14
people37, said a doctor or nurse had never discussed with them how to keep
the condition from worsening.38 As more than two-thirds of hospital patients are
over the retirement age the failure to adequately treat and care for older people
in hospital has a significant impact on the public purse, as well as on patients'
quality of life.
The quality of rehabilitation and dementia care is also dramatically below what
it should be. People with dementia on average stay in hospital seven days longer
than those without39 and are at higher risk of developing major complications
including pressure sores, falls and incontinence while there.40 The Alzheimer's
Society also claims that statistics show that half of those with moderate dementia
who are admitted to hospital with an acute illness, such as hip fracture or
pneumonia, will die within six months.41
The Care Quality Commission's 'Hospital Intelligent Monitoring: 2013' survey
found that 44 out of 161 trusts fell into the two highest risk categories; a rise on
previous figures.42 However, the issue of poor care is not resigned to a single
area, cutting across care in hospitals. After carrying out spot checks at 100
geriatric wards, The Care Quality Commission found that 35 hospitals needed
to make improvements.43 An ITV News Index carried out by ComRes revealed
that 34 per cent of the people polled said that they, or someone they knew, had
experienced poor standards of care in the past two years.44
2.3 Cases of poor care outside a clinical setting
While much social care is excellent, the media has highlighted a number of
high profile scandals. For example, the BBC Panorama documentary exposed
mistreatment at Winterbourne View hospital, with police arresting four people.
Such scandals have encouraged negative public perceptions of social care. There
are various forms of social care. In this report we use the phrase 'housing with
care' as defined in a recent report by Demos as care homes, residential care,
extra care and supported living.45 A survey commissioned by Demos found that
only one in four people would consider moving into a care home if necessary
in old age, while 43 per cent said that they would definitely not move.46 It is
also possible that the almost solely negative coverage of the care industry has
contributed to people's reluctance to save for their future care (see below).
However, such perceptions do not reflect the norm of social care as experienced
by many hundreds of thousands of vulnerable people. In other words there is a
significant gap between perception and reality. This perception gap is boosted
by the rare but shocking recent failures in care allied to the lack of media interest
in the vast majority of those who receive excellent care. For example, while fear
of abuse was one of the most commonly cited reasons against wanting to move
into housing with care (54 percent of members of the public cited this47) a 2013
survey of 20,000 care home residents from 1,000 care homes found that 92
per cent of care home residents said they were happy living in their care home,
97 per cent of residents agreed that staff treated them with kindness, dignity and
respect and 95 per cent were happy with the care and support they received.48
2.4 An unaffordable system
The financial pressures on councils seem set to continue. The NHS is projected to
have a £20bn funding gap by 2020/21.49 And despite the fact that the Association
of Directors of Adult Social Services (ADASS) survey recently reported that more than
£3.5 billion has been saved from Adult Social Care budgets during the past four
years,50 councils are still facing a £12.4bn funding gap by 2020.51 This is largely as
37 National Institute on Health,
What is Osteoarthritis?
(Accessed December 2014)
38 Royal College of Nursing, Safe
staffing for older people's wards
(2012)
39 The King's Fund, Making our
health and care systems fit for an
ageing population (2014)
40 Alzheimer's Society, The journal
of quality research in dementia
issue 8 (accessed December
2014)
41 Alzheimer's Society, The journal
of quality research in dementia
issue 8 (accessed December
2014)
42 Triggle, N "Quarter of hospitals
'at raised risk of poor care', BBC
News (24 October 2013)
43 Beckford, M "Elderly suffer poor
care in half of NHS hospitals"
The Telegraph (13 October
2011)
44 ITV News, "1/3 'experienced
poor NHS care'" (14 May
2013)
45 Demos, Commission on
residential care (2014) define:
Care home is a housing
with care setting usually with
communal living and dining
areas, separate bedrooms, and
care staff on site. People living
in care homes might be older
or disabled people. The CQC
defines care homes as offering
accommodation and personal
care for people who may not
be able to live independently.
Some homes also offer care from
qualified nurses or specialise in
caring for particular groups such
as younger adults with learning
disabilities.' Unless stated, this
report will use 'care home' to
refer to both residential care
home and nursing homes.
Residential care is all
care delivered in specialist
accommodation. Residential
care therefore includes not only
residential care and nursing
homes, but also extra care and
care village settings, as well as
supported living.
Extra care describes a range
of settings where people have
their own apartments, set around
communal living and dining
areas and other on-site leisure or
health facilities. These are often
in 'village'-style layouts but can
also be more widely dispersed
within neighbourhoods.
Supported living describes
apartments lived in individually
or by small groups of people
where care is provided on site
- this might be round-the-clock
support, or for part of the day.
46 Demos, Commission on
residential care (2014)
47 Demos, Commission on
residential care (2014)
48 Ipsos Mori, Your care rating
2013 survey (February 2014)
49 NHS England, The NHS
belongs to the people - a call to
action (June 2013)
50 ADASS, "Social care services
'unsustainable'" (2 July 2014)
51 LGA, Future funding outlook
2014 (July 2014)