Funding Institutional Care
Archie, Bertie and Charlie are all elderly and require full-time institutional care: food and accommodation, supervision and security (they need to be kept in) and visits from family and friends. Archie is the lucky one: he has his own bedroom and his institution is dedicated to making his stay as pleasant as possible. Bertie shares his bedroom with five others who keep him awake at night with snoring and strange noises. The staff try to be kind but it is clear they don’t think he should be there. Charlie shares his bedroom with just one other and they get on well. The staff, on the other hand, are dedicated to making his experience so disagreeable that he will not wish to return once he leaves.
Archie’s stay would cost a paying customer an average of £93 per day without nursing or £130 with full-time nursing. Local authorities can achieve lower prices. Bertie costs £400 and Charlie costs £103. Suppose England has Archies, Berties and Charlies. HM Treasury would save £510M a year by putting all the Berties and Charlies in the same type of institution as Archie and they would be better off there too.
Unfortunately the Bertie and Charlie institutions, namely NHS hospitals and HM Prisons, are nothing like as underfunded as Archie’s, the local authority social care institutions. NHS hospital beds are full of elderly people who should be in residential homes and our prisons likewise could reduce overcrowding with a more imaginative re-location of their older inmates. The government is cutting off its nose to spite its face by the gross underfunding of adult social care.
Looking more closely at the figures:
In 2019, the average number of “bed-blockers”, i.e. NHS hospital patients who should have been discharged, was about 4,500 per day.
The average cost of prison to the state is £37,543 p.a. per prisoner or £103 per day. There are about 1,700 prisoners aged 70 or over in England and Wales, one of them (in January 2019) aged 103. How likely is it that these old folk, locked in secure homes, would escape and ravage the community?
The moral of this story is that government thinking is not joined up, even within HM Treasury. The green paper on adult social care is now overdue by several years, there is no sign yet of the “urgent” cross-party talks on the subject and the budgets are set in isolation with little regard for the best outcomes for individual frail, elderly people.