Daily Mail, March 20 2002

A pretty safe bet would be that demonstrations on the doorstep of No 10 Downing Street generally leave its occupant distinctly unmoved. But when 102 year-old Rose Cottle turned up in her wheelchair to hand in a petition of more than 5,000 signatures, the Prime Minister and his advisers will undoubtedly have felt a sickening feeling grip their stomachs.

For Miss Cottle is the visible symbol of an appalling and still unfolding catalogue of neglect, disruption, misery and premature death among elderly people who live in residential and nursing homes. It is a situation for which the government bears direct responsibility, but for which it is disgracefully trying to avoid taking the blame. Now, though, it fears with good reason that chickens are about to come well and truly home to roost.

Miss Cottle faces being made homeless for the second time in three years. After her first care home closed for renovation, she moved to Boreham Wood Care Village. Now, this home’s owners say it must close because it has already lost £3 million and can no longer afford to sustain such losses. So Miss Cottle and 95 other elderly residents, several of similarly great age, are to be made homeless.

This home’s predicament is the tip of an iceberg. In the last five years, care homes for the elderly have been closing at such a rate that some 50,000 places have disappeared, about one eighth of the total.

The reason is that they simply can’t afford to keep going. To many Labour MPs, for whom anything not run by the state is the acme of evil, this simply proves the rapacious character of private care providers.

Some may well be heartless rogues. And it’s true that the steep rise in property prices has made selling an attractive option. But that is largely the result of a double whammy of chronic underfunding. First, central government doesn’t provide care homes with enough money; and second, of the money it does provide, local authorities take a heavy top-slice and spend it on other things.

Although residents who own a house or other assets have to pay for their care, those with no assets are paid for by local authorities. Councils pay care providers for every such resident they take from their borough. But for several years now, councils have been paying homes a lower increase than the rate of inflation, causing a shortfall currently estimated at £70 per week per resident – about one-sixth of the real cost of care.

Take, as an example, the experience of Jewish Care, a charity which runs more than 1,000 residential and nursing care beds and is widely considered one of the best providers around. Last year, the government increased its funding of residential care places by 5% for Barnet and Camden councils and 6% for Redbridge. But these authorities passed on to Jewish Care only a 2.9% increase for their residents. This year, the government has awarded these councils an increase of between 10% and 11%. Yet Barnet is passing on only a 5% increase, Camden a measly 1% and Redbridge an even more derisory 0.7%.

Big charities like Jewish Care are subsidising their places by huge amounts, relying on philanthropy. Other smaller providers have no such reserves and simply cannot afford such losses.

The knock-on effect of these home closures is proving catastrophic for the NHS, since frail, elderly people with nowhere else to go are ‘blocking’ hospital beds and helping cause the distressing trolley waits in corridors.

But there is also an appalling human toll among residents themselves. For them, the care home is ‘home’. They may have lost everything they cherished– their spouse, their family home, their possessions, their health. Old, vulnerable or ill, they cling to the security of the only home available to them. Then they are thrown out.

It has been estimated that one in four elderly residents dies within a month of being moved. That means -- as a conservative estimate -- that more than twelve thousand souls have died as a direct result of home closures in the last five years.

But this is only half of this unhappy picture. For underfunding also means that too many residents are getting a poor standard of care. With people living so long, the degree of frailty in nursing homes in particular is extremely high.

Such intense needs demand high concentrations of well qualified staff. Instead, there are nowhere near enough staff and, of these, there are even fewer are nurses; many are poorly qualified carers.

For someone who has lost her home and her health, whose horizons have so poignantly shrunk to the four walls of her room and for whom mealtimes or dressing may be ordeals of effort and humiliation, the attitude of staff is crucial.

Yet the carers are often utterly ill-equipped, having been trained – at best – only in certain basic practicalities. But they are used because – appallingly paid as they are – they are cheap.

Many nurses and carers are heroes, but it is painful to watch a mere handful of qualified nurses desperately trying to minister simultaneously to dozens of very needy patients. It is shattering to see carers fail to understand the way the physical, mental and emotional needs of such vulnerable people interact.

To add insult to injury, the very local authorities which fail to provide enough money also threaten to close homes down if they don’t meet the minimum standards.

From April I, legislation comes into force to raise the standards of care, with a new body, the National Care Standards Commission, charged with inspecting homes and reporting to government. But although new regulations mean more money has to be spent, the homes are not being given the cash to do so. So more homes are now cutting their losses and closing.

Simon Morris, director of community services for Jewish Care, has estimated that the cost of meeting all these regulations will be an additional £16 per resident per week – which neither government not local authorities will provide.

Many of these regulations involve nit-picking or marginal requirements such as the precise width of doors, the temperature at which water comes out of the taps, or brochures which each home has to produce.

What they singularly fail to address is the quality of care. Indeed, they introduce a dangerous flexibility on staff numbers, saying that these should be assessed by each home ‘according to the needs of residents’; and they even imply that carers should perform nursing tasks, which would be positively dangerous and contrary to current practice.

‘I am not sure’, says Tim Evans, director of the Independent Health Care Association, ‘that the people who dreamed up these ludicrous regulations understood the consequences of their actions’.

For those residents who once had assets, the startling fact is that they have been forced to sell their homes to end up with often poor care and -- as with Miss Cottle -- even eviction. The outrage by people forced to sell up caused the government to offer as a sop a rebate for part of the nursing care.

Now that too has blown up in the government’s face. For the untold story is that when the care homes protested that the nursing rebate made no sense when they didn’t have enough money to pay for proper care and might even have to close down, civil servants gave them a nod and a wink to take this rebate money themselves to keep their homes going.

But the junior health minister Jacqui Smith has now caused outrage by publicly blaming the homes for siphoning off the nursing rebate. The most likely explanation for this inconsistency is that, panicking at the build up of the care homes crisis, ministers have decided to blame their ‘unscrupulous’ owners.

Many Labour MPs are privately not unhappy that care homes are going to the wall. They believe old people should be cared for in their own homes instead. All other things being equal, this is often an ideal solution. But other things are often not equal.

With so many now living so long, more and more are simply so frail or ill there is no alternative but to provide the intensive care and support of a residential or nursing home.

The government is blaming not just home owners but local authorities for the mess. Yet ministers refuse to ring-fence the care home funds which would prevent councils from top-slicing them. Instead, it is sheltering behind the new Commission which, unless it speaks up bluntly about the unacceptable standards of care, will be simply worthless as a government poodle.

Yet once the Commission starts work, the pressure on ministers will increase. For the gap between the higher standards being expected and the absence of funds to pay for them will become apparent, and the gap between ministerial rhetoric and reality --particularly the drag on the NHS -- will be exposed.

In the long term, a totally new system of insurance is surely needed to meet the awesome costs of decent residential and nursing care. In the short term, Tim Evans estimates that it would take another £1.5 billion just to stop the haemorrhage – and that’s before the inadequate standards of care are addressed.

Miss Cottle worked for 40 years as a teacher. She says having lived through hard times and two world wars, she now feels she is having to fight a war herself.

At 102! How can a society look itself in the face when it treats its venerable elders in this way? Ministers behave as if old people are expendable. In fact, they are a significant political force and their anger can put the government out of office. Miss Cottle’s plight is a harbinger that Tony Blair cannot afford to ignore.

Posted by admin at March 20, 2002