Feature

Any sense in going private?

Recent proposals to use private nursing homes for NHS ‘bed blockers’ haven’t been thought through, says Lorna Easterbrook

In the first May bank holiday Monday the Daily Mail and the BBC ran a story suggesting that the NHS might use private nursing home beds for older patients who no longer needed to be in hospital. And – as they say in Private Eye – er…that’s it. No details, no Department of Health press release, nothing (apparently) of any substance. Just the news reports with a cast of John Hutton (health minister), Dr Chai Patel (chief executive of Westminster Healthcare plc, member of the recently announced Partnership NHS modernisation action team, and author of the proposal), a case study – the daughter of an older woman who’d paid privately for a few weeks of ‘convalescent care’ in a private nursing home following a spell in hospital – David Hinchliffe (chair of the commons health select committee) and…er…me.

But what did the media reports say? In brief – because that’s all there was – lots of older patients don’t need to be in hospital but they can’t yet go home. The term ‘bed blocker’ featured more than once. Private nursing home care costs £400, compared with acute hospital’s £1200. Nursing homes have some spare capacity so this approach could save money and free up beds for other patients, all without the need for new buildings. And it would deliver the recovery/rehabilitation/convalescent/intermediate care older patients need but which hospitals can’t deliver.

And there you have it. This last point throws up one of the most important and confused aspects, namely: what is such an approach expected to achieve, exactly? Recovery, rehabilitation, convalescence and intermediate care all tend to mean different things to different people. Clarity about the expected outcomes is essential before a judgement can be given on whether care could appropriately be provided by nursing homes.

The practical issues generate more questions than answers. For example, do nursing homes already employ appropriate staff and, if not, how would they be attracted given the shortage of nurses and therapists in all sectors? Would GPs be able and willing to offer medical supervision? What about community geriatricians? Would nursing homes – with a history of caring for increasingly dependent people – foster an ethos of care aimed at increasing independence and helping people move on? What might be the effect on permanent residents if homes introduced short-stay patients? And perhaps most important, what would happen once the short-stay in the nursing home had come to an end? Isn’t there a real risk that this nursing home provision becomes just more beds to be blocked?

On a positive note, the NHS would at least fund this care, something that many might welcome given its large-scale withdrawal from long-term care over the last two decades. The story was also promoted as providing something positive for older people – albeit something that still seemed rather wrapped up in the value-laden language of ‘bed blocking’. In addition, permanent residents in nursing homes might also benefit if homes’ overall care ethos followed a more therapeutic approach, or if they gained access to potentially increased numbers of community-based specialist staff.

Even so, the underlying ideology needs some careful consideration. In the overall scheme of long-term care for older people, using public funding to pay the private sector to deliver the state’s functions has become very much par for the course. Indeed, within some elements of social care one might argue that the only thing that is still mixed about the current economy of care is that the state funds what the private sector provides. But the argument that this specific proposal would not represent a huge shift in the overall system of providing and funding care for older people misses two key points. First, most of the shift has been within social care. For the NHS to take this route would indicate a significant change and potentially herald the future restriction of direct NHS provision to active medical treatment, at least in terms of hospital care. The second point is that even though this shift has taken place within social care, much of the preceding discussion centred on precisely the same pragmatic approach being cited in support of this proposal. In other words, the ideological debate may still need to take place.

Perhaps more importantly, this announcement came before the consultation period on the Department of Health’s national beds inquiry had even ended. This document began as a study of acute hospital beds but developed into a study of the care needs of the elderly for the next 10 to 20 years. This is where the consideration of alternative care models should be located. But it may well be that we are in for more of these ‘news item’ debates over the next few months, particularly while the government consults on its proposed ‘national plan for the NHS’. Spotting the firm government proposals among ministerial kite-flying of possible future policy options may increasingly become the most pressing task for the rest of the year.