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Waiting for an ambulance, unable to breathe, brings austerity home | Frances Ryan

Anyone witnessing Jeremy Hunt defending the NHS to Donald Trump on Twitter this week likely found themselves in the unprecedented position of agreeing wholeheartedly with the health secretary. And yet this was ultimately a sideshow, a spat that must seem particularly hollow for say, a heart attack patient left in an ambulance waiting for a bed or the nurse now sent to 999 calls because there aren’t enough ambulance crews.

I called an ambulance myself last month. I’d developed flu complications suddenly after work and couldn’t breathe. In central London on a Friday night, I knew the service would be strained but, as the minutes went on, I worried whether they would get to me in time. I ended up calling 999 three times due to the wait; in the end, paramedics got to me after about 45 minutes (time blurs when you can’t breathe).

I was lucky in the end. I was at least well enough to take myself to A&E a day later for the tests I needed and had the family support to recover at home. But I can’t help but be struck by a worrying thought: rather than the NHS being a safety net, nowadays it’s as if it isn’t safe to be sick.


The public are already lining the streets in protest. Time is ticking.

As of last week, hospitals are more full than at any point this winter, according to the latest NHS performance figures. That means 95% of beds are occupied across the NHS – 10 percentage points higher than what the government has said is the safe operating level. On Sunday, it emerged some hospitals are now cancelling urgent surgeries for patients with cancer and heart disease because of a shortage of intensive care beds, with the Patients Association warning the sickest could die as a result. I saw a woman with a brain tumour tweet Jeremy Hunt last week in desperation because her operation had been cancelled four times since December. “HELP ME!” she wrote.

As the public took to the street this weekend in defence of the NHS, Theresa May’s protestations that this is all “part of the plan” appear increasingly delusional. Inexperienced undergraduate medical students are plugging the gap of staff shortages. The A&E four-hour waiting time target is scrapped entirely until next year. Ambulance delays are linked to more than 80 people’s deaths  in one trust alone. The term adopted by the media and many politicians to describe this state of affairs is “winter crisis”. Yet to use the term “winter crisis” is in many ways disingenuous. It implies that this is a temporary problem or one caused by the season. Yes, a bad flu season has put pressure on the health system but the underlying strain is caused by ongoing underinvestment. NHS England will have a £22bn “funding black hole” by 2020-21. The Tories responded by giving a one-off payment of £1.6bn at the last budget – less than half what experts advised.

This is compounded by cuts to other services, as a domino effect of short-termism puts unnecessary added pressure on the NHS. For example, gutting social care means perfectly well elderly and disabled people are languishing in NHS beds because they haven’t got a care package to help them at home, while cuts to services such as meals-on-wheels are contributing to mass malnutrition . Meanwhile, prevention services such as alcohol and drugs rehabilitation are being obliterated as public health services are pushed on to cash-strapped local authorities (the health thinktank, the King’s Fund estimates planned government cuts of at least a further £600m by 2020-21).

Research this month stressed public support for the principles of the NHS was so strong that any government seeking to change its funding model to a US-style private system would be committing “political suicide”, but pushing it to breaking point by starving it of resources is no less unforgivable.

Austerity has long been an abstract term – used by politicians and the media but removed from people’s lives – but it only takes a moment of being in need to make the cuts real to people. Because the ambulance delays and shortage of ventilators and oxygen cylinders you read about cease being empty headlines and are happening now and to you, or your family or friends. It’s hard to imagine the tipping point isn’t coming, that cancer patients being refused surgery is a political scandal that can be ignored. The public are already lining the streets in protest. Time is ticking. It’s not an exaggeration to say this is a matter of life and death.

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

Shifting care closer to home will ease pressure on hospitals | Ewan King

New year is associated with hope and optimism. But for the NHS, the headlines tell a different story: hospitals at full capacity. As you might expect, these articles focus on what is going wrong: headlines such as “NHS in crisis”, stories of beds in corridors and stressed-out nurses. Clearly these problems are real, but focusing only on hospitals won’t solve the problem. We need to think more broadly if we are to find lasting solutions; we must think about prevention, and how far it is embedded in local systems.

For some time, health and care reforms have been about shifting care closer to home. The programme of vanguards and sustainability and transformation plans was intended to herald a greater focus on prevention and self-care to reduce pressure on hospitals. There is some evidence that these reforms are working: Hertfordshire’s prevention-focused Better Care for Care Home Residents Vanguard, for instance, led to a 45% reduction in hospital admissions and A&E attendances between April 2015 and May last year.

But we are not yet able to see the scale of change necessary to make a significant dent in demand across England and beyond, because of financial pressures, which make it difficult for organisations and commissioners to fund new, innovative services; inward-looking leadership teams focused on short-term goals and local evidence and solutions; a lack of integration across health and social care and housing; and outdated performance management and contracting systems.

A seismic shift – at the level needed – is not straightforward to deliver. As Nesta, Shared Lives and the Social Care Institute for Excellence (Scie) argue in a new report on innovation, we know a lot about what works to support independence in ways that reduce demand for urgent care, but less about how to extend the benefits to more people. As the report concludes: “New and better ways of delivering relationship-based care are needed, and already exist, but are inconsistently implemented or poorly scaled.”

So what can national policymakers and local health and care leaders do differently? First, we need to restate the case for preventive, community-based care and, as part of this, more clearly articulate how it will make a difference to people’s lives. For example, in our report we describe a place in the near future where people are supported to maintain their independence, improving their wellbeing at reduced cost to the NHS. What if you have a long-term condition such as chronic obstructive pulmonary disease; are you able to join a Breathe Easy peer support group to help you manage the condition?

We also talk about North Yorkshire, where an innovation fund has been used to fund initiatives reducing isolation, preventing falls and supporting people to stay at home when they want to. Local care and support providers say this has helped them to build their networks, and they are now working in partnership with more local services.

Second, we need collective local leadership focused on keeping people well and better supported at home, underpinned by a strong commitment to integrated commissioning and to changing funding flows to support more community-based care.

A hospital trust chief executive recently told me that investment away from beds and A&E services would support far better preventive approaches – but there has to be a system-wide strategy for all to lead and support if bed pressures arise.

Third, we need to make better use of the evidence we have, making a stronger case for investment in preventive care. In Scie’s prevention library, we have a mass of evidence-based examples of community-led care and support that helps to reduce demand for hospital care. Age UK’s personalised integration approach in North Kent is a model of holistic support targeted at older people with long-term conditions. It has led to a 26% reduction in non-elective hospital admissions. Commissioners need to use these examples to argue for spending more on preventive models of care and support.

Carrying on as we are is unlikely to succeed; we are firefighting in the face of growing demand in hospitals without always considering what wider changes are needed to prevent this growth. The social care green paper, to be published in the summer, provides a good opportunity for setting out plans for a more preventive, person-centred, health and care system, but there is nothing to stop leaders being more ambitious about prevention right now.

Join the Healthcare Professionals Network to read more pieces like this. And follow us on Twitter (@GdnHealthcare) to keep up with the latest healthcare news and views

If you’re looking for a healthcare job or need to recruit staff, visit Guardian Jobs

The price of driving down care home costs? Staff who quit after a few weeks | Michele Hanson

My friend Mavis just applied for a job in a care home for the elderly. Marvellous, I thought. She is bound to get it. She is perfect for the job: personable, bright, forthright, cheery, hard-working, her social skills are top-notch, and we are desperate for care workers.

Off she went for her interview, told the fellow all about her life and past experience, including running two successful employment agencies, and when he’d heard all that, he started asking questions: “When you felt under pressure, what did you do about it? What are your strong points and weaknesses?”

“Are you seriously asking me these questions?” said Mavis.

“Well they’re on my sheet,” he said. “I’ve got to ask, so what are your answers?” Mavis had a stab at them, but knew she’d blown it. She asked a few questions herself and found out that his average staff turnover was four weeks. Yes. Four weeks. And the business was a franchise. You put in a bid, as low as you can because the cheapest usually wins, then you pay your staff flumpence to look after vulnerable and often weak, poorly people who need intense care and therefore a care worker with physical strength, great patience, kindness, empathy and time to talk with them. No wonder staff only last a few weeks.

This is the trouble with making money out of the sick, feeble and helpless. It’s frightfully difficult to make much profit without treating them, and their care workers, like rubbish, unless you charge private residents an arm and a leg to make up for the peanuts you’re getting for the state-funded residents. Or unless you’re part of a chain owned by private equities – as long as it doesn’t get into too much debt with its owners, who may pull out if they aren’t trousering enough profit for their rich investors; then your whole chain goes down the pan and the elderly residents are out on their ears. Then what?

The councils will have to mop up the mess. Perhaps they could take the care homes back in-house again. And have them adequately funded and staffed. Wouldn’t that be lovely? My dream for 2018.

The price of driving down care home costs? Staff who quit after a few weeks | Michele Hanson

My friend Mavis just applied for a job in a care home for the elderly. Marvellous, I thought. She is bound to get it. She is perfect for the job: personable, bright, forthright, cheery, hard-working, her social skills are top-notch, and we are desperate for care workers.

Off she went for her interview, told the fellow all about her life and past experience, including running two successful employment agencies, and when he’d heard all that, he started asking questions: “When you felt under pressure, what did you do about it? What are your strong points and weaknesses?”

“Are you seriously asking me these questions?” said Mavis.

“Well they’re on my sheet,” he said. “I’ve got to ask, so what are your answers?” Mavis had a stab at them, but knew she’d blown it. She asked a few questions herself and found out that his average staff turnover was four weeks. Yes. Four weeks. And the business was a franchise. You put in a bid, as low as you can because the cheapest usually wins, then you pay your staff flumpence to look after vulnerable and often weak, poorly people who need intense care and therefore a care worker with physical strength, great patience, kindness, empathy and time to talk with them. No wonder staff only last a few weeks.

This is the trouble with making money out of the sick, feeble and helpless. It’s frightfully difficult to make much profit without treating them, and their care workers, like rubbish, unless you charge private residents an arm and a leg to make up for the peanuts you’re getting for the state-funded residents. Or unless you’re part of a chain owned by private equities – as long as it doesn’t get into too much debt with its owners, who may pull out if they aren’t trousering enough profit for their rich investors; then your whole chain goes down the pan and the elderly residents are out on their ears. Then what?

The councils will have to mop up the mess. Perhaps they could take the care homes back in-house again. And have them adequately funded and staffed. Wouldn’t that be lovely? My dream for 2018.

The price of driving down care home costs? Staff who quit after a few weeks | Michele Hanson

My friend Mavis just applied for a job in a care home for the elderly. Marvellous, I thought. She is bound to get it. She is perfect for the job: personable, bright, forthright, cheery, hard-working, her social skills are top-notch, and we are desperate for care workers.

Off she went for her interview, told the fellow all about her life and past experience, including running two successful employment agencies, and when he’d heard all that, he started asking questions: “When you felt under pressure, what did you do about it? What are your strong points and weaknesses?”

“Are you seriously asking me these questions?” said Mavis.

“Well they’re on my sheet,” he said. “I’ve got to ask, so what are your answers?” Mavis had a stab at them, but knew she’d blown it. She asked a few questions herself and found out that his average staff turnover was four weeks. Yes. Four weeks. And the business was a franchise. You put in a bid, as low as you can because the cheapest usually wins, then you pay your staff flumpence to look after vulnerable and often weak, poorly people who need intense care and therefore a care worker with physical strength, great patience, kindness, empathy and time to talk with them. No wonder staff only last a few weeks.

This is the trouble with making money out of the sick, feeble and helpless. It’s frightfully difficult to make much profit without treating them, and their care workers, like rubbish, unless you charge private residents an arm and a leg to make up for the peanuts you’re getting for the state-funded residents. Or unless you’re part of a chain owned by private equities – as long as it doesn’t get into too much debt with its owners, who may pull out if they aren’t trousering enough profit for their rich investors; then your whole chain goes down the pan and the elderly residents are out on their ears. Then what?

The councils will have to mop up the mess. Perhaps they could take the care homes back in-house again. And have them adequately funded and staffed. Wouldn’t that be lovely? My dream for 2018.

The price of driving down care home costs? Staff who quit after a few weeks | Michele Hanson

My friend Mavis just applied for a job in a care home for the elderly. Marvellous, I thought. She is bound to get it. She is perfect for the job: personable, bright, forthright, cheery, hard-working, her social skills are top-notch, and we are desperate for carers.

Off she went for her interview, told the fellow all about her life and past experience, including running two successful employment agencies, and when he’d heard all that, he started asking questions: “When you felt under pressure, what did you do about it? What are your strong points and weaknesses?”

“Are you seriously asking me these questions?” said Mavis.

“Well they’re on my sheet,” he said. “I’ve got to ask, so what are your answers?” Mavis had a stab at them, but knew she’d blown it. She asked a few questions herself and found out that his average staff turnover was four weeks. Yes. Four weeks. And the business was a franchise. You put in a bid, as low as you can because the cheapest usually wins, then you pay your staff flumpence to look after vulnerable and often weak, poorly people who need intense care and therefore a carer with physical strength, great patience, kindness, empathy and time to talk with them. No wonder staff only last a few weeks.

This is the trouble with making money out of the sick, feeble and helpless. It’s frightfully difficult to make much profit without treating them, and their carers, like rubbish, unless you charge private residents an arm and a leg to make up for the peanuts you’re getting for the state-funded residents. Or unless you’re part of a chain owned by private equities – as long as it doesn’t get into too much debt with its owners, who may pull out if they aren’t trousering enough profit for their rich investors; then your whole chain goes down the pan and the elderly residents are out on their ears. Then what?

The councils will have to mop up the mess. Perhaps they could take the care homes back in-house again. And have them adequately funded and staffed. Wouldn’t that be lovely? My dream for 2018.