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Regarding the announced policy of closing Devon County Council Care Homes

Mr Stuart Barker Cabinet Member for Adult Social Care and Health Services Devon County Council

Dear Stuart,

Having attended the Health and Well Being Committee last Monday afternoon, I later saw you on BBC Spotlight SW announcing the closure of 20 care homes in Devon.  I was angered by the manner of the announcement and very disturbed by the content and rationale.

This letter is no attempt to 'shoot the messenger' but to question what is going on in our country as presently directed by a Coalition government where no party gained a majority, and by your council, in this large and wonderful county.

As an orthopaedic and trauma surgeon I had the privilege, and occasionally the burden, of helping many elderly citizens get back on their feet.  The oldest orthopaedic patient I operated on for a very painful hip was 98 years old.  On the trauma side, I dealt with many, many hundreds of ladies with fractures about the hip.  (The ratio of female to male was about 3:1)  The numbers then were increasing at about 6% pa.  I saw the spectrum from remarkable fitness and independence to marked frailty of body or mind, or both.  For the record, given that there is a 'nitwit' drive to close Community Hospital beds as well, we relied on being able to transfer some of the patients to CHs, in order to make space for the inexorable flow inwards.  We had many patients who were accommodated on 'outlying' wards to the detriment of those other admitting 'firms'. Sometimes I needed to follow them up and most often in private care homes, and less often CHs.  So aside from having knowledge of caring for elderly family members, I learned a lot and cared a lot about our older sisters and brothers. (Sue's Mum was in our home for 3 months as she died without pain from a cancer of the pancreas  She had wonderful help from district nurses, Macmillan, Marie Curie, GP etc)  

We are taught, are we not, to love and respect our elders?  If this exists widely, it reflects harmony in any society arising out of that continuity.  The generation that are represented in care homes are the ones that suffered all manner of depredation and loss in WW2.  Some will have suffered that extreme poverty before that war, and see evidence of that again.  The last of our citizens to suffer should be these people.

The process

I recall that the closures will take place steadily.  The residents will be taken to private care homes (but public in the sense they will be taxpayer funded) so they can choose one they like.  The choice will be limited in the cities, and in the rural areas it will be Hobson's choice.  How will they judge?  Fawlty's Towers might fit the bill at first.  And then having chosen there comes the wrench.  The frail old lady might never rise out of her sadness from leaving old friends and staff members behind her.  There is no going back is there, except horizontally?  I believe that when Plymouth CC closed a large care home, figures emerged showing a distinct rise in mortality in the weeks following 'transfer'.  This alone is a most serious matter.  I know from my long experience that the spirit within the elderly is what sustains them.  If they 'turn their faces' to the wall, the end comes quickly.

You said the ladies would be given a budget for the home of their choice and that a fund would be held by DCC to pay for any difference between what was afforded by that budget and the full charge.  That sounds open ended and unusual public accounting.  There surely is a ceiling?

The vacated buildings, often with generous grounds, will then be bought by speculators.  Is any saving likely accepting that economy alone is not a moral matter.  It must be difficult for any in-house accountant to compute whether there will be savings but review in say 5 years might show no pecuniary advantage.

The care homes

We hear frequently of physical and mental abuse in nursing and care homes.  The ones I recall have been private in the main.  That reported the other day by the BBC was typical in that the management appeared to know nothing of the long sustained abuse, reflecting the poverty of that management.  I paraphrase 'What has occurred, does not reflect the high standard of care in our establishment'.  This was after two of the three were jailed.  Of course, these are most serious matters.  And care and nursing homes go bankrupt frequently; their charges are squeezed by 'commissioners' so they run on a shoe string.

Because profit margins are tight, and the costs of property very high, the care and nursing homes I have seen tend to be poky and the corridors tight.  But I know there is considerable variation.

The staff are paid around the minimum and those who have recently come into the UK might be paid less than that.  Instead of care for the vulnerable and for the elderly being the best British society can afford, the care 'industry' is sometimes central in the 'race to the bottom'.  With that, goes a reduced tax 'take'.

Austerity and cuts

It is reasonable to infer that austerity is driving the draconian cuts in public services.  'We need to tighten our belts' and 'We are all in this together' set the scene.  The bubble was burst by excess personal debt, both plastic and mortgage, but especially by the reckless behaviour of bankers with cocaine a factor in the fever (1).  That the public has bailed out the banks to the tune of £580 million is but one sign that we are not 'all in it together.'  So the central fault which is fractional reserve banking remains unaltered, current leverage is as it was in 2008 at about 3%, and collapse is as likely now in spite of very tightened belts for many.

This is very briefly the financial background to the cuts in precious public services.  We are expected to remain submissive.

What evidence is there of 'austerity' in other national policies?

The plan to build HS2 Phase One, a 155 mph line to Birmingham, has been given the go ahead by the Coalition Government.  It will save 20 minutes in journey time; a majority of the passengers will be working with the help of wi-fi.  Millions will not afford it. The Institute of Economic Affairs puts the cost at £80 billion.

The construction of two aircraft carriers is nearing completion.  A cost of £6.2 billion was floated.
We can guess that figure will quadruple with the fitting out and completion by ? 2020.  More to the point, an aircraft carrier is for attack in aggressive wars, as proscribed at Nuremberg and in the Charter of the UN.

The plan for the Hinkley Point C, nuclear power plant, was approved in 2013, two years after the disastrous meltdown of 3 out of 4 reactors at Fukushima.  This approval was given in face of the unsolved challenge of nuclear waste disposal and the vast cost of decommissioning both now and in the future, about which there is silence.  This will be at least £70 billion.  As with the 12 defunct nuclear powered submarines (2) lying at their moorings at Devonport, there will be the greatest difficulty in finding places to dump the reactors and their shielding.

We can conclude that 'austerity' is not applied wall to wall and that forethought is not a feature of UK governments.


Studies show clearly that the chasm between the rich and the poor becomes ever deeper.  We see that reflected in the public estate and services.  An assumption is made that the better off are greatly concerned with taxation levels.  Yet proper provision for the elderly, the mentally frail, for young people, for good and well staffed libraries and all the rest, are vital for those served and for the well being and harmony of all within the communities in our county.

The deep concern about 'cuts' was obvious when Councillor Hart, leader of DCC and Councillors Connett, Westlake and Julian made their joint plea for the reversal of government spending cuts 16 June. (3)

If the present path is pursued, we will see public provision continuing to be hollowed out in parallel with increasing poverty in many.  A reckless 'slash and burn' 'policy' will lead to greater distress in the elderly, and discontent and 'disconnection' in the younger.  Society is harmed, irretrievably.

The bankruptcy of thought and responsibility of some in government towards vital services is demonstrated today by the words of this minister within the Department of Health (4).
She did not need to tell some of us -

NHS reforms 'gave away control' of health service

In the recording leaked to the Observer, Conservative health minister Jane Ellison said:

I don't know how much any of you realise that with the Lansley act we pretty much gave away control of the NHS, which means that the thing that most people talk about in terms of health, the NHS, we have some important strategic mechanisms but we don't really have day-to-day control.

From a political point of view, it is a bit like being on a high wire without a net at times, it can be quite exciting.

We want economy Stuart, but above that we want the rational, the thoughtful and the kindly.  It is an irony that the party which is called 'Conservative' is, for the time being, doing the opposite.   

For truth, reason and justice

David Halpin MB BS FRCS  
ccs to Councillors Alan Connett, Richard Westlake, Robin Julian and to my web site

  1. Prof Nutt in answer to a question re square mile and cocaine use by me at the Torquay Medical Society