News and Comment from Roy Lilley.

How much credibility can you attach to a study that involved talking to 14 people, outcomes for a handful of patients and four places? 

Not a lot…

Why would it take five people?  I have no idea.  How could it be so complicated as to require a ‘mixed methods approach, incorporating retrospective cohort analysis and semi-structured interviews conducted with staff’.

Gawd knows…

Except, I’m pleased someone has done it.  It’s the Nuffs.

It’s a vanity project commissioned by the Barking and Dagenham, Havering and Redbridge CCGs to evaluate their new primary care service, piloted in four nursing homes who previously had difficulty accessing GP services.   

They knew it was good and very similar to approaches elsewhere and a hoop-la evaluation was superfluous but…

The NHS struggles with a hidden problem.  Something we don’t talk enough about.

Think very carefully before you put yer granny in a care home.  They don’t want to be useless and they don’t set out to be useless  but a combination of circumstances conspires to make the whole care home concept useless, worrying and in some cases unsafe.

There was a time when there was an identifiable difference between a care home and a nursing home.  Not any more.  

Yer granny goes into a care home because she needs a bit of help to rub along.  Before you know it, her daytimes are nowhere near meaningful, one week blurs into the next.  

Family don’t pop-in as promised.  She misses her neighbours.  Her husband died four years ago and each day brings its aching memories and loss of companionship.  

She is forced to live with people she doesn’t know, many of whom can’t remember who she is today, tomorrow or yesterday.

Medication management is lazy, she stops eating properly and retreats to a room with a single bed and pictures of her memories on a shelf.  The rest in a box in the wardrobe.  She knows she’s warehoused, waiting to be with her husband.

Her acuity drops off a cliff.  She’s confused by staff whose first language is not English and churn so frequently she has no idea what’s what and who’s who.

By then she’s on the cusp of nursing care but she is in a care home.  When the Nora Virus does the rounds the staff, untrained to cope, terrified of liabilities, ring for an ambulance.

Don’t tell me none of this happens… I get ten emails a week about care home standards.

Somebody wrote to me the other day.  They work in a care home that, six times, called for ambulances, for six different residents, in one day. 

A&E admissions from care homes  are up by 62%.

When it’s time for yer granny to be discharged, because she lives in a care home and not a nursing home, she’ll need a visit from the community nurse, the community pharmacist, the chiropodist and a GP… don’t expect a care home to do this.  It’s a nursing job.

Then there is money-thing.  There isn’t any.  Local authorities buy care home places, priced at the bone.  If yer granny has to pay for herself; she’ll be ripped off.

Quality of the care… forget it.  A quarter of the big homes might be failing.  

Really?  I hate to think about the rest.  One home a week going broke.  The CQC are spectators.

Don’t put yer granny in a care home.  Go on a carers course, take leave of absence from work, use yer granny’s money to replace your wages and look after her yourself.  If the government had any sense they’d encourage this with tax breaks.

I can’t think of a more fragile corner of health and social care provision, policy that is so moribund, politicians so useless, society so left gawping.

Twenty seven organisations claim to represent the interests of the elderly and when push comes to shove… what have they done?  Care homes… do me a favour.

The Nuff’s dinkey-do report is right.  Dynamite right, it tells us what we already know.  But, we can’t say it often enough.

The Academy has examples; here, here, here, here, here, here, here, here, here of which these are just a few.

The uniting theme, predominately, improvements arise out of frustrations with poor care-home performance, third parties going in to sort them out.

It should not be like that.  The industry and the CQC need to step-up, fix this.  Care homes must up-their-game.  There are no nursing homes, no care homes, just safe homes.

The real message; do not register a care home without a rock solid balance sheet and a performance bond, 24-7 nurse prescribing on the premisses, weekly visits from on-call GPs and recognise…

…the clue is in the word, c a r e; comprehensive, available, robust and effective, not warehouses. 


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Reproduced at TrainingPrimaryCare.com by kind permission of Roy Lilley.