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package of care and support in place within specified timescales, the NHS body

can require the local authority to pay a daily charge.29 Unfortunately, despite this

a combination of the numerous systemic glitches we describe in the next chapter

and the magnitude of the demographic drivers means that the trends are currently

moving in the wrong direction, with delayed transfers of care on the rise.

The latest data shows that the numbers are continuing to rise for all patients. Numbers

hit a record high in October 2014 with 96,564 bed days taken up by patients

who were fit to leave but could not do so because adequate social care support

was not in place. This represents a 20 per cent increase on the 78,487 seen in

October 2013. In response to this in January 2014 the Government approved an

emergency injection of £25 million to 65 English councils for social care for older

people in areas where hospitals have large numbers of delayed discharges.30

2.2 Poor care in hospitals for older people

The otherwise avoidable occupation of hospital beds places greater pressure

on services, which in turn exacerbates the chances of receiving poor standards

of care. For instance, 23,663 patients in England waited between four and 12

hours on a trolley in A&E in November 2014; a figure that has tripled in the last

four years.31 This illustrates another of our key findings, a drastic variation in older

people's experience of hospital.

No one enjoys being in hospital but the impact on an older person's quality of life

can be especially profound. Besides the illness itself, the inconvenience caused

and the exposure to further infection due to spending several weeks in hospital

can cause great distress and loss of independence for many people.

And, of course, older people, like everyone else, worry about the standard of

care they will receive. Cases of poor care in hospitals are well acknowledged

with the failings of Mid Staffordshire NHS Foundation Trust being the most

renowned example.32 The Government has quite rightly taken the failings at Mid

Staffs and elsewhere very seriously, commissioning the Francis Enquiry, one of the

key findings of which was the importance of responding to complaints about the

quality of care.33 So it is concerning that recent investigations have found a third

of hospitals ignoring complaints for incorrect reasons.34

The Care Quality Commission inspected 50 hospitals to ensure that they were

meeting the standards necessary to care for elderly people. Of the 50 hospitals

surveyed, only 33 met all the standards. A third of the hospitals inspected had

problems including: not carrying out risk assessments, inaccurate monitoring of

patients' food and fluid balance, incomplete record filling by staff (for example,

incomplete 'do not attempt resuscitation' records).35

Whether it is due to poor hygiene, inadequate feeding, or premature discharge

and consequent readmission, many older people experience a much poorer

standard of care than they should. The Royal College of Nursing considers one

registered nurse to seven patients an appropriate ratio for basic safe care. On

children's wards the ratio was one registered nurse for 4.6 patients but older

people's wards regularly average one nurse for 10.3 patients. According to

a report published by the Royal College of Nursing, older people's wards are

already so badly under-staffed that it is "not enough for safe care, let alone good

quality care". The report also stated that, "the vast majority of hospitals still have

inadequate basic nursing establishments on older people's wards".36

Older patients also face poor outcomes of care. For example, 62 per cent of

people with osteoarthritis, the most common cause for disability amongst older

29 Care Act 2014, Chapter 23,

Schedule 3

30 Brindle, D, "Councils get

emergency £25m for social care

to tackle hospital blockages",

The Guardian (20 January


31 Donnelly, L and Sawer, P,

"Number of patients waiting

on trolleys in A&E triples" (29

November 2014)

32 "Stafford hospital to be

sentenced over poor care of

diabetic patient who died" The

Guardian (21 February 2014)

33 The Mid Staffordshire NHS

Foundation Trust, Report of

the Mid Staffordshire NHS

Foundation Trust Public Inquiry

Executive Summary (February


34 Smyth, C "One in three hospitals

ignore visitor complaints", The

Times (5 December 2014)

35 Care Quality Commission,

"Time to listen in NHS hospitals"

(March 2013)

36 Royal College of Nursing, Safe

staffing for older people's wards


Chapter 2 - What Are The Symptoms? Or What Are The Problems Facing

Older People In Health And Social Care?



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