Social Care is Nursing Care  By Jean Calder

All major political parties seem to agree that the NHS is a ‘treasure’ and must remain free at the point of use. Politicians differ as to the extent the private sector should be involved in delivering services, but it’s taken for granted that the care of the sick is currently free and that charging applies only to dentistry and prescriptions. In fact, this is an outrageous lie – a political con trick played on the British people. 

When I first came to England in 1972, most general hospitals had what were then called ‘geriatric wards’ for elderly patients with long term needs. There were also psycho-geriatric wards for those with dementia, where the assumption was that patients would almost certainly remain until death. Until the government closed them, every county had a large psychiatric hospital and there were large numbers of specialist hospitals for people with learning disabilities or dementia. These institutions were run by the NHS and most had the capacity to accommodate people until death.

No one would mourn the loss of the old geriatric wards and long stay hospitals. They were horribly institutional and though some were well run, providing good care and genuine ‘asylum’, others fostered abuses of power as bad as anything we’ve seen more recently in some care homes. However, the one thing you could say for all of them is that they were there, free at the point of delivery and were part of a genuinely national NHS which had not yet been divided into competing trusts.

These wards and hospitals were ripe for reform, but in the 1980s and 1990s, instead of being improved or replaced, were nearly all closed, while inadequate housing and community services were provided for future need. Patients were denied nursing care by the simple expedient of pretending they didn’t need it. Instead, elderly people requiring 24 hour care for complex illnesses, such as dementia and Parkinson’s, were told that the care required was ‘personal care’ rather than nursing care and thus not the responsibility of the NHS. 

It can hardly be co-incidence that around the same time, the State Enrolled Nursing qualification, which had trained practical nurses to provide basic and essential nursing services (services which would certainly have been recognised as nursing by Florence Nightingale), was phased out. SENs were offered the chance of upgrading their qualifications and required to undertake duties which were previously the responsibility of more highly trained Registered Nurses. Basic nursing care for patients – including essential tasks such as maintaining personal cleanliness, providing bedpans and ensuring patients eat and drink – was devolved to under-trained, poorly paid and badly supervised care assistants, with disastrous results.

The policy of so called ‘community care’ decimated services for vulnerable adults, replacing much of it with inadequate privatised housing and support services. Older people, in particular, were forced to make do with limited access to means-tested council care services or private ‘care packages’, paid for by the local authority (or by themselves if they had assets of their own). Private companies made a killing from services which were at best inadequate and at worst life-threateningly bad.

In theory, those at the end of life or with complex needs, have a right to NHS funding for appropriate residential care in the community (known as NHS Continuing Care funding). In reality, few receive it. The NHS does all it can to prevent widespread access to these funds by the simple means of: failing to publicise the existence of the funds; turning down most applications, forcing families to appeal; making the application process extraordinarily time-consuming, opaque and complex so that legal advice is often required; failing to properly educate health professionals and care home managers, whose notes are crucially important in progressing these applications; and, when applications fail, relying on local authorities and families to take up the financial slack.

Lawyers who work in this field say they quite often have to advise patients with a clear right to funded nursing care, that the financial risks of pursuing an unsuccessful application and then having to appeal would be too great – especially if means-tested funding is available from the local authority. In this way, cash strapped local councils are forced unwittingly to subsidise both the NHS and private care companies – while patients are often denied the skilled nursing care they need. 

The situation is a scandal – but not one I heard addressed in the General Election campaign. I fear that, under cover of reorganisation and recent cross-party talk about integration of nursing and care services, NHS Continuing Care funding may, by sleight of hand, quietly be abolished. 

After all, how can we defend a service most of us never knew we had?


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