The declining state of residential and nursing care system in this country is, like so many services, something that has been bundled into the welfare cuts introduced by the Coalition – and now that the Conservatives have a majority it is set to worsen.
While the Tories have promised billions of pounds to the NHS an equally pressing (and in many ways the more important) concern is the lack of social services support on which most preventative and after-care services rely.
In the case of the elderly, if a person living alone has a fall within their own home and are taken to hospital they are not allowed to return until a social worker has done an appraisal to make sure they will be safe living alone. Due to the pressure this puts on already over-stretched local social services not all of these assessments can be undertaken promptly and leads to elderly patients (who do not have anything physically wrong with them) taking up hospital beds in a number of departments – and more critically in A&E departments.
By increasing investment in local social service networks a lot of the ‘backlog’ issues can be addressed and therefore save time and money for local councils, NHS Trusts and the tax payer, as well as (and most importantly) improving the health and well-being of the most vulnerable. As part of the increased investment into local social services, increased investment and regulation of residential/nursing care homes (to act as part of the local social services network) can improve care for residents of these homes and help relieve additional pressure on the NHS.
Again to use the state of elderly care as an example, under current guidelines the ratio of residents to carers can be as high as 8:1, and when many instances require two carers (such as if a resident cannot support their own weight and a hoist is required) this effectively increases the ratio to 16:1 pair of carers. If bills were introduced to increase the number of carers in these homes to a ratio of residents to carers of 4:1 then it would help create jobs, improve the welfare of the residents and allow for more person-centred care and allow the carers to spend more on-on-one time with vulnerable elderly people.
By integrating residential/nursing care homes more thoroughly to provide out-patient and hospice support both private and council-run residential homes can provide the personal care and emotional support needed to allow other health care professionals to concentrate on their main duties.
While residential/nursing care homes provide support and care for those who cannot care for themselves alone the investment into, and the increased numbers of, day care centres for the elderly (to stay with this example) would allow the carers of those looking after a loved-one the much needed time and respite to improve their quality of life. The number of day care centres has decreased dramatically over the past 10 years despite the fact that private carers are some of the unsung heroes in our society.
The Liberal Democrats are a party that aims to help improve the lives and well-being of others. We have a real opportunity to campaign for the strengthening of social services to save money, save peoples dignity and, ultimately, save lives.
* Ian Thomas is the pseudonym for a party member. His identity is known to the Lib Dem Voice editorial team.
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7 Comments
This is an excellent article Alex.
As a carer I have been championing the issues around the inadequacies in our current ‘care’ system for a few years now.
Hopefully we can both have involvement in formulating future Lib Dem policy on the issue.
The declining state of residential and nursing care system in this country is, like so many services, something that has been bundled into the welfare cuts introduced by the Coalition – and now that the Conservatives have a majority it is set to worsen.
Yes, and we are told welfare cuts are popular in this country, and we see contenders for the Labour Party leadership running along to say “me too” to the Tory cuts under the impression that their party lost the election due to not being right-wing enough.
This is because the right-wing press have given people in this country a very wrong idea about what “welfare” means, generally by highlighting a few extreme and unrepresentative cases, and of course by completely ignoring the fact that in those cases the prime factor is generally housing benefits going straight into the pockets of private landlords, this being the inevitable consequence of the Tory policy of running down council housing.
We just need to be honest with people and tell them it as it is – if you want a government service to be provided, it has to be paid for, it has to be paid for by a tax which will raise the amount it costs. But we weren’t honest about this in the 2015 general election, neither was any other party. Right-wing parties bang on about tax cuts without spelling out the consequences in terms of public service, left-wing parties bang on about how bad spending cuts are without spelling out the consequences of them bit being made would be higher taxation. We managed to take the unrealistic left-wing approach in 2010 and came a cropper for that because people didn’t get the point that we couldn’t meet spending pledges if we couldn’t get agreement to raise the tax needed to meet them. Then we took the unrealistic right-wing approach in 2015, and came a cropper because by seeming to agree with the Tories that taxes can be cut with no service consequence and that the Tories were doing a wonderful job managing our economy, past supporters either saw through that nonsense and didn’t vote for us or didn’t see through that nonsense and didn’t vote for us because we seemed to be saying “Vote Conservative – they have brains and are doing a good job, Labour means well, but they have no brains and so would do a bad job”.
Hi Alex
Great article.
I can only speak from the personal experience of watching my partner go through the system but your point about coordination really struck a chord. Its not the care you receive, the health care professionals you deal with are almost without exception committed and fantastic, its the transfer between stages of care that destroys the benefits gained. Its the administration and management of the system that’s the real problem.
Thanks for your comments guys!
While there is a need to tackle the deficit the cuts that are being made (especially to welfare services) need to be more evenly spread rather than ‘slash-and-burn’ due to the interdependent nature of health, social and community services. By disproportionately targeting/ring-fencing one area over another it destroys the balance between those services and causes the system to break down.
Hi Alex, can I comment form a position of carefully chosen anonymity on a little understood point of fact:
” if a person living alone has a fall within their own home and are taken to hospital they are not allowed to return until a social worker has done an appraisal to make sure they will be safe living alone.”
Up to a point. Due to this thing called human rights, telling an older person they ‘cannot’ go home against their wishes would be an unlawful deprivation of the right to liberty (assuming they are free to walk out the door).
In theory what should happen is that – if the person in question is not too unwell to understand the decisions involved – the hospital staff should ask the person if they are in agreement with remaining for treatment, record this, after treatment ask them if they are in agreement with remaining for assessment by rehab therapists (if they need therapy to recover functional ability) and then ask them if they consent to remaining where they are for assessment by social workers. There should be no referral to social work (which is not an NHS service but a local authority service) without consent. This is not understood by many people I have worked with in the context of older people’s advice services, including distressed and concerned family members who would like the NHS to lock their parents up temporarily in hospital so that the council can effectively bully them into accepting care (or a particular type of care) against their wishes.
This is supposed to be for their parents’ own good, and indeed it may well be if the distresssed family members are proportionately assessing the risk – which is not a given. But even so its still effectively an illegal imprisonment unless there is consent.
Telling someone – on the basis of their age alone – that they ‘have’ to stay in hospital to be assessed would also be age discrimination.
But yes, it is not possible to access many forms of care without an assessment, and an assessment requires someone to carry it out. Because local authorities and social workers are not psychic and consent is key at all stages of the process it is not possible to predit how many visits a day someone needs, get all the equipment that might be needed in place, without actually seeing the patient and talking it through with them.
It is possible at times that not all the people waiting for social care assessment who have ‘nothing physically wrong with them’ are as fit as is believed by the health managers who run the hospital and are trying to collate figures that show that they are moving patient flow through their hospital nice and fast. If someone has just finished their course of anitbiotics to get over an infection and resultant fall, and still has bruising and wounds requiring dressing, yes maybe in theory they could be cared for in the community, but they are still in pain, fragile, fatigued, and vulnerable. And, oh, look they’ve got an unrelated ear infection that means they can’t understand any of the questions I’m asking them. Fit for discharge? In theory…
‘Get them out fast’ (the mantra of many ward managers) is not the answer in all cases and having a medical or nursing degree does not make you infallible.
About the only advantage of our fractured health and social care system is it allows in theory for construtive argument where local authorities are able to challenge the health service when – not if – it is wrong about a particular patient’s fitness for discharge.
There has been a reduction in the number of hospital beds across the country in recent years – effectively a transer of hospital costs to the community health services and local authority social services. Local authorities are in no way blameless in the assessment processes being dysfunctional, but it is not possible to argue that incresed hospital wait times are not affected by hospital closures and a sleight-of-hand don’t-mind-the-quality-of-care, feel-the-targets-we’re-meeting management style being adopted by hospital trusts.
Hi Susan, thank you for your detailed comments they are really insightful. I have to admit that my article was simplistic in terms of the example I gave regarding an elderly person who had a fall and of course the process is much more complicated than I suggested, as your comments show. I was using the example more as a vehicle to highlight the need to a more stream-lined care system that incorporates the NHS within a community care framework and that the issues surrounding the failures in the care system outside of the NHS are things that the Lib Dems could really focus on as a USP for the party. While I know that what I wrote didn’t even touch the tip of the tip of the iceberg regarding ways on which social services and their interconnecting dependencies could be improved I feel it is definitely something that should be examined in greater detail.
It is important that you have highlighted the staff ratio issue Alex.
Back in March 2012 I highlighted on LDV my experiences on a dementia unit as a reminiscence worker. The reminiscence work itself was beyond rewarding – some people were completely transformed by finding an anchor in the past with scrapbook work, singing old songs etc. However (even with a good ratio of 24 residents to 5 staff) there was constant pressure to abandon this “icing on the cake” work and be dragged back to the basics. The tragedy is that even in expensive, rural residential homes the staff ratio is such that people go for many, many days at a time without going outside and feeling the air on their faces.
The right to some sunlight – our system is not even fulfilling that basic right for thousands of older people who served our country so well when they were young and strong.