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Cuts in community nursing spending threaten elderly care

Exclusive Primary care organisations are cutting their spending on community and residential nursing care for elderly patients, and in some cases relying on unqualified healthcare assistants to provide care, a Pulse investigation reveals.

The average spend on community nursing provision and nurses for elderly patients in residential and care homes is being reduced by 5.5% over the current financial year, figures obtained under the Freedom of Information Act show.

The sharp reduction came as a Pulse survey of 300 GPs found only 10% felt PCOs were properly prioritising spending on hands-on care of the elderly versus drug treatment, while 80% believed elderly patients were being ‘substantially over-treated' with medication.

Responses from 45 PCOs across the UK showed funding for community nursing and healthcare assistants employed tolook after the elderly is due to fall from an average of £9m in 2010/11 to £8.5m in 2011/12.

Ten of the PCOs also admitted they commissioned or provided care through healthcare assistants with no formal qualifications.

NHS Stockport said qualifications for healthcare assistants were merely ‘competency based' while NHS Bournemouth and Poole said it had ‘no required qualifications' for them.

NHS Forth Valley said there was no qualification for healthcare support workers, although they had to comply with mandatory induction standards and a code of conduct. NHS Fife said healthcare assistants needed only a ‘good level of education' plus a commitment to undertake a qualification in health and social care.

But other PCOs required that all healthcare assistants had at least an NVQ level 3 qualification, and additional training¸ as in Torbay Care Trust which said: ‘All healthcare assistants have also undertaken our in-house mandatory training courses.'  

Cuts in spend on care came as figures collated by the NHS Information Centre show the number of drugs prescribed to elderly patients as a proportion of all drugs prescribed in primary care rose by 9% in six years.

Dr Keith Ridge, the Department of Health's chief pharmaceutical officer, warned: ‘Demand for medicines is increasing. We are committed to ensuring the safe use of medicines and are working with clinicians, the care home sector and other key organisations so we can drive up standards of care for older people.'

Professor Steve Iliffe, a GP in north west London and professor of older people's care at University College London, said: ‘Excessive prescribing in the elderly can be iatrogenic. From the research between 10% and 30% of admissions in the elderly are due to adverse drug reactions so this is still very much an issue for GPs.'