Care Homes need better policy leadership

Clive Bowman, Residential Forum member writes:

I recently submitted a response to a seasonal piece on admissions from care homes in the BMJ, as usual I felt much better for so doing. The letters editor invited me to edit what was a bit of a brain dump of around 700 words to 300 and publication in the journal would be considered. Whilst those who might have heard me before will feel familiar with the general themes, the second paragraph has what is possibly a new exposition of the care home resident population. 

For too long able health and social care have been variously seconded to do “stuff” in and around care homes – its not enough, the letter was published as letter of the week and I offer it here to the Residential Forum readership which I suspect may not have the BMJ as a routine read.

BMJ 2019; 367 doi:

(Published 26 November 2019)
Cite this as: BMJ 2019;367:l6604

Hospital admissions from care homes1 are often due to a clinician being unable or unavailable to “do something,” such as make the difficult decision that admission would be futile. The PEACH study joins an increasing litany of well crafted studies identifying the potential for supportive interventions.2 These generally ignore the realities of staff availability.

Care home residents do not fit the traditional medical paradigm or a social care model, as their quality of life is largely determined by optimisation of their health. Recognising this today is probably as important as palliative care has been in oncology. Re-engineering the support for care homes and their residents is overdue and given the size of the sector deserves a designated division in the Department of Health and Social Care and fresh strategic and policy leadership.

The decision to be admitted to a care home, whether simple or complicated, requires someone to take responsibility for assessment and review. This should fall to NHS practitioners with a caseload of 60-100 residents working as a consortium providing continuity supported by technology. Professional nurses in care homes currently have poorly developed roles, and providing round the clock presence is unsustainable. Removing the need for an omnipresent registered nurse would allow some to step up to the responsible practitioner role. This would reduce the number of professional nurses required by care homes by many thousands across the UK and create new professional roles and relationships with patients living in care homes, their carers, and families.

General practitioners and hospital specialists receiving referrals from these practitioners could expect greater clarity of the context and purpose of referral and be more measured and effective in their responses.

Most of these things exist internationally—the opportunity to develop an informed UK model would deliver many gains in a way that “more of the same” will not.

Full response at:


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: