Frail elderly ‘failed by care deserts’

Older people’s needs ignored: another North-South divide?

“A new report by Incisive Health on behalf of the charity Age UK reveals that many frail old people are not getting the levels of care they need and deserve.  The availability of residential home places is severely limited in some areas and the report states “there are some parts of the country where there are no longer providers available to deliver nursing home services”.  The report concludes that the current market-based approach “has broken down in some areas of the country and is no longer capable of delivering care to people in need.  Immediate action is needed to stabilise the system and set it on the course to delivering sustainable care in the long-term.”

Comparison between areas is revealing.  Hull clearly has insufficient capacity whereas in other areas such as Guildford there is a good number and spread of service providers.  The report postulates that this is possibly a reflection of the high numbers of self-funders in the South-East of the country.  This is because self-funders, who do not meet means-testing criteria for local authority funding, effectively subsidise local residents who do depend on council funding.  On the other hand, workforce vacancies are a big issue in the South East, including dependence on high numbers of EU staff, some of whom have already left because of Brexit.  Nursing homes, which need to have a registered nurse on duty, have seen the vacancy rate for registered nurses triple over five years to over 12%.  This may be one reason why places like Hull have lost over a third of their nursing home beds in the last three years.  The local “care market” is largely influenced by how many better off people there are paying higher, private fees for care homes in a given area.  Overall, against a situation of rising demand for home care as well as residential/nursing home care the number of hours of care provided to older people in England have fallen by three million over three years.

The increasing number of old, and especially very old people has been predicted for many years.  This combined with a failure of successive governments to make proper provision, the shift of care into the private sector and more recently the terrible impact of government austerity policies in poorer areas has created a “perfect storm” for health and social care.  The predicted increase in numbers of people with dementia (who are particularly likely to need residential care) can only make matters worse, with the Alzheimer’s Society predicting a doubling of the number of people living alone with this condition over the next 20 years.

The government has been promising a Green Paper to reform the entire system since 2017; but the situation is increasingly urgent; and people are suffering (and probably dying) because of the current situation.  The social contract with today’s old people who paid into state funds, expecting they would receive decent care if they needed it, is broken and growing inequality between people and regions is stoking up resentment.  We urgently need a fairer system.”

 

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Professor John Wattis is a Professor of Psychiatry for Older Adults at the University of Huddersfield