Change that leads to better lives

Turning Older People into Commercial Commodities

According to the BBC, Lord Carter’s review for the Government on how to save the NHS £5billion is recommending that the NHS should establish its own social care homes and/or make arrangements with the independent sector to do this for them.

Rob web

This idea just commodifies (particularly) older people given the demography of NHS usage. Some of his other ideas may well have merit, but (assuming the BBC have got this right) this one just flies in the face of evidence, rights, morals and indeed government policy. It is driven purely by a mindset that sees older people as ‘bed blockers’ who cost the NHS money, whilst forgetting other factors.

Most importantly from my perspective, it completely fails to consider what older people want and need. When NDTi engaged with older people as part of developing the Joseph Rowntree Foundation’s ‘Older People’s Vision for Long term Care, they told us they frequently felt services treated them as an economic commodity - to be moved around to suit the financial and business needs of public services. They also spoke of their aspirations to get support that enabled them to maintain family and community connections, to age ‘in place’ (i.e. where they lived, felt comfortable and had relationships), how they were not listened to by services and how they still had things to give to society to reciprocate for the care and support they were needing. So, first and foremost, Lord Carter’s proposal fails the humanity test alongside the NHS policy commitment to listen to people and ‘put patients first’.

Then there are all the other reasons:

  • It contradicts Government policy. Care and support should be designed to enable people to live a good life, as independently as possible, as members of their local community – rather than just being designed to save the NHS money. It is called ‘wellbeing’, and that concept is the headline requirement of care services in the Care Act. Saving money without considering wellbeing is about being cheap, not cost-effective.
  • People living in an NHS-run care home are legally patients of the NHS. That means that other people (not them) will decide whether they stay there or are moved on elsewhere, who they are living with, who supports them, the income sources they can receive and so on.
  • NHS care homes are not a new idea – they existed in the past but were scrapped because they didn’t work as a concept. For example, just look at the evidence from learning disabilities where the Government required all NHS campuses – which were NHS-run care homes – to be closed because the evidence on quality (and cost) was so appalling.
  • One reason for this poor record on long term care is that the NHS is structurally and culturally set up to deal with ill-health – not community engagement and wider life outcomes. That is quite understandable – it generally does those other things really well. Given this inherent culture, NHS-run care homes will almost inevitably be in mini institutions, with people looking at the community through their windows. (OK, fair point about how does this differ from many residential care homes at the moment?)
  • What about integration? Social care is the statutory responsibility of local authorities. According to the BBC report, Lord Carter is basically saying ‘Local authorities have failed, so the NHS should do their job for them’. He may have a point about local authority failure in some places – but did he consider the question of...
  • Money! It is now generally accepted that social care funding is in crisis. This is arguably the major reason why there is a growth in people not being discharged from hospitals. The idea that the NHS develops its own care homes might actually help social care funding (and thus welcomed by some in social care) by the NHS taking over the long-term care costs of people who move into these places! How does that help NHS funding? A care home place may be cheaper than an acute bed for a few weeks, but if the NHS then has to fund it for years? Unless of course, the intention is that the local authority is sent the bill for these NHS care homes. That would be an interesting new definition of integration – one authority commissions and the other pays.

Finally, don't even get me started on how this proposal contradicts the UN Convention on the Rights of People with Disabilities (UNCRPD). It blatantly contradicts Articles 19 and 26 of the Convention. Interesting that journalists have reported that the UN are visiting the UK at the moment to conduct an investigation into whether ‘austerity’ is leading the UK to contravene its UNCRPD Treaty obligations. I wonder if they’d like to take a look at this idea?

Let’s hope Government Ministers knock this ridiculous proposal on the head straight away. Instead, why don’t we try dealing with the organisational problem of delayed hospital discharge in a way that we know works and respects people’s rights and personal integrity? Intensive case management, real person centred planning, genuinely integrated health and social care practice, access to properly resourced personal budgets and alternatives to residential care would be a far more sensible and workable set of proposals from any government advisor.

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