NHS chief: Hospitals are bad for old people's health

 

Hospitals are "very bad places" to care for frail, elderly patients and new ways must be found to treat them in the community, the new independent head of the NHS has warned.

In his first newspaper interview since being appointed head of the NHS Commissioning Board, Sir David Nicholson told The Independent that a revolution was needed in the way the health service cared for Britain's ageing population.

Sir David likened the current plight of elderly patients in hospitals to the "national scandals" resulting from the treatment of mental health patients in large asylums in the 1960s and 1970s, and committed the NHS to massive expansion of community care.

"If you think about the average general hospital now, something like 40 per cent of the patients will have some form of dementia," he said. "They are very bad places for old, frail people. We need to find alternatives."

Plans to expand community treatment are likely to lead to the closure of some hospital facilities and the concentration of services in a smaller number of large, highly specialised centres.

Sir David also pledged that the new independent Commissioning Board – set up by the former Health Secretary Andrew Lansley as part of his controversial health reforms – would be prepared to challenge ministers over NHS budgets.

In future, he said, the public would know how much the NHS believed it needed to spend to keep waiting lists down and improve life expectancy.

"We will be saying, 'If that's the amount of money which is available, these are the sorts of things we will be able to deliver and these are the sorts of things that we can't,'" he said. "That's a big change." He added: "We will be saying, 'If you do this, this is what we think the implications will be."

In April the Commissioning Board will take over responsibility for all NHS services in England from the Department of Health. It will be accountable to Parliament but not to Jeremy Hunt, the Health Secretary.

Sir David said one of his main priorities was to bring about a fundamental change in caring for the elderly – particularly those patients with dementia. This would involve spending money to keep them out of hospital as well as transferring treatments for common conditions into the community.

"The nature of our patients is changing – and changing rapidly," he said. "You are getting a larger and larger group of frail, elderly patients who are confused." Sir David's warning comes after a series of national scandals over the treatment of elderly patients in hospitals, including Stafford Hospital where between 400 and 1,200 more patients died than would be expected, due to substandard care.

"I would compare it with where we got to with the big asylums. If you remember what happened in the 1960s and 1970s, there was a whole series of national scandals about care of mentally ill patients," he said. "The response was not just to say that the nurses who looked after these patients needed to be more caring but actually there was something about the way we treated these patients and the model of care that needed to change."

Sir David said preventing falls, managing long-term conditions and new community-based treatment centres for elderly patients would be key to the new type of care. Last night Sir David's stance was backed by both the British Medical Association and the NHS Confederation, which represents hospital managers.

Dr Paul Flynn, chairman of the BMA's Consultants Committee, said: "Sir David Nicholson is right to highlight this as a major issue for the NHS. Hospitals generally do a very good job of providing acute care to older patients – scheduled surgery for example – but standards over the longer term are often not high enough."

Mike Farrar, head of the NHS Confederation, added: "We estimate that 30 per cent of patients in hospital don't need to be there.

"The challenge is how to improve community care within existing tight budgets."

Start your day with The Independent, sign up for daily news emails
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
Independent Dating
and  

By clicking 'Search' you
are agreeing to our
Terms of Use.

iJobs Job Widget
iJobs General

Ashdown Group: Senior VMware Platform Engineer - VMware / SAN / Tier3 DC

£45000 - £55000 per annum + benefits: Ashdown Group: Senior VMware Platform En...

Recruitment Genius: Purchasing Assistant

£10000 - £16000 per annum: Recruitment Genius: A distributor of specialist ele...

Recruitment Genius: Sales Ledger Assistant

£17000 - £19000 per annum: Recruitment Genius: A distributor of specialist ele...

Ashdown Group: Automated Tester / Test Analyst - .Net / SQL - Cheshire

£32000 per annum + pension, healthcare & 23 days holiday: Ashdown Group: A gro...

Day In a Page

War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

Baghdad fights to win back Tikrit from Isis – but then what?

Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable
Living with Alzheimer's: What is it really like to be diagnosed with early-onset dementia?

What is it like to live with Alzheimer's?

Depicting early-onset Alzheimer's, the film 'Still Alice' had a profound effect on Joy Watson, who lives with the illness. She tells Kate Hilpern how she's coped with the diagnosis
The Internet of Things: Meet the British salesman who gave real-world items a virtual life

Setting in motion the Internet of Things

British salesman Kevin Ashton gave real-world items a virtual life
Election 2015: Latest polling reveals Tories and Labour on course to win the same number of seats - with the SNP holding the balance of power

Election 2015: A dead heat between Mr Bean and Dick Dastardly!

Lord Ashcroft reveals latest polling – and which character voters associate with each leader
Audiences queue up for 'true stories told live' as cult competition The Moth goes global

Cult competition The Moth goes global

The non-profit 'slam storytelling' competition was founded in 1997 by the novelist George Dawes Green and has seen Malcolm Gladwell, Salman Rushdie and Molly Ringwald all take their turn at the mic
Pakistani women come out fighting: A hard-hitting play focuses on female Muslim boxers

Pakistani women come out fighting

Hard-hitting new play 'No Guts, No Heart, No Glory' focuses on female Muslim boxers
Leonora Carrington transcended her stolid background to become an avant garde star

Surreal deal: Leonora Carrington

The artist transcended her stolid background to become an avant garde star
LGBT History Month: Pupils discuss topics from Sappho to same-sex marriage

Education: LGBT History Month

Pupils have been discussing topics from Sappho to same-sex marriage
11 best gel eyeliners

Go bold this season: 11 best gel eyeliners

Use an ink pot eyeliner to go bold on the eyes with this season's feline flicked winged liner
Cricket World Cup 2015: Tournament runs riot to make the event more hit than miss...

Cricket World Cup runs riot to make the event more hit than miss...

The tournament has reached its halfway mark and scores of 300 and amazing catches abound. One thing never changes, though – everyone loves beating England
Katarina Johnson-Thompson: Heptathlete ready to jump at first major title

Katarina Johnson-Thompson: Ready to jump at first major title

After her 2014 was ruined by injury, 21-year-old Briton is leading pentathlete going into this week’s European Indoors. Now she intends to turn form into gold
Syrian conflict is the world's first 'climate change war', say scientists, but it won't be the last one

Climate change key in Syrian conflict

And it will trigger more war in future
How I outwitted the Gestapo

How I outwitted the Gestapo

My life as a Jew in wartime Berlin
The nation's favourite animal revealed

The nation's favourite animal revealed

Women like cuddly creatures whilst men like creepy-crawlies
Is this the way to get young people to vote?

Getting young people to vote

From #VOTESELFISH to Bite the Ballot