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Education And Debate

Long stay care and the NHS: discontinuities between policy and practice

BMJ 1998; 317 doi: (Published 03 October 1998) Cite this as: BMJ 1998;317:942
  1. A R Turrell, senior research fellowa,
  2. C M Castleden, professorb,
  3. B Freestone, joint planning officerc
  1. aUniversity of Sheffield, Trent Institute for Health Services Research, Sheffield S1 4DA
  2. bMedicine for the Elderly Department, Leicester General Hospital, Leicester LE5 4PW
  3. cLeicestershire Health Authority, Leicester LE5 4QF
  1. Correspondence to: Dr A R Turrell
  • Accepted 29 May 1998

The rapid growth of residential and nursing homes in the independent sector and the absolute and relative decline in continuing care beds funded by the NHS have established the former as the major provider of long term care in the United Kingdom.1However, the distribution of homes is uneven, producing wide variations in the range and type of local provision. This presumably results in competition for places in homes and some misplacement of older people in areas where there is poor provision of places relative to demand. These outcomes are the result of a range of factors shown in the box.

Independent long stay care

Factors in the growth and distribution of long stay care in the independent sector include the following:

  • Poor and ineffective planning

  • Financial incentives operating on independent sector care providers

  • Growing demand from an ageing population

  • Market forces dominating the pace and location of independent sector provision

  • Reactive and partial legislation impinging on homes and processes of placement

The impact of the National Health Service and Community Care Act on residents in long stay homes is unclear. Before 1993 the lowest reported percentages of independent or minimally dependent residents in residential homes and nursing homes in the United Kingdom were 19% and 12% respectively.2 The impact of needs led assessment and eligibility criteria of social services departments under the act should have increased the level of dependency of old people in long stay care. However, this assumption and its implications for the NHS, like many others, has not been explored in research published in the United Kingdom.

Summary points

The independent sector now provides most long stay care for elderly people

The ageing population in homes will result in greater demands for NHS support

Failure to maintain best nursing practices and lack of specialist knowledge in many homes places special demands …

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