Conditions in nursing homes across the country could deteriorate as owners "cut corners" to save money, the head of England's care standards watchdog warns today.
"Financial issues are going to weigh very heavily on quality issues," Dame Jo Williams, the chairwoman of the Care Quality Commission (CQC), told The Independent, warning that nursing home operators will look to slash costs as a result of public-sector cuts.
There will be less money to spend on training staff, repairing dilapidated buildings, and on activities for residents in nursing homes, she said.
In her first major interview since taking up one of the most challenging jobs in healthcare, Dame Jo warned: "The providers will be asking themselves: what can I do to cut corners?"
She said that more needed to be done to train staff in nursing homes – but that cutbacks could mean they received less training instead. "The workforce in nursing homes is very patchy," she said. "In some parts of the country they are very stable workforces – people who have worked as a team for a long time and they have a loyalty to their employer.
"But in other areas, like the South-east, there is a more transitory work force. It is a very, very mixed picture. That becomes a problem with the cuts."
She added: "If you look at where the providers spend their money, it is on their workforce – that's where the big money goes – and many staff are already on the minimum wage so there are not many savings there.
"Then there is the fabric of the buildings. They [the nursing home providers] are being squeezed and won't have the money coming in, so where do they find the resources to make that investment?"
More than half a million elderly people are in nursing homes and the number is expected to rise to 1.3 million by 2050. Dame Jo revealed that spot inspections of 234 health and social care institutions, including nursing homes, over Christmas revealed worrying lapses in standards in more than a third of cases. Ten reviews resulted in the highest form of censure from the regulator, which could to lead to the CQC withdrawing licences to operate.
After one review, a nursing home in Luton – run by Southern Cross, Britain's largest care home provider – was closed immediately because conditions were so bad. The Commission found 26 other institutions were not meeting required standards in all areas and ordered improvements. In a further 18, minor concerns were uncovered. The CQC is considering further investigation in another 47 cases.
The Association of Directors of Adult Social Services says that the amount of public money available for each nursing home place is likely to fall in real terms by around 3 per cent a year for the next three years as a result of public-sector spending cuts.
It is against this background that the Commission is signalling it will take an increasingly tough line to ensure that "essential standards" are met – even when budgets are cut. "Money is a challenge," Dame Jo said.
"Our focus has to be on essential standards and how we monitor those standards. We will be looking at those services that are risky and are likely to put the public at risk.
"Quality in our terms is making sure a service is safe – but it is also about how you're treated. It's about staff remembering your birthday, calling you by the right name and engaging with you as well as maintaining your dignity."
Dame Jo said that to counter the threat, the Commission is looking at new ways to identify failing care homes, including software used by the security services to identify suicide bombers.
"What we are looking to do is to use an organisation which currently does a lot of work for the security services by scanning what's out there – either in newspapers or on the net – and identifying risk."
The system works by scanning the thousands of reports the Commission receives each month – along with other sources of information – and looking for trigger words and anomalies. Those are then reviewed by the Commission's analysts, and inspectors are sent to make unannounced visits. The system, used by MI5 and anti-terror police, is credited with foiling a number of recent terror plots.
Dame Jo said: "We can never guarantee that we can do everything but we can try and identify where there are risks to public safety. I don't think you can ever have a faultless regulatory system.
"If you look back over history, every time you have an inquiry [into when things go wrong] many things are said that have been said before, and there is always a conclusion that they must never happen again. But systemic failures, human frailty – a whole range of things – mean that they do.
"It is our job to minimise that – but we can't eliminate it. That's every regulator's challenge."
Dame Jo admitted that the Commission would have a smaller budget than the combined total of its predecessor organisations.
"Our three predecessor organisations were probably operating on a budget of about £250m and we are currently on £164m. We anticipate it will be something in that region next year."
She said the Commission was looking into ways of reducing back-office costs and was also considering how to make a "qualitative judgement" on nursing homes which would help residents and their families make an informed choice.
Dame Jo added: "The thing which drives us here is the commitment to absolutely try and do the best we can for people who are vulnerable because of their circumstances.
"The big thing about a regulator is that we can do something about the balance of power between the individual and the institution."
'My mum became a prescription drug addict'
Dave Currey's mother, Barbara, was 92 when she died in 2006 after spending her final years in a care home
"We chose a home in south London that was OK, but depressing and boring. My mother started to scream out a lot and we eventually found she had been on Lorazepam, which is highly addictive.
"We began to suspect her screaming was due to her withdrawal: she had become a prescription drug addict in the home.
"Too many professionals view family enquiries as a threat and become defensive. None of this helps provide the patient with any dignity."
'She was left wet and dirty, and then moaned at'
Sarah Williams' mother Daphne, survived the Blitz, but the care she received when she went into a nursing home was "a national scandal", her daughter said
"At the age of 80, my mother was diagnosed with a terminal cancer. Through her treatment, she kept her enthusiasm for life. But, within days of going into a care home, she was deeply depressed and anxious. Heavily medicated, she was struggling to get her bearings and increasingly helpless and afraid.
"She was left wet and dirty in bed during the night and then moaned at about the mess she was in in the morning. I had to call a carer when I found her complaining of the cold because her sheets were wet.
"There were some kind carers and nurses, as well as some indifferent or surly ones, but they clearly didn't have anything like enough time for each patient.
I am haunted by one of our last conversations, when she told me: 'You don't know what goes on when you're not here'."
'All my aunt received was neglect'
At the age of 83, Irene Clarke's aunt Winn Bone, died following three-weeks in hospital after spending only 10 days in a care home
"She had vascular dementia and had spent the previous four months in an NHS mental health assessment ward, so it was doubly shocking that she fell into a diabetic coma so quickly. The care home staff had no knowledge of diabetes and failed to monitor her decline from the day she arrived.
"The home was not fit for purpose. My aunt had led a totally independent life until dementia entered her world. Then she needed care and support from professionals for the first time in her long and happy life.
"She was subjected to substandard care and neglect in those 10 days. There were so many failings in that one care home that new admissions were blocked for a year. Staff there are now able to monitor diabetes. It's not rocket science; it just requires care. My relative deserved better care but all that she received in the name of care was neglect."