The green paper still deferred,
advisors doubtless once more considering well-thumbed evidence supported by
economic expertise in the attempt to find the elusive politically acceptable
solution that is sustainable financially.
These can be predicted to distill
down to who pays for what rather than a broader view of what epidemiologically is
needed and practically achievable both in terms of available staff and funds.
It is widely agreed that the
burgeoning demand overrunning health and care services is principally older
people that are variously frail, burdened by multiple illnesses and
disabilities, dominated by neuro-degenerative disease a population we have
previously described as progressively dwindling.
Whilst Health Services span
prevention, diagnosis and treatment and social care may be summarised as
seeking to meet locality needs of housing, support and the promotion of safety,
independence and personal autonomy. This population simply don’t neatly fit
either established health or social care paradigms; even though responsibility
for care is somewhat arbitrarily allocated to one or the other or both without
a complete mandate. Current initiatives integrating health and care
organisations in partnership are promoted to establish greater capability,
though even the most optimistic are unlikely to be heard suggesting this
approach of its own will create a sustainable service let alone reconcile the
fundamental differences in eligibility and funding.
This is an expanding population;
their escalating dependence means inevitably care home admission becomes a
commonplace when personal dependency and care needs are unpredictable and
around the clock. Whilst people’s medical conditions may be beyond specific symptomatic
treatment, frailty and vulnerability to inter-current illness are best suited to
a proactive rather than reactive approach to maintain the best possible sense
of well-being. It’s important to
distinguish the population we are describing from the terminally ill, they are
not actively dying with a typical 1-3-year life expectancy on admission to a
So perhaps a focus on care homes
may be in order after all the greatest resource is presently committed to the
funding of care homes. In broad terms 80% of adult social care budgets and cumulatively
a significant health service resources are committed to care home residents
whether through assessment, funding or support from CCG’s or hospital outreach.
The reality is that no existing organisation has a national coherent approach
for the leadership of care homes and their staff. The fact that for every NHS
bed there are some 4 care home beds and thousands of professional nurses
employed relatively dis-articulated from the NHS. The NHS beds inappropriately occupied
by frail older people waiting for care because of difficulty accessing funding further
emphasises the lack of fitness of the present approach.
There remains much confusion
regarding the responsibilities for care home outcomes. They are the sum product
of care home provider, their staff, commissioners and various aspects of
primary and secondary care with assurance largely dependent on regulation. There
is no compelling argument that that more of the same in terms of services and
support will achieve any more than more of the same.
A radical rethink could address
and define the population in a way that could make confidence in care homes
rise as well as quality and clarity of funding, components of this may include:
A new national approach to care
home residents, the homes in which they live and the staff who provide care.
This piece from Forum member Clive Bowman in December 2018 is worth revisiting as we rethink the purpose of #carehomes