FoI request reveals 'utterly disgraceful' figures, with toll improving only slightly since David Cameron became PM
More than 2,000 people have died of dehydration or malnutrition while in a care home or hospital in the last decade, according to figures published by the Office for National Statistics.
The figures show the "underlying cause of death" in 2,162 recorded cases since 2003 was dehydration or malnutrition. They do not include the death toll in 2013.
Campaigners said the figures were an "utter disgrace". "How can we call ourselves civilised when people are left to starve or die of thirst? … It is an utter disgrace that they are ever left without the most basic care," Dr Alison Cook, a director at the Alzheimer's Society, told the Daily Telegraph. The figures were made public following a Freedom of Information request by the newspaper.
The toll has improved only slightly since David Cameron became prime minister in 2010. In the previous seven years, an average of 223 people died annually as a result of dehydration or malnutrition in a care home or hospital. From 2010 to 2012, that figure fell to slightly more than 200 per year.
The Daily Telegraph reported that Dot Gibson, general secretary of the National Pensioners Convention, said the care system needed an urgent overhaul. She said: "It is not good enough for ministers or the care regulator to talk about making improvements by 2015 when, in the meantime, older people are dying from neglect.
"The public would be outraged if animals were treated in the same way – we need to show the same compassion when it comes to caring for our elderly loved ones," she added.
A spokesman for the Labour party told the paper that every elderly person "deserves the high standards of care that we would all want for our own mum or dad". "We will never get the care we aspire to from a social care system that has been stretched to the limit and cut to the bone," he said.
Norman Lamb, the care and support minister, said the deaths from thirst and starvation were "entirely unacceptable". He added that new CQC rules would allow it to intervene more effectively, and ministers would act to make company directors personally responsible for the care their organisation provides, the paper reported.
Meanwhile experts have predicted a sharp rise in the number of elderly people looking for care homes after Christmas, the Press Association reported.
In the past three years there had been a steep increase in the number of people searching for care after the festive period, carehome.co.uk said.
One reason could be that as families gathered over the holidays they might realise that an elderly relative was no longer able to cope on their own, said a spokeswoman for the site, which compares care homes across the UK.
Davina Ludlow, the director of the website, said: "Over recent years we have noticed a significant trend during January with a huge rise in the number of people searching for care homes after the Christmas period.
Martin Green of the English Community Care Association, which represents care homes in England, said: "This phenomenon often results from the fact that people have been in contact with their relatives over the Christmas period and then they realise that they're not able to manage because of illness or confusion."Kevin Rawlinson
Shadow health secretary calls for new patient rights to be added to NHS constitution, including being cared for at home
The NHS constitution needs to be expanded to give patients new rights, including a right to see their medical records online and to be cared for in the home if it is safe, Andy Burnham, the shadow health secretary, has said.
He said the rights would help rebuild the NHS to better provide integrated care which blends health, social care and mental health services.
"We have to make whole-person care a reality," he told the Guardian, adding he did not believe such a goal was possible under the coalition's NHS reforms. He predicted his vision of whole-person care would be the dividing line between parties at the election. "You cannot put the patients and the individual at the heart of the fragmented system," he said.
Burnham was responding to a pamphlet by the Institute for Public Policy Research thinktank calling for an integration of health and social care including an alignment of incentives. The pamphlet warns: "The current NHS system of paying hospitals for activity and paying community-based services under a block contract creates a financial incentive to treat as many people as possible in hospital and as few as possible in the community."
It also proposes that health and wellbeing boards take responsibility for high-level decisions signing off investments across health and social care, starting with spending on older people and people with long-term conditions. The incentive to treat patients in hospitals should be removed by linking payments for more integrated providers to the outcomes they deliver, rather than paying individual providers for the activities they undertake.
The simple guarantees, or rights, would promote the benefits of whole-person care, Burnham believes. He proposes:
• Each patient should have a single health and care co-ordinator, not necessarily of a clinical background, with authority to get things done. Burnham said: "A single point of contact for patients would remove one of the single greatest frustrations in the NHS."
• Online access to personal health and care records with an ability to share these electronically, sweeping aside some of the data protection rules that prevent co-ordination between organisations. The patients would have a clear right to own their own records.
• A personalised care plan covering health and social care, so care needs are tailored to personal circumstances, and not restricted by service boundaries.
• Access to other people with the same condition who can provide peer support.
The current NHS constitution includes a right to be treated within 18 weeks, the right to choose a hospital, the right to view personal health records and the right to have a complaint addressed within three days.
Burham has been talking about whole-person care for over a year, but insisted the plans need not cost extra money. He said: "We know that 30% of beds occupied in the NHS are occupied in an inappropriate way either because they need not have been admitted or they have no system of care if they go home."
Burnham said he was anxious that whole-person care should not result in another major reorganisation of the NHS.Patrick Wintour
Public opposition to non-NHS providers used by Labour and BMA to claim private companies have fragmented patient care
The public's attitude has hardened against private providers running healthcare services, a poll has found.
When asked last month whether they agreed with the statement: "as long as health services are free of charge, it doesn't matter to me whether they are provided by the NHS or a private company", 47% of people said they disagreed – up from 36% in February 2011. The Ipsos Mori poll for King's College London found the proportion of people agreeing with the statement had barely changed over the same period, rising from 41% to 42%.
The results were seized upon by Labour and the British Medical Association, with both claiming that use of private providers had led to fragmentation of patient care.
Dr Mark Porter, chair of the BMA council, said the consistency and quality of care had been adversely affected. "It has created a shift from an ethos of co-operation to one of competition in the NHS, with providers picking and choosing what services they can provide at a profit," he said. "Given this, and as the true effects of the NHS reforms becoming more apparent, it's not surprising that people are increasingly averse to commercial companies, whose ultimate aim is to turn a profit, operating in our NHS."
Jamie Reed MP, Labour's shadow health minister, said: "People can now see what David Cameron's privatisation plans have done to the NHS. The next Labour government will repeal Cameron's Health and Social Care Act and put the right values – collaboration, not competition – back at the heart of the NHS."
The poll showed that people were much more likely to be amenable to healthcare services being delivered by an external provider if it was a charity or voluntary organisation (54% agreed it would not matter in this case) rather than a private company.
The slice of the NHS's £100bn a year budget going to non-NHS providers rose from £5.6bn in 2006-07 to an estimated £8.7bn in 2011-12, according to a study by the Institute of Fiscal Studies and Nuffield Trust health thinktank.
A department of health spokeswoman said: "The crucial thing is that patients get the best possible services on the NHS, free to all who need them.
"Other providers, whether they are from the private sector or from a charity, have to comply with exactly the same quality and safety standards as any NHS provider."
Ipsos Mori interviewed a representative sample of 1,009 adults in Great Britain aged 18 and over by telephone between 12 and 14 October.Haroon Siddique
Jeremy Hunt says total of 32 hospitals are now under investigation over links to claims of sexual abuse by presenter
A further 19 hospitals are to be investigated over their links to allegations of sexual abuse by Jimmy Savile, the health secretary, Jeremy Hunt, has said.
The move takes the number of hospitals under investigation to 32. Savile, who died in 2011 aged 84, is believed to have abused hundreds of children. He had a bedroom at Stoke Mandeville hospital, an office and living quarters at Broadmoor, and widespread access to Leeds General Infirmary. All three of those hospitals were among the 13 previously announced to be under investigation.
The wave of allegations made against Savile sparked the launch of the Operation Yewtree police investigation, which is also looking into claims about others linked to him, as well as separate allegations about a number of high-profile figures.
Hunt said last month that new inquiries could be launched after the Metropolitan police found "further relevant information" about Savile.
He said he had asked the Met to review its evidence to see whether any of the information it held "related to health and care settings".Haroon Siddique
A legislation gap has left prospective funders concerned about what would happen if an foundation trust couldn't pay its debts
So much has been mooted about the Nicholson Challenge that you would be forgiven for thinking all the answers have already been thought up, written about and tested. If only life were that simple.
Yes, it's true that the task of removing 20% of costs from the NHS has been met head on. Budgets available to the acute sector have, after all, slowly eroded to the point where the national tariff – the pricing mechanism used by NHS hospitals to charge commissioners – will be reduced by almost a quarter, at least in real terms – by 2014-15.
The net result, especially when combined with measures to cap paid-for activity, is that hospitals are increasingly doing more clinical work with less funding. Easy wins, such as delivering smarter procurement processes, are harder to find and providers are being forced to look to increasingly innovative models to deliver quality health outcomes.
The search for a new way of delivering healthcare means hospitals are re-organising how and where services are delivered on a grand scale. In some cases, this means operating more efficient urgent care centres and minor injuries units to take pressure off A&E; in others, it's about the delivery of more complex services in social, community and GP settings.
It is our belief that providers have been doing their best within existing infrastructure, but their task is not made easy by the poor standard and unsuitable configuration of much of the community estate, not to mention existing acute infrastructure which, in some areas, is certainly in need of replacement. It's a situation that cannot be allowed to continue indefinitely; funding will have to be found to reconfigure and improve some existing estate. Better yet, budget will need to be found to construct new facilities which are more fit for purpose – and recognise the needs of today's patients.
Asking whether this is realistic is a fair question. NHS capital budgets are shrinking, not expanding, and have seen 17% over the past three years. The fact is that unless land and buildings are about to get dramatically cheaper (housing prices suggest otherwise), the NHS is going to have to look outside the system and appeal to the private sector for funding.
Again, if only life were so simple … In the wake of the credit crunch, funders are understandably more cautious and the Health and Social Care Act 2012 contains some loopholes which make convincing those funders much harder than it needs to be.
All this begs a question about what, exactly is scaring the funders. Why are they loathe to invest in the NHS, when doing so will ensure we have a health system better able to deliver what clinicians need to perform and what patients need to recover?
Firstly, a key question for any lender always revolves around whether they can rely on being paid if the borrower fails. In their position, debate in the news about whether foundation trusts could become insolvent must be unsettling. No wonder potential funders fear they won't see a return on investment and find themselves out of pocket.
That is why initial consultation on the new Unsustainable Provider Regime was promising. Buried deep into the consultation document (paragraph 34 of "Securing continued access to NHS services" to be exact) was the notion that creditors would be entitled to be repaid in full either by the unsustainable Foundation Trust (FT) or its successor. The proposed terms were also fair – allowing FTs negotiation space to restructure any repayments to more viable terms.
Sadly, nothing so definitive has found its way into the Health and Social Care Act. Little wonder that with a lack of central government support, prospective funders are concerned about to what would happen if an FT couldn't pay its debts. It's easy to say that this would not be allowed to happen, but lenders and their credit committees are not easy to pacify with general statements of what a future government might "allow" to happen. After all, the US has just finished a monumental game of "political chicken" with its own lenders. And they do say that when America sneezes, the UK catches a cold.
Regrettably, this is a gloomy scenario – one which seems to be nothing less than Catch 22. But that doesn't mean the sensible option is to give up.
In our view, the legislative framework should provide adequate protection for lenders without separate need for central government support mechanisms, such as deeds of safeguard. Trusts are already closely monitored and already need layers of approvals from their own boards, commissioners and the Trust Development Authority or Monitor to enter into major transactions. So closing this legislative gap doesn't really create a great deal of additional risk for central government. It would also reflect the commitment made in the consultation documents on the Unsustainable Provider Regime.
Without this, funders will need to revisit their credit analysis of foundation trusts in the light of the existing legislation and take something of a leap of faith in relation to the protection offered by untested laws. Given that trust in and around the economy is still lukewarm at best, this could well be a difficult call.
Until the issue is met head on, reconfiguration will be harder to achieve, infrastructure improvements will be delayed and those that do occur will be more costly, both in terms of credit and advisory costs. It's a fairly stark choice, but as things stand it is difficult to see how improved infrastructure will be delivered.
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Finding comes in a government report showing wide variations in dementia care in England
Less than half of people suffering from dementia in England are being formally diagnosed with the condition, leaving hundreds of thousands struggling without support, the health secretary, Jeremy Hunt, has revealed.
The finding comes in a government report that shows wide variations in standards of dementia care with three quarters of patients receiving a formal diagnosis in the best areas but only a third in the worst.
The figures are also being published in an interactive online map, which Hunt said would help raise standards by allowing patients to see which parts of the country were guilty of "poor performance".
He added that stigma was a serious hurdle in tackling the disease with patients either too fearful or too complacent to seek a diagnosis.
He is launching a strategy to encourage people to discuss diseases such as Alzheimer's more openly. "We must come together as a society to get better at fighting dementia," he said.
The online dementia map will show diagnosis rates, referral rates and the frequency of anti-psychotic drug prescription for the 670,000 people with dementia.
Although there has been a slight improvement in the national diagnosis rate, up from 46% to 48% since 2011, the gap between the best and worst performing areas is stark. The best is Corby in Northamptonshire on 75%; the worst are Herefordshire and Harrow, in north-west London, on 33%.
"In too many parts of the country, people think there is no point in getting it diagnosed because they think nothing is going to happen," Hunt told the Daily Mail.
"And sadly, in some parts of the country, that is true. We need to ensure that when someone is diagnosed, the system swings into action and gets people the support they need. There is a demographic timebomb but we are not giving people the care we should be giving them."
The national dementia survey assesses how well the condition is being dealt ahead of a G8 summit next month called by David Cameron to discuss how to tackle the growing issue.
The World Health Organisation estimates the number of people worldwide living with dementia could more than treble to 115.4 million by 2050 due to ageing populations. The number in the UK alone is expected to pass the 1 million mark by the end of 2020.
The report pointed to an almost doubling in government-funded research, a fourfold increase in the numbers being assessed by memory clinics, and training for 108,000 NHS staff in spotting early symptoms.
But the shadow minister for care and older people, Liz Kendall, said dementia care was getting worse. She said: "If David Cameron was serious about improving the quality of dementia care, he would not have cut council budgets for older people's social care to the bone.
"And if Jeremy Hunt was serious about improving transparency, he would be publishing how many 15-minute home visits there are in each area, and people with dementia have unnecessarily ended up in hospital or having to go into a care home because they can't get the help they need to stay living in their own homes."
MPs also called on the government to set out a long-term strategy for tackling dementia, before its presidency of the G8 summit in December.
Conservative MP Tracey Crouch warned that the current dementia strategy is due to expire in 2014.David Batty
Online 'customer' comments could allow us to indulge in our latest national pastime: leaving silly reviews
As part of the creeping privatisation of our National Health Service, a "Tripadvisor-style" reviews site for hospitals will be rolled out over the coming year.
On the one hand, it's reasonable that patients' views about their treatment are heard. On the other, it seems a trifle unwise to judge neurosurgeons in the same way that we appraise B&Bs in the Cotswolds. On this third hand that a clearly under-qualified sawbones has accidentally stitched to my elbow, what we're looking at here is a new outlet for the thing we do best: leaving playful and/or wilfully silly reviews for things. It's practically a national pastime.
To mark the beginning of this glorious new strand to our shared culture, let's warm up with a few practice swings …
• "Dreadful service. Uncomfortable beds. And to make matters worse I dozed off one afternoon and when I woke up someone had removed a mole I was particularly attached to." – Now-unemployed Marilyn Monroe lookalike, Cheshunt.
• "After a torrid beginning to my stay, in which I was given the most undignified bathrobe I've ever worn and was kept awake all night by another guest constantly yelling 'they've taken my leg', I was all set to check out early. But then one of the staff gave me a frankly rather intimate wash while I was still in bed and I'm now planning to book for next Easter." – Ukip voter, Macclesfield.
• "A distinctly unmemorable holiday. I was only discharged yesterday and I honestly can't recollect a single thing about the place. Bland and forgettable." – Amnesia sufferer, North Shields.
• "For a spa, the therapies were distinctly thin on the ground. There were no massages on offer and the only treatments we were offered consisted of a daily injection that made my hands swell up like two balloons." – Medical guinea pig, Oxford.
• "After a restful start to my holiday, in which I'm told I slept for four months, I was rudely awoken by David Soul singing by my bedside. I don't even like David Soul. I think he was booked for the next patient along." – Coma survivor, Abingdon.
• "I don't even know what my spleen is and I am now told that someone's removed it. I'm immensely bitter about this turn of events. And a chap in a white coat blathering on about Howell-Jolly bodies isn't helping. There's nothing remotely jolly about it. Insulting." – Charles Baudelaire, Hull.
• "A lovely stay. Friendly staff. A chocolate on my pillow every night. Well, I think it was a chocolate. The only negative was when I was presented with the bill. Quite a shock, I can tell you." – Health tourist, abroad.
• "Had a perfectly lovely time. Friendly staff in lovely starchy uniforms. Other guests very friendly and always pulling hilarious pranks. A substantial matron who bore a close resemblance to the late Hattie Jacques gave me an extra glass for my Lucozade so I could share it with the charming malingerer in the next bed. The only negative was that someone else ate my grapes." – Time traveller, Bromley.
Leave your own candid patient reviews below.Michael Moran