Care homes failing patients
It is, of course, a scandal that residents in care homes, who are among the most vulnerable people in society, often receive poor care. Last week, the Commission for Social Care Inspection published a damning report into medicines management in care homes. It found that nearly half of all care and nursing homes in England are failing to meet minimum national standards.
The reasons for this are numerous. The CSCI highlighted inadequate or
non-existent training for care home staff. Even when staff have been
given basic training, home managers fail to ensure that staff then put
into practice what they have been taught. Too often the right medicine
in the right dose fails to reach the right patient at the right time.
This can also be a problem in hospitals, of course, where staff are ostensibly
trained to a competent level — so it would be wrong to blame the
staff at the sharp end for the failings in the system. And it must be
remembered that staff in homes are paid little, are often not well educated
and may not speak particularly good English.
Another factor that the CSCI drew oblique attention to is the impact
of the new pharmacy contract on the provision of medicines management
services in care homes. With so much emphasis on medicines use review,
primary care trusts are now commissioning community pharmacies to undertake
these for the residents of care homes — sometimes, it seems, at
the expense of ensuring that prescribed medicines are administered properly
in the first place.
In other words, in the relatively recent past pharmacists were commissioned
to provide the medicines advice training for care home staff. That role,
in some parts of England, seems to have been overlooked in the scramble
to provide MURs. There is no reason why pharmacists should not be employed
to do both: it is not a question of doing one or the other. PCTs need
to be aware that spending money on MURs is pointless if the appropriate
basic services are not already in place.
More importantly, there are parts of England where care is of a high
quality — as we describe in this week’s News
feature (p198).
The fact that good services are possible within existing resources gives
the lie to the complaint that PCTs have too little money to provide such
services. Rather, it seems it is part of a larger problem: they are choosing
not to commission enhanced services, of which care support is one.
Two years ago a report into medicines management at care homes found
services were bad. Little has improved since then. For the sake of all
residents in these institutions, young and old, let us hope that matters
improve in the next two years.
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