today, tells us:
"... three quarters of care home care is 'nursing care', although there is a great deal of overlap between 'nursing care' and 'residential care'. The substantial decline in the number of hospital beds for older people and the associated transfer to nursing home care has led to the increased medicalisation of care home care and greater levels of dependency among care home residents."
The NHS struggles with demand.  Yes, there are the Saturday drunks and the 'I've twisted my thumb' time-wasters but here's a fact; care home residents experience 40-50% more emergency admissions and A&E attendances than the general population of +75yrs. 
I say; care homes should be the last place admissions come from.  Why aren't they?
Staff turnover?  Maybe; 42% of care staff leave within 12 months of joining and 61% leave within 2 years...  might have something to do with it?  Training, language, aptitude, pay, hours of work, qualifications.  Take your pick of key influencers.
I've bombarded you with numbers.  Sorry...  but each trend and tendency is a person, a relative, a Mum, a Dad, a Granny a member of someone's family and begs us to ask the question; is the present model of care homes fit for purpose. 
Hasn't the time come when a care home without:
  • a prescribing nurses on every shift, 
  • a weekly check-up from a tissue viability nurse, 
  • and a continence nurse specialist and nutritionist.  
  • a nursing-and-care trainer, providing on-the-job and on-the-web, compulsory training
  • a weekly visit from a GP with geriatric training and a better-than-good understanding of diabetes.
... cannot be licensed.

The distinction between nursing care and residential care is becoming increasingly difficult to make.  A medical model is marching down the road.

The paucity of services in the domiciliary setting doesn't bear thinking about.
Blurring the boundary between health and social care creates 'who-pays' issues; social care means-tested, health care not.  Tarzan is right to demand a political consensus on funding elderly and social care.  
In 2018 the NHS will be 70yrs.  We could fix it by then.  What better birthday present?
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
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>>  I'm hearing - @MarkBritnell is in Davos dispensing wit and wisdom and sampling the odd glass of champagne.  Apparently all the talk is of an economic slowdown.
>>  I'm hearing - Manchester will launch biggest 7 day service.
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