17 August 2007
MPs and peers have called for a thorough reform of NHS regulations, equality guidance and human rights law to counter the abuse of older people in hospitals and care homes.
The August 15 report from the Joint Committee on Human Rights said the delayed discharge regulations designed to limit 'bed blockers'; guidance to uphold the right to dignity; equalities legislation; and the Human Rights Act itself should all be amended.
'We are convinced that the existing legislation does not sufficiently protect and promote the rights of older people in health care,' said the committee, adding: 'None of the evidence that the Department of Health has provided to us during this inquiry gives us confidence that the Human Rights Act is in fact “an integral part of policy-making” within the DoH.'
The committee drew particular attention to the delayed discharges regulations, under which councils are fined if a patient over 65 is deemed fit to leave hospital yet must stay there because no social care place is available.
But the committee collected evidence that the policy was causing infirm elderly people to be discharged into inappropriate care settings, with no time to consider their options or to exercise choice.
Sometimes people were forced into homes miles from their families with the option to undergo rehabilitative support in their own home ruled out.
On occasions this has led to an infringement of Article 8 of the HRA which guarantees a right to a private and family life.
In the worst cases, the delayed discharge policy meant people were discharged into inappropriate care settings where their health needs could not be adequately addressed. This 'premature or inappropriate discharge of older people could lead to their readmission shortly afterwards,' the committee said.
In June, official figures showed that in 2005/06, 16% of patients over 75 years were readmitted into hospital within 28 days of discharge: an increase of 31% since 1998/99.
Care minister Ivan Lewis said the government was launching 'a major programme of change' to address the issues raised.
'This includes the integration of the inspection, regulation and complaints systems for health and social care, the review of adult protection guidance and the development of a national strategy to improve dementia services,' he said.
The committee praised the recent political leadership given by Lewis on raising the profile of human rights and dignity for older people, but said that it had come too late.
'The fact remains that it has come seven years after the HRA came into force,' the report said. 'The failure by the DoH to give a lead has meant that the government's job has, of necessity, had to be done by voluntary organisations, often with few staff, no power and scarce resources. Inevitably, it has been an uphill struggle to make an impact.'
Earlier this summer the Law Lords ruled that, contrary to the intention of government, private care homes do not fall under the HRA, even if the residents they are caring for are publicly funded.
This meant that care home residents had 'alarmingly' little protection against eviction from homes and the committee said that lacuna should be addressed 'as soon as possible' by regulation in the short term and by an amendment to primary legislation in the longer term.
But it also urged an 'entire culture change' in the way services are provided to older people and called for the current prohibition on age discrimination in the workplace to be extended to the provision of goods and services.
Anne Williams, president of the Association of Directors of Adult Care Services, said her members wanted to improve services, but warned: 'This is very difficult in the context of rising demand and very tight financial constraints. We hope [the] government will, as part of the Comprehensive Spending Review, recognise the need to adequately fund social care services.'
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