David Oliver: The crisis in care home supplyBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4076 (Published 02 October 2018) Cite this as: BMJ 2018;363:k4076
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Home is hope, but no home is nope: no address, access, ingress, egress, or recess. With its noxious no-nos and no-gos, homelessness is a hellish mess of helplessness. To quote William Wordsworth, "And homeless near a thousand homes I stood. And near a thousand tables pined and wanted food."
Competing interests: No competing interests
David Oliver rightly identifies a challenge in the health and care landscape. Many are waiting for the Green Paper as a new messianic totem but it is likely to be disappointing, why? Care Homes neither fit the paradigm(s) of the NHS or social care.
Talk of medical complexity is its odds with the basic care needs characteristic of most residents. Similarly, talk of promoting independence and autonomy is at odds with the more usual progressive frailty and dependence. Whilst Palliative care has transformed many confronting insuperable illnesses the prolonged processes of escalating dependence often without specific watershed or medical symptoms make end of life care as widely perceived a poor fit.
Simply, there is little clarity on purpose, let alone who needs to do what in the process of care, and regulation has proved a flawed instrument. Building a business case on such foundations and previous datasets and reports is likely to produce similar if slightly differently presented solutions to previous attempts to produce a sustainable solution.
What we need is another Royal Commission, the game, the pitch and the players have changed. I would hope it would recognise the need for a National Care Service with specific eligibility criteria and a role for both long term and short term care in Care Homes. Taking these items away from overstretched Health and Social Care will allow new distinct funding models that recognise the epidemiology of the new demographics. It also would allow a new approach to care management, medical support and care home provision.
Unless such a radical approach is adopted we will continue to witness muddled thinking, choked hospitals, neglected elderly people and continued negativity.
Competing interests: I am a NED to a small Care Home Group and Chair a technology company working with care homes