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CQC Data Reveals Erratic and Inequitable Access to NHS services for Older Care Home Residents

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Over half (57%) of older people resident in care homes do not have access to all the NHS services that they may require reveals data collected by the Care Quality Commission (CQC) as part of a Special Review into health support to care homes and analysed and published today by the British Geriatrics Society (BGS) under a data-sharing agreement. The data shows that primary care trusts (PCTs) do not accord sufficient priority to care home residents when planning and ensuring the delivery of local healthcare services. This has resulted in considerable variation in the extent to which their healthcare needs are being met. The BGS report has been published at the same time as the CQC report to complement its findings.

There are 376,250 older people living in 10,331 care homes in England[1] and the majority are frail with multiple needs and require help with self-care. Over 40% suffer from dementia.[2] The BGS report Failing the Frail: A Chaotic Approach to Commissioning Healthcare Services for Care Homes  based on its analysis  of the CQC data focuses on the provision of NHS healthcare support to care homes and confirms many of the findings of the BGS’s inquiry Quest for Quality published last year. This described the unmet need, unacceptable variation and often poor quality of care provided by the NHS to older people resident in care homes.[3]

The BGS analysis has drawn the following key conclusions:

1.      Limited access for care home residents to specialist geriatric care. Only 60% of PCTs have ensured access to a geriatrician.

2.      Variable access of care home residents to community health services. CQC’s data shows significant variations in the specialist services available to older people (including  mental health teams, dietetics, occupational therapy, physiotherapy, podiatry, continence, falls and tissue viability) with 52 different combinations across 152 PCTs.  Only in 43% of PCTs are older people likely to have access to all the services listed above.

3.      Healthcare commissioners interest in their services for care homes is limited. PCTs can use response or waiting time standards to ensure that people can access their services.  PCTs had set a standard and provided data for just 39% of care home specific services. 40% of all services lacked a response standard. While 87 (63%) PCTs monitored all the response standards they had set, 50 (36%) only monitored some.  Furthermore, response standards varied greatly between services and areas. Some providers had testing response standards of two weeks or less, but standards of between six to eight weeks were common and the general NHS ‘18 week target’ was used for 31% of services.  Despite these non-ambitious standards, they were not met in nearly half of services for which there was data.

The fault in many cases is not with care homes but with those responsible for ensuring that the NHS plays its part in ensuring that healthcare needs of residents are met. The BGS strongly recommends that local health service commissioners should ensure that clear and specific service specifications are agreed with their local NHS providers to meet the needs of older care home residents.  These need to link with quality standards based on patient experience and appropriate clinical outcomes.

Professor Finbarr Martin, BGS President and co-author of Quest for Quality said: “We are delighted that the CQC has finally published this report.  The data set which we analysed confirms our fears that the healthcare needs of older care home residents are being neglected in some areas as we identified in our report Quest for Quality.

“We are deeply concerned that having identified this important issue from the CQC data, CQC no longer has responsibility for monitoring the work of commissioners and we are currently in a transition phase to a new configuration of commissioning arrangements in England.  Who is looking out for the needs of this very vulnerable group of older people?

“It is evident that while there are pockets of excellent NHS care such as in Sheffield, Leeds or South Manchester there are striking geographical differences.  It is unacceptable to leave people waiting for over three months to receive treatment which could  significantly improve their quality of life, especially when you consider that the average life expectancy of an older person entering a care home is between one and two years.  It is time that commissioners and health service planners matched their obligations to ensure that the healthcare needs of this vulnerable group are adequately met.

“For our part, the BGS is developing a series of materials and case studies to help commissioners develop appropriate services and recommends that NICE considers the development of quality standards for integrated care home care.”

This issue has been raised in Parliament by MPs through the tabling of Early Day Motion 2578 which calls for improved access to NHS services for care home residents, especially with regard to the provision of medications management, dementia care and end of life care.

Notes to editors

1.      For further information on the CQC data, including breakdowns of the findings mentioned above, and on the BGS report Quest for Quality, please contact Tom Thorpe on 07766 227724  or Iona-Jane Harris on 07807 231432 or email This email address is being protected from spambots. You need JavaScript enabled to view it.  We can arrange interviews with spokespeople and experts.

2.      Failing the Frail: A Chaotic Approach to Commissioning Healthcare Services for Care Homes. The Care Quality Commission (CQC) special review of healthcare support for care home residents published on 7th March 2012 has two elements. Firstly, a survey of all 152 Primary Care Trusts (PCTs) in England to identify what services they were providing to care home residents in their area.  The second stage was to use the survey findings to identify nine PCTs areas to undertake inspections and interviews with residents and staff.  The CQC has not published data from the first stage but under a data sharing agreement with CQC the BGS analyzed the survey data from the first element with specific regard to the healthcare services received by older people. Our analysis of the data supports the conclusions that the BGS made in its inquiry in to NHS support to care homes Quest for Quality.[1] This tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 376,250 older people resident in England care homes. [2]

3.      About the Quest for Quality. This was a BGS led inquiry into the quality of healthcare support for older people in care homes: a call for leadership, partnership and improvement. It was launched in June 2011 and describes current NHS support for care homes. It tells a story of unmet need, unacceptable variation and often poor quality of care provided by the NHS to the estimated 400,000 older people resident in UK care homes. It describes what should and could be done and calls for national action by government and local action by NHS commissioners, planners and clinical services to improve the quality of NHS support to care homes. It highlights the need to build joint professional leadership from the health, social, and care home sectors, statutory regulators and patient advocacy groups to find the solutions that none of these can achieve alone.

The report sets out the following problems:

Care homes residents have complex healthcare needs, reflecting multiple long-term conditions, significant disability and frailty.

The social care model is central but insufficient to meet residents’ health needs.

As the independent sector grew to take on this area of care over the last three decades, the NHS gradually withdrew its expertise and support. Most geriatricians and old age psychiatrists now play no part.

Regulation can highlight problems and promote improvement but care home providers cannot achieve this without necessary support.

No model of co-ordinated healthcare has been developed to meet the needs of care home residents. ‘Traditional’ general practice in many areas does not appear equipped or supported to fill this void.

Our report shows that many care home residents are denied equitable access to suitable NHS primary and secondary healthcare. While NHS policy makers, commissioners or managers acknowledge that there are problems, they have little consensus on their obligations to address this. Ensuring effective healthcare for individual residents and effective support for care homes seems to be a low priority. As a result, residents are denied the necessary healthcare resources, support and expertise they need and many are inappropriately admitted to hospital.

Care homes will continue to be an important component of care provision for frail older people. But healthcare for residents remains a “Cinderella” service in the NHS. This is a betrayal of older people, an infringement of their human rights and is unacceptable in a civilised society.

4.      About the British Geriatrics Society (BGS): The BGS is a multi-disciplinary professional membership association that seeks to promote better health and care for older people. We do this by holding scientific meetings, producing clinical guidelines, sharing best practice and acting as an ‘expert voice’ on the care of older people and promoting better health in older age. We have over 2,500 members including doctors practicing geriatric medicine, old age psychiatrists, general practitioners, nurses, therapists and scientists. For more information please visit www.bgs.org.uk

5.      Professor Finbarr Martin, Consultant Physician at Guys and St Thomas’ Hospital and President of the BGS. Dr Martin has been an NHS consultant geriatrician since 1984, working across acute and community services. His clinical and research interests include falls and frailty, delirium and intermediate care in the community. He has been a clinical director of medicine in his trust and had various local and leading national advisory roles.

6.      Older people in care homes.

In England 376,250 older people live in 10,331 care homes.[4]

Care home residents comprise about 4% of the UK population aged 65 and over, but nearly 20% of those are aged 85 and over.[5] Future demand for care homes is forecast to rise by perhaps 150% over the next 50 years.[6] In Scotland, if age specific rates of care home provision do not alter significantly, their requirement for placements is estimated to increase from a current 33,000 to over 57,000 residents by 2028 (a 72% rise).[7]

Many older people who live in care homes have high levels of healthcare needs. Some reports have suggested that three quarters of people in care homes have a disability.[8] Others have found that 57% of women and 48% of men needed help with one or more 'self care' tasks.[9] A survey by Bupa in 2003 of 16,043 people resident in 244 Bupa care homes (25% residential and 75% nursing) across the UK identified that: 78% had at least one form of cognitive impairment, only 22% were said to have a ‘normal’ mental state and 64% were ‘confused’ or ‘forgetful’. [10]

A survey conducted by the Commission for Social Care Inspection (CSCI) of 657 care homes in England found that 40% of residents had particular needs as a result of dementia, and over 84% of homes in the survey had at least one resident with dementia.[11] In England, around 208,000 people with dementia live in care homes, with 91,000 of those in dedicated dementia care beds.[12]

[1] Quest for Quality, British Geriatrics Society, June 2011

[2] The Adult Social Care Market and the Quality of Services, Care Quality Commission, November 2010, Figure 7: Places in homes for older people by population aged 65 and over, 7.

[1] The Adult Social Care Market and the Quality of Services, Care Quality Commission, November 2010, Figure 7: Places in homes for older people by population aged 65 and over, 7.

[2] The state of social care in England 2007-08, Commission for Social Care Inspection, February 2009, 45.

[3] Quest for Quality, British Geriatrics Society, June 2011, 3.

[4] The Adult Social Care Market and the Quality of Services, Care Quality Commission, November 2010, Figure 7: Places in homes for older people by population aged 65 and over, 7.

[5] Care homes for older people in the UK - a market study, Office of Fair Trading, Annexe K, consumer behaviour and care homes - a literature assessment, May 2005, 7.

[6] Wittenberg R, Comas-Herrera A, Pickard L and Hancock R, Future demand for long-term care in the UK. A summary of projections of long-termcare finance for older people to 2051. York. Joseph Rowntree Foundation 2004.

[7] British Geriatrics Society Scotland and Royal College of General Practitioners Scotland, Frailty, Older People and Care Homes, Can we do better?: Improving What we do? October 2009, 8.

[8] Care homes for older people in the UK - a market study, Office of Fair Trading, May 2005, 21.

[9] Care homes for older people in the UK - a market study, Office of Fair Trading, May 2005, 22.

[10] Help the Aged, Quality of life in care homes, A review of the literature, 2007, 96-97.

[11] The state of social care in England 2007-08, Commission for Social Care Inspection, February 2009, 45.

[12] National Audit Office, Improving Dementia Services in England – an Interim Report Part One, 2010, 18.

 

 

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