Social care - long term care
April 2002
The BMA commends the Scottish example of fully funding the personal care element of long term care of the elderly and deplores the Government’s failure to introduce similar measures in England. Asking patients to fund such care is the equivalent of a tax on the sick. The BMA calls on the Government to follow the Scottish example.
The broad definition of long term care should include all care received by people unable to live at home without support. It should encompass long term care in hospitals, nursing and residential homes, and the health and social services support people receive in their own homes. In the case of the latter, the majority of long term care for individuals in their own homes is provided by unpaid carers, usually family members.
- The BMA believes that a state funded NHS should continue to be responsible for long term health care, and health and social local authorities should work together to ensure that long term social care is provided.
- There is no clear line between health care and social care which means that doctors are being asked to make arbitrary decisions on whether their patients' needs, and the care required, are the responsibility of the health service or the local authority.
- The separation of personal care from nursing care is artificial and will not solve the problems experienced by older people who require nursing home care. We believe that this split will lead to greater bureaucracy and could drive down the nursing skill mix in nursing homes.
There is a need for increased flexibility in patterns of care and for care which allows patients to move more easily between home and institutional care and between health and social care. This would be facilitated by better joint working between health and social services departments and integration of health and social work teams. Currently only a limited number of areas have adopted joint working schemes as introduced in the Health and Social Care Act 2001.
The proportion of elderly peope over 65 is expected to increase from about one in six of the population to about one in four by the middle of the next century. Within this group, the very elderly will make up an increasing proportion. It is expected that the number of over 85 year olds will rise from 0.9 million in 1992 to 2.9 million in 2061.
The Health Survey for England 2000 showed that 4% of people aged 65 and over are resident in care homes. Three in ten residents were in a care home for less than a year, while a fifth were there for five years or more. Three out of four care home residents are severely disabled, with senile dementia the most commonly reported disability.
The Statistical Bulletin, "Community Care Statistics 2001: Residential Personal Social Services for Adults, England" showed that at 31 March 2001:
- There were 341,200 residential places in 24,100 residential care homes and 186,800 registered beds in 5,700 nursing homes, private hospitals and clinics.
- Between 2000 and 2001, there has been a 4,700 decrease in the number of residential care home places (1%).
- Between 2000 and 2001, there has been a 6,500 fall in the number of registered beds in nursing homes (3%) suggesting the number of beds is 5% lower than in 1997.
- The number of residents supported by local authorities in local authority residential, independent residential, nursing and other homes has decreased for the first time since 1994 to 261,800.
- Over half (54%) of supported residents were in independent residential care homes, 27% in independent nursing homes, and 16% in local authority staffed homes.
- Between March 2000 and March 2001, councils provided 2.88 million "contact hours" of home care services to 395,500 clients in 381,200 households. This represents a 3 per cent increase in contact hours but a 4 per cent fall in the number of households receiving home care. This is the continuation of a trend over the last decade.