Older people, health managers and cheap tricks

4 Feb 2015 Nick Garbutt    Last updated: 5 Feb 2015

Claire Keatinge: speaking her mind

Older Peoples’ Commissioner Claire Keatinge had some tough messages for the health service when she spoke to Scope.

Keatinge is getting very frustrated about the lack of progress on the department’s flagship programme Transforming Your Care and has very little sympathy for the health managers charged with delivering it on the ground.

“It’s very clear that Transforming Your Care was an attractive policy in principle. The idea of being cared for in one’s own home for as long as possible with the levels of support and services that make it possible to lead a dignified, fulfilled and independent life is hugely attractive to most people of any age. However I don’t see the focus on rights of what older people can expect to receive. Instead what I see is chipping away at front line services making cuts without the involvement of older people and without reassessing what their individual needs are."

She says that these cuts are not matched by any clearly costed plan or any evidence of drive and leadership from the authorities.

“What I see is a promise of TYC but instead endless cuts, chipping away at older peoples’ rights and their confidence and their ability to live at home and I think this is entirely unreasonable and unfair.”

Health Managers Get Little Sympathy

And she has little sympathy for health managers who have been charged with driving forward change.

“There are a very large number of people being paid a very large amount of money to plan manage and deliver the Health and Social Care system. So we are not short of well-paid managers. Regardless of the nature of the system there are people who have a responsibility to plan for an ageing population. This is no surprise. It is both a national, a European and an international phenomenon. Everybody should be planning for it.

“I just don’t see leadership or drive and most certainly don’t see confidence and certainty amongst older people that they will have the support and services they need to lead dignified and independent lives."

She is incensed by cuts to front line services for older people as she says that there is no slack in the system on the front line and so cuts which to bureaucrats look “quick and easy” directly impact older people:

“Any spare capacity that there may be in the public sector does not exist amongst front line care workers, who are on turn around times so tight that they are often not paid between jobs and trying to make up time by giving the best care that they can."

Where the failings lie

Keatinge was not holding back, so Scope asked her if she felt any responsibility for spreading fear of and negativity towards the health service.

“That is an important question. I try very hard to ensure that in any media coverage I get that I am authoritative and independent and do not generate any further distress. Instead I want to create confidence in safeguarding the interests of older people and to seek remedies when they are needed. It is desperately important not to add to existing fear and distress. It’s also very important not to blame front line workers for failings in the system.

"I think too often criticism is directed at front line services and failures there instead of failures in planning, resources and leadership. Over and again older people say “I get a really good service, I like the person who came to see me, they are really kind to go above and beyond". Again and again stories of domiciliary care workers’ kindness attention to detail comes through: putting in hours they are not paid for, and stretching their own worktime to make sure the person’s needs are met.

“It is very important to reflect on that. Any failings we have got are primarily in terms of planning, transparency, rights and resourcing. When things also go wrong because there is bad practice in the service it needs to be addressed very hard and directly by the Trusts, regulator and the police if necessary."

Keatinge is furious about how some health commentators and authorities characterise older people.

Blaming older people for failings in the system

“We need to change the narrative. Those endless stories in the press that blame older people for clogging up the system as if they are somehow the problem are an absolutely shameful affront. If the investment was there to enable people to be supported in their homes there would be less admissions to A&E, less problems with medication, malnutrition and mental health and less mental health problems caused by loneliness and isolation.

“And nobody wants to stay longer in hospital than necessary. Clogging up the system and bed blocking can be prevented by the right care packages being available.

“Yet over and over again decision makers the media and people in authority blame the older person as if it is their fault that they needed an emergency admission or that it is their fault that the community care package isn’t there and that is a cheap trick."

It’s shameful.

She’s not giving the regulator, the RQIA, an easy ride either and says the health trusts must do much more to support and impose high standards.

“We need a robust plan for all of our care services affecting older people and that has to include setting the very highest standards not setting the “what is the least we can do” standards, investing properly in those services and regulating hard when there are failings and we need to be much more decisive about the responsibility of the trusts who purchase care.

“And again we have seen a number of occasions when nursing care facilities have failed in their duty to deliver even the minimum standards for an extensive number of years and yet health and social care trusts continue to place vulnerable older people in those homes and where the regulator has decided improvements can still be made and it is not right to close the facility or deregister it.

"We need to include the trusts in that regulatory process so that they take responsibility for purchasing care and for their placement of vulnerable people and they can’t take their hands off their responsibility for the care itself."

Keatinge’s office has recently carried out an economic valuation of older people, and the results demonstrate that far from a cost, and therefore a burden, older people make a net contribution to the economy.

“Older people talk a lot about feeling a burden. That is shameful. I am sick of hearing about the costs of ageing it does upset older people and creates a whole sense out there in the media that older people cost us money and this is not true.

"Just take one example. Scope readers will be aware that many voluntary organisations would be on their knees without the contribution of older volunteers."

It is clear that this debate is only just warming up and that trusts that cut care services to older people are waking up to the fact that this is not necesarily the "quick and easy" option Keatinge alleges they thought it was.

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