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
Arts and Entertainment
Lou Reed distorted the truth about his upbringing, and since his death in 2013, biographers and memoirists have added to the myths
musicThe truth about Lou Reed's upbringing beyond the biographers' and memoirists' myths
Arts and Entertainment
Lena Headey looks very serious as Cersei Lannister in Game of Thrones
tvGame of Thrones season 5 episode 1 review
News
people
News
Ed Miliband received a warm welcome in Chester
election 2015
Have you tried new the Independent Digital Edition apps?
ebooks
ebooksA special investigation by Andy McSmith
Life and Style
Apple CEO Tim Cook announces the Apple Watch during an Apple special even
fashionIs the Apple Watch for you? Well, it depends if you want it for the fitness tech, or for the style
News
i100
News
people
News
Astronauts could be kept asleep for days or even weeks
scienceScientists are looking for a way to keep astronauts in a sleeplike state for days or weeks
Sport
Fabian Delph celebrates his goal
footballChristian Benteke and Fabian Delph turn semi-final after Liverpool goal
Life and Style
Model wears: top £29.50, leggings £25, jacket £29.50, bag £25, all marksandspencer.com
fashion
News
people
Arts and Entertainment
The new-look Top of the Pops could see Fearne Cotton returns as a host alongside Dermot O'Leary
music
  • Get to the point
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

Recruitment Genius: Project Implementation Executive

£18000 - £23000 per annum: Recruitment Genius: They work with major vehicle ma...

Recruitment Genius: Chiropractic Assistant

£16500 per annum: Recruitment Genius: A Chiropractic Assistant is needed in a ...

Recruitment Genius: Digital Account Executive - Midlands

£18000 - £26000 per annum: Recruitment Genius: They work with major vehicle ma...

Recruitment Genius: Web Developer

£28000 - £30000 per annum: Recruitment Genius: This company provides coaching ...

Day In a Page

Armenian genocide: To continue to deny the truth of this mass human cruelty is close to a criminal lie

Armenian genocide and the 'good Turks'

To continue to deny the truth of this mass human cruelty is close to a criminal lie
Lou Reed: The truth about the singer's upbringing beyond the biographers' and memoirists' myths

'Lou needed care, but what he got was ECT'

The truth about the singer's upbringing beyond
Migrant boat disaster: This human tragedy has been brewing for four years and EU states can't say they were not warned

This human tragedy has been brewing for years

EU states can't say they were not warned
Women's sportswear: From tackling a marathon to a jog in the park, the right kit can help

Women's sportswear

From tackling a marathon to a jog in the park, the right kit can help
Hillary Clinton's outfits will be as important as her policies in her presidential bid

Clinton's clothes

Like it or not, her outfits will be as important as her policies
NHS struggling to monitor the safety and efficacy of its services outsourced to private providers

Who's monitoring the outsourced NHS services?

A report finds that private firms are not being properly assessed for their quality of care
Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

Zac Goldsmith: 'I'll trigger a by-election over Heathrow'

The Tory MP said he did not want to stand again unless his party's manifesto ruled out a third runway. But he's doing so. Watch this space
How do Greek voters feel about Syriza's backtracking on its anti-austerity pledge?

How do Greeks feel about Syriza?

Five voters from different backgrounds tell us what they expect from Syriza's charismatic leader Alexis Tsipras
From Iraq to Libya and Syria: The wars that come back to haunt us

The wars that come back to haunt us

David Cameron should not escape blame for his role in conflicts that are still raging, argues Patrick Cockburn
Sam Baker and Lauren Laverne: Too busy to surf? Head to The Pool

Too busy to surf? Head to The Pool

A new website is trying to declutter the internet to help busy women. Holly Williams meets the founders
Heston Blumenthal to cook up a spice odyssey for British astronaut manning the International Space Station

UK's Major Tum to blast off on a spice odyssey

Nothing but the best for British astronaut as chef Heston Blumenthal cooks up his rations
John Harrison's 'longitude' clock sets new record - 300 years on

‘Longitude’ clock sets new record - 300 years on

Greenwich horologists celebrate as it keeps to within a second of real time over a 100-day test
Fears in the US of being outgunned in the vital propaganda wars by Russia, China - and even Isis - have prompted a rethink on overseas broadcasters

Let the propaganda wars begin - again

'Accurate, objective, comprehensive': that was Voice of America's creed, but now its masters want it to promote US policy, reports Rupert Cornwell
Why Japan's incredible long-distance runners will never win the London Marathon

Japan's incredible long-distance runners

Every year, Japanese long-distance runners post some of the world's fastest times – yet, come next weekend, not a single elite competitor from the country will be at the London Marathon
Why does Tom Drury remain the greatest writer you've never heard of?

Tom Drury: The quiet American

His debut was considered one of the finest novels of the past 50 years, and he is every bit the equal of his contemporaries, Jonathan Franzen, Dave Eggers and David Foster Wallace