The long wait
It is December in the Bristol Royal Infirmary and in a room tucked away on a top floor is 89-year-old Iris Sibley. She has been living here for more than six months.
Keeping her company are her devoted husband and son – Arthur, who is 90, and John.
“Mum has got dementia and other problems and she now needs 24/7 nursing care,” says John.
“At the moment she is being funded by the NHS. But it’s just a system where you’re going from one organisation to another and nobody seems to be co-ordinating.”
Tracing the steps that John, Arthur and Iris have tried to take to get her moved on to a care home is mind-numbingly complex. Everyone is well meaning but no-one is fully in charge of the whole process.
Julia Clarke, chief executive of local NHS services provider Bristol Community Health, says Iris’s case is simple to process and fund – but finding space in a care home is the difficult part.
“I’ve seen the printout of all the calls that we made to the various homes between August and December and it was more or less a daily effort,” she says.
“Twenty-four homes were contacted during the period, 11 had no vacancies and another 11 felt they couldn’t meet Mrs Sibley’s needs. And the two able to meet her needs with vacancies, unfortunately were too far away for the family and for Mrs Sibley to have access to her support networks.
“So it’s a combination of circumstances. Some people would call it a perfect storm.”
There are two big costs here, the human and of course the financial cost for the NHS, which is providing a place for Iris to live.
Robert Woolley, the chief executive of the Bristol Royal Infirmary, says he has 800 beds available. On any given day around 60 people are ready to leave but can’t and that is when it gets pricey.
“The sort of medical ward that Mrs Sibley was on, the costs are in the order of £450 a night.
“Given the delay that she had leaving hospital, going on for six months that is probably £90,000 that we didn’t really need to spend in the NHS if there had been appropriate care available for her outside of hospital.”
Iris’s husband Arthur appreciates the care given to his wife but said: “She needs a bit of stimulation. I’m not sure that being alone in the room is good for her.
“We’ve tried all sorts of ways to hurry things up but if they can’t find a vacancy, they can’t find a vacancy.”
Anne Morris, director of nursing for South Gloucestershire’s clinical commissioning group which orders the area’s NHS and community health services, says: “Iris is an elderly lady with some health needs that some of the care homes would struggle to be able to meet.”
She adds they are working to put appropriate support in place for staff.
However space is not the only problem John and Arthur face – money can potentially be an issue.
“We went to see a home where there was a vacancy and it was great,” says John.
“It had everything that mum needed, a window to look out into a garden to see birds. But then a few days later we heard from the NHS people that the bed had gone.”
John believed his mum lost out on the place because a private person could pay more.
David Sallacombe, chief executive of Care and Support West, the body that represents the homes, is blunt about the cost.
“What often happens is that the provider has to make some difficult judgements about the percentage they have in their organisation who might be self-funders and the percentage of state-funded,” he explains.
“Some organisations have made the decision to only have self-funding clients, whereas on the residential side it can be often 70% self-funders, 30% state funded.”
Since December, Iris has been found a place in a nursing home and she loves it.
However, she has been reassessed by the funding authority and although she is still doubly incontinent, living with dementia and needing a hoist to be moved out of bed, the family are now being told that she no longer qualifies for NHS funding.
This means she will be back with the council and the family will have to pay towards her care.
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Mike Hennessy, director of adult social services for Bristol City Council, says fully-funded NHS care is free at the point of delivery, whereas council services are means tested. He points out there is usually a contribution to be made by the service user towards their care.
“The cost of a care home varies significantly. In actual fact it could be anywhere between £800 and £1,100 a week depending on the needs of the individual,” he says.
He says the amount to pay is decided on the individual’s income and any assets that they have.
“Sometimes if people have got over £23,500 they will be required to pay the full cost of their care.”
Everyone we talked to about Iris mentioned the future that we all face, with an ageing population and a lack of money. Could some planning and a national conversation make it less gloomy?
Mr Sallacombe says: “Is there any conversation about what that might mean – are we talking here about whether it will cost everybody a pound a week more or five pounds a week more?
“That debate hasn’t in my view been engaged in the public with enough vigour.”