The regulatory system that is supposed to protect private nursing home residents in England and Wales is flawed because of compromises made by the government, suggest researchers at University College London in this week's BMJ.
As over half of the healthcare beds in the United Kingdom are in independent nursing homes for older people, adequate staffing, monitoring, enforcement, and accountability are key to delivering good quality care, they write.
Under new legislation, which comes into force in England and Scotland in 2002, responsibility for registering and inspecting homes and enforcing regulations will be transferred to the National Care Standards Commission in England, the National Assembly for Wales, and the Scottish Commission for the Regulation of Care. Yet, since the mid-1980s the number of places in nursing homes in England has increased sevenfold but the number of inspectors has only tripled. Furthermore, little attention has been paid to what structures and mechanisms will be required to ensure high quality care and accountability to users.
In particular the government has failed to stipulate national minimum standards in the key area of staffing against all the international evidence.
A Treasury commissioned report recently highlighted the difficulty for accounting for public funds when care is provided by the private sector and the need for government to put in place robust mechanisms to safeguard all clients and those on behalf of whom it is commissioning services. The paper highlights the absence of information on and monitoring of the healthcare needs of some 500,000 vulnerable residents in care homes.
International evidence shows that public information on quality of care, staffing and good systems for public accountability are essential to help prevent the risk of regulators and government being pressurised, captured and paralysed by the private sector industry.
If new regulations are to protect patients, they must be strengthened to ensure that frail and vulnerable elderly people are not at increased risk of neglect and poor quality care, they conclude.