Ros Altmann conveniently glosses over the history of care home ownership and, in doing so, omits one of the main causes of the current crisis (The lesson of the Covid-19 care homes tragedy: renationalising is no longer taboo, 6 July). Responsibility for care homes was not “passed from the NHS to local authorities” in the 1980s; they were privatised, by the first Thatcher government. This policy had two dimensions. On the one hand, local authority social care budgets were cut and, on the other, private providers were given financial incentives to enter the newly created market. The full cost of care for those on low incomes was met by the government, but only for those in private homes. The result was an explosion in private homes, and the budget grew exponentially (so, later, it had to be cut).
The initial promise of small “homely homes” was soon ditched as private providers sought to maximise profits by expansion. This legacy still bedevils social care today. Until it is restored to democratic oversight and funded to the same quality levels as the NHS, social care will continue to be the poor relation of the welfare state.
Professor of social policy and social gerontology, University of Sheffield
• Taking care homes into the public sector is certainly not taboo as far as I and others working and researching in this field for many years are concerned. We’re all for it. And there are many more reasons why it would be a good thing in addition to those that Ros Altmann suggests – all making social care a more humane, fair and caring service for citizens.
But what is particularly welcome is to know that Altmann, in backing nationalisation, is also a Conservative peer. Could it be a sign that a cross-party agreement might finally become possible? This may be the golden opportunity we’ve all been waiting for – not for a quick fix, which so far has always failed to materialise under a welter of inter-party fighting, but for a genuine resolution of a seemingly intractable problem. With the Tories currently looking to the state to solve its Covid-19-related problems, and with money to spend, a fair and humane social care system to partner the NHS, all within the public sector, may just become possible.
• Ros Altmann makes a good case for the reform of care homes, but the domiciliary care system is equally in need of scrutiny where dementia patients are concerned, again highlighted by recent events. My husband, in the late stages of dementia and cared for at home by me, developed an infection at the height of the coronavirus pandemic in April. He was diagnosed over the phone by a doctor from the 111 service, and a team of nurses and carers visited three times a day. This was a time-limited service. Admission to hospital was not an option because of the virus. It became obvious that his condition was deteriorating, and he needed ongoing care as the time-limited service came to an end.
A social worker informed me by telephone that she was arranging a care package for my husband, that she would not be coming to assess him because of lockdown, and that as I had over the threshold of savings, I would have to pay for the care. The stress at being given this information while watching my beloved husband approaching death was indescribable. Eventually, by my own efforts, a fast-track assessment of his condition took place, and two days later my husband died.
How can it be right for such gross discrimination against those with dementia to take place? Surely people with dementia dying at home are entitled to the same care as anyone else.
• How brilliantly serendipitous of you to carry the piece by Stephen Reicher (Boris Johnson’s blundering was political genius. But now that moment has passed, 6 July) at the same time as reporting that Boris Johnson felt it appropriate to castigate care home staff for not following procedures (Fury as Boris Johnson accuses care homes over high Covid-19 death toll, 6 July). Mr Johnson has once again given a clear example of how he is not only capable of blundering on, but also of being out of step with the nation and most of his own advisers. As Prof Reicher rightly points out, an effective leader can only operate in concert with their followers. The time is now that the “followers” will no longer follow such blundering.
Dr Simon Gibbs
Reader in educational psychology, Newcastle University
• My husband has late-stage Alzheimer’s and is resident in a small privately owned care home. A week before lockdown, the manager took the decision to close and refused to take in anyone leaving hospital. The staff agreed to work on site, sleeping in caravans and having only virtual contact with their families. With great difficulty and expense, she managed to keep up with the demand for basic personal protective equipment supplies and was grateful to local businesses for donating face shields made on their 3D printers.
Testing was not available until nearly a month later, and even then results took a long time to come through. Her amazing efforts were successful, and there have been no cases among staff or residents. No “protective ring” around care homes was indicated. If she could predict the issues raised by coronavirus, how come Boris Johnson and his cohort failed to do so? His attempt to lay the blame at the door of the care homes is a shameful lie.
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