Intended for healthcare professionals

Education And Debate Regulating nursing homes

Caring for older people in the private sector in England

BMJ 2001; 323 doi: (Published 08 September 2001) Cite this as: BMJ 2001;323:566
  1. Susan H Kerrison, Rubin research fellow,
  2. Allyson M Pollock, professor (
  1. Health Policy and Health Services Research Unit, School of Public Policy, University College London, London WC1H 9QU
  1. Correspondence to: A M Pollock

    This is the last in a series of three articles

    Over half of all beds allocated for health care in the United Kingdom are in independent nursing homes for older people; this is a result of policies initially introduced to change the basis of social security payments1 and now directed towards privatising long term care. Official statistics from the Department of Health indicate that between 1979 and 2000 the total number of beds in the NHS in England decreased from 480 000 to 189 000, while the number of beds in the independent sector, which is run mainly for profit, increased from 23 000 in 19832 to 193 000 in 2000.

    Experiences in the United States and Australia have shown the lack of political will to promote the interests of residents against the interests of the industry and its shareholders. 3 4 In Australia the industry successfully lobbied to replace legally enforceable regulations with less effective accreditation schemes; this has had disastrous consequences. In the United States the industry successfully opposed the introduction of robust standards for minimum numbers of staff, and the result is continuously declining health outcomes for residents. The risks to residents of nursing homes in the United Kingdom are considerable as subsidiaries of large US multinationals enter the United Kingdom5; some of these companies have come under scrutiny in the United States for fraud and embezzlement of government funds and for abusing patients.3 This paper considers whether the new regulatory framework for nursing homes in the United Kingdom offers adequate protection for patients.

    Summary points

    Over half of the healthcare beds in the United Kingdom are in independent nursing homes for older people

    Little information is collected centrally about the needs for care or outcomes of services used by residents of nursing homes …

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