PAUL WILENIUS: In a modern Health Service,
patients have to keep moving. To cut waiting lists, to free up beds, to
make way for more operations. Tony Blair's spending billions of pounds
to create an effective and modern Health Service. Yet his plans to revive
it could be held back by the number of blocked beds, which are clogging
up the system and leaving parts of it idle. Ministers have been given
a real health scare by the number of beds blocked in NHS hospitals across
the country. The crisis, caused mainly by the rapid decline in the number
of care homes beds, could undermine key Health Service reforms. The government
wants to ease that crisis, by giving more money to local councils and by
imposing fines, but critics say this won't lead to a full recovery.
Time for tea at Triscombe ward in Taunton's Musgrove Park Hospital. Joan
Evans has been waiting a month to be discharged. She wants to be near her
home in Bridgewater, but there's no beds. So she's having to stay in an
expensive hospital bed because there aren't enough available in care homes.
But she's not alone as there's another six thousand like her in beds across
GILL MORGAN: It can be costly in terms
of time but the most important thing is what it does to the rest of the
system. It's like having a lock on the end of a flow. So what it does,
it actually stops people getting in to hospital at the front end of the
treatment and that's where the big anxiety runs, because obviously it impacts
on things like treating people with waiting lists, handling emergencies
and that's where the cost to the NHS really comes.
DAVID HINCHLIFFE MP: The Health Committee last
year did a calculation that on the basis of six thousand blocked beds average
per day in the NHS then it was around seven hundred and twenty million
pounds a year. My personal view is that that is a gross under estimate
of the cost because that only takes account of the actual costs of an acute
WILENIUS: Indeed the true cost
to the NHS will be revealed to be nearer one billion pounds a year in a
Select Committee report this summer and it's even accepted as a major problem
JACQUI SMITH MP: What we are clear about
is that it isn't good for the whole system, it is not good if older people
are in beds that are not appropriate to them and which potentially could
be used for something else.
WILENIUS: Casting a little sunshine
over residents in the autumn of their lives is the role of staff at the
Tyndale Nursing Home in Yeovil. But many care homes like this across the
country have closed down in recent years. Falling fees and rising costs
are pushing many out of business, the whole sector is in serious trouble.
PAUL BURSTOW MP: When it comes to the crisis we've
already got in the care home sector I think that the government has yet
to do enough to stabilise the situation. I think things are going to get
a lot worse before they get better, the fact of the matter is that we've
already lost fifty thousand care home beds in the last five years, the
trend suggests that that's going to carry on and not only that, people
are not coming into this sector.
WILENIUS: Hilary Cobban, owner
of the Tyndale care home, has seen the volume of paperwork increase dramatically
and now costs are rising further with new regulations imposed by the government.
They lay down rules on room and corridor sizes, installing lifts and staff
training. She fears they'll have a big impact.
HILARY COBBAN: One of the problems that
is facing the smaller homes at the moment, is the introduction of the new
care standards which came in in April of this year. We all accept these
standards and we welcome them, because indeed they are very good standards,
they're national standards but they are going to be extremely costly.
WILENIUS: New regulations aren't
the only problem. Many residents require intensive nursing from skilled
and dedicated staff and those costs are rising too. So Tyndale is reluctant
to take social services funded patients, paying around three hundred and
eighty pounds a week. Fees must rise to stop the loss of more care homes
and beds, say industry experts.
WILLIAM LAING: We estimate that very roughly
across the country as a whole, the local authorities are underpaying by
about seventy or eighty pounds a week. So that's the sort of figure that
they have to come up with.
WILENIUS: On The Record has seen
a worrying report from Somerset County Council showing that the introduction
of new care standards will mean that even more beds could be lost over
the next six years. Unless more new care homes are opened up to replace
those that closing, up to eight hundred beds could be lost in this county
COBBAN: There are certain exit
strategies and yes, various homes will be closing as the owners, proprietors,
get to retirement age and wish to retire, and of course that's been exacerbated
now by the increase in property values in this area and the properties
are now worth a lot of money and might well be worth more money just to
be sold for the ordinary retail property market.
BURSTOW: The booming property market
in the South East has been a significant driver in the closures of a number
of care homes that people have made the decision, understandable from their
own personal point of view that this is their nest egg for their retirement,
they're leaving the market, they're selling on the home and it's much better
redeveloping it from their point of view for flats for people to buy, than
it is to continue to receive the meagre fees that they get from the local
social services to care for elderly people.
WILENIUS: The government has come
up with a carrot and stick approach to help ease bed blocking. It'll be
generous and give extra money to social services, to help pay for more
care home beds. But if hospital beds aren't cleared, it's planning a new
system of fines and charges to try to remedy the crisis.
SMITH: It is important that we
put in place the incentives that are necessary, we will talk as we have
done to our partners about how that is necessary, but I am very clear that
when we are putting significant extra investment, as we are, into social
services departments and into the NHS, we also need to put in place the
systems to ensure that that money is spent most appropriately.
HINCHLIFFE: I've not yet met anybody in
social services or the NHS who believes that the idea of fining social
services for blocked beds makes any sense whatsoever. And I think that
many in the Health Service are perhaps more hostile than Social Services.
WILENIUS: The government's critics
say that, as in Scandinavia, where idea came from, the government will
need to put in a lot more money. Ministers will dish out an extra four
hundred million pounds next year and a six per cent rise in spending each
year for the next three. Yet there are fears this could be diverted into
other services, like child care and mental health and that nationally it
won't satisfy the hunger for extra cash.
RODNEY BICKERSTAFFE: Four hundred million, now
that's not a very large amount of money when you know all the councils
throughout the UK and you know all the potential problems about well, what
about training and recruitment of staff, nursing staff and care staff in
residential accommodation in nursing homes and the like.
CHRIS DAVIES: I think if all that new money
could be applied to care home fees, then it would make a significant difference.
But that can't be the case. There are lots of other pressures within Social
Services that will also have to be addressed, with that money.
WILENIUS: You don't think the money
will go very far really?
DAVIES: I think it's important
to wait and see and there's a lot of work to bed done on those figures.
But there's a huge gap to close.
WILENIUS: Thelma and Kitty are
inseparable in the Tyndale care home. They share a passion for knitting
and also a room full of fond memories. Experts in the care home sector
say the government will need to put in much more money to modernise homes
and stop the whole industry unravelling.
LAING: In order to fully modernise
quote unquote the care home sector, to make it fully compliant with all
the new physical requirements and regulations over a period of say five
years, you would need at the end of the day to be paying about one billion
pounds more than you're paying now for care home fees.
WILENIUS: And it's not only our
elderly residents who are flexing their muscles. Senior MPs in all parties,
local government leaders and even powerful NHS managers say fines will
do more harm than good.
MORGAN: They are also concerned
that if there's a pressure in the system to get people out of hospital,
people will be moved out too early, or placed inappropriately in a home
or somewhere that may not actually suit their individual needs, that wouldn't
be good for the system, and wouldn't be good for health care. But if you
start fining between one organisation and another, where does it stop?
Could local government then fine the Health Service for re-admissions
to hospital? How do you actually get into what's appropriate and not appropriate?
DAVIES: This is likely to introduce
perverse incentives which actually result in the wrong decisions being
made for elderly people, and it will deplete the resources we've got to
pay for home carers, night sitters, residential care homes and nursing
WILENIUS: On The Record has learned
that Ministers are talking to senior local government leaders to try to
make this policy work. It's vital for the government's own political health,
to show before the next election, that the condition of the NHS really
is improving. And as the grey vote is increasingly significant, the way
the government treats old people is more important than ever.
BICKERSTAFFE: If there are fifty nine million
people and if over the course of the next thirty or forty years the fifth
of the population over pension age now is going to move towards a third,
this is a huge amount of voters which I think all political parties are
going to have to come to terms with. Older people are almost twice as
likely to vote at all as people in the eighteen to twenty-four age bracket
and I think that it will become an electoral, almost a manifesto necessity
to say, well something has got to be done for these people. So it will
HINCHLIFFE: I'm very conscious that in
my constituency and elsewhere in the country the older constituents are
more prepared to use their vote and I believe that there are many old people
who are saying look the kind of second rate service we've offered them
over the years is no longer acceptable.
WILENIUS: Through no fault of her
own, Joan is still waiting to be discharged. If the government doesn't
do more, they'll not just incur the wrath of elderly voters but risk its
plans for the NHS.
HINCLIFFE: The fact that we are
wasting huge resources by inefficient use of acute beds, in some hospitals
I'm told a third of the beds are occupied by people who don't need to be
there, means that we cannot make progress on other fronts, it's an urgent
issue that needs to be resolved, it's a long-standing problem.
BURSTOW: I think the government
will fail to deliver on the NHS plan unless it finally wakes up to the
fact that health and social care are two sides of the same coin. If you
under invest in one you undermine the other, and we've seen that in spades
when it comes to delayed discharges in the NHS.
WILENIUS: One day Tony Blair will
himself get old and New Labour will no longer be new. The question is,
will he be able to look back and say that he improved care for the elderly
and put the NHS on the path to recovery?