As a former community matron, I was interested to see your report highlighting malnutrition admissions to hospital, sometimes termed “social admissions” (Hospital admissions for malnutrition triple in decade, 26 November). My 91-year-old mother fell and was admitted earlier this year, and no cause was found except that she weighed 39kg. Living alone, she had always done her own shopping and cooking. My weekly visits supplemented her fridge contents, but I was unable to persuade her to accept help. Following her fall, I persuaded her to accept help, and we can, luckily, pay for private care to visit her to encourage her to eat. I ask the carers to eat with her and ensure they have enough time to do so.
The lack of mention of social care in the autumn statement is fundamental, but we must remember that few, if any, local councils will fund care just to encourage nutrition. Loneliness has a huge effect on eating. In general, councils do not provide social care for someone who can “self-care” but who is not eating. Meals-on-wheels services do not provide company to eat, and some councils advocate a fortnightly provision of frozen ready meals, so there is not even the daily contact of someone delivering the meals.
A recent visit with my mother to her GP revealed she has put on weight and is fit and healthy. The doctor did not question this or ask how this had come about. Your article quotes Stephen Dalton, chief executive for the NHS Confederation, as saying that “people are most at risk … if denied basic compassionate care”. He is right – but basic care includes recognising the social element of eating.
Sophie Howson
Clinical director, SK Nurses
• How much of the increase in hospital admissions for malnutrition is due to pensioners simply finding modern life more difficult and simply “giving up”? In the past few years simple tasks such as paying bills without some extra charge have become harder as post offices have closed en masse and now one must go online to pay or discover whether it is Pingit, Paypoint or whatever. TV has become louder, brasher, more celebrity-based and harder to operate, with multi-channels that regularly need updating. Then we have the erosion of social cohesion as we shift from walking and public transport to cars, from libraries to the internet, and from corner shops to anonymous supermarkets. I suspect many of our pensioners are suffering psychological “death by a thousand cuts”; each change may be trivial, but together they make this no country for old men (or women).
Dr Hillary Shaw
Director and senior research consultant, Shaw Food Solutions
• Louise Tickle (Safety in numbers, 26 November) asks “what can be done” about the soaring numbers of children being removed from their families and placed in care – a draconian measure, the right to private and family life being enshrined in the Human Rights Act. I am no longer in practice, but I recently asked a solicitor colleague working in local authority child protection if she thought the removal in recent years of effectively all public funding for private family law proceedings had anything to do with it. Her response was unequivocal.
It’s unsurprising that when vulnerable families in difficulties cannot access professional legal advice and representation, their situation deteriorates and children are put at risk. The wider financial cost of this under-reported £2bn “saving” (doubtless another one the government thought it could get away with) is evident – the social cost can hardly be imagined.
Jan Williams
Knaresborough, North Yorkshire
• The Baby P case continues to cast a long shadow over the system, but Louise Tickle fails to mention other factors that are contributing to a “risk-averse” approach by local authorities. Two such factors are being driven by the senior judiciary. These relate to local authorities’ use of section 20 of the Children Act 1989 (voluntary arrangements to protect children) and the increasing number of actions brought against local authorities under the Human Rights Act 1998.
While I do not excuse local authority shortcomings, the judicial criticism of the use of section 20 and the rising levels of Human Rights Act damages awards is causing greater risk aversion, increasing care applications and draining local authority budgets of scarce resources that should be going into the early help and preventive work which Ms Tickle correctly highlighted as being so important.
Graham Cole
Chair, Lawyers in Local Government Child Care Lawyers Group
• Perhaps we need to look no further than Philip Hammond’s autumn statement to find the funds now vital to save what is far and away the most important “infrastructure” we have – the rapidly crumbling NHS and concomitant social care. New runways and high-speed rail projects – which anyway primarily benefit the overfed south-east – should surely wait a few years for the pot of gold promised at the end of the Brexit rainbow.
John Reynolds
Collingham, Nottinghamshire
• As the national charity for seriously ill children and their families, we are dismayed by the missed opportunity within the autumn statement. The government has failed to address a growing crisis facing the UK’s seriously ill children, young people and their families – a crisis that has serious implications for the future sustainability of the NHS.
There are estimated to be over 100,000 children and young people in the UK with serious illness or exceptional health needs. Many spend months and years in hospital because there is no support enabling them to leave. Charities like WellChild have picked up the pieces, making it possible for these families to leave hospital and be cared for at home. Last year we managed to help over 1,200 families (1% of the estimated number that need help).
We believe the government has missed four fundamental opportunities:
1. Investment in social care for the growing numbers of children and young people living with exceptional health needs, so that they can be cared for in their own homes.
2. Investment to address a growing workforce crisis in the field of children and young people’s nursing and allied health professions.
3. The government must challenge local authorities that still do not provide adequate short break services for families despite their legal obligations.
4. Greater provision for supporting families caring for a child with exceptional health needs at home.
We call for the government to take action to mitigate a growing crisis affecting thousands of children, young people and families across the UK.
Colin Dyer
Chief executive, WellChild
• The government says malnutrition is identified earlier with improved data collection. That does not explain the increased numbers; neither is its one-off £500,000 grant to Age UK a solution.
I’m a retired adults social worker, disgusted that any malnutrition occurs in this country, with cuts to social care, eg meals on wheels, now endangering health. In my training (1975-77), symptoms, effects – and causes – of social problems were addressed. Our government seems uninterested in addressing what causes malnutrition.
The so-called health and social care “internal market”, resulting in widespread privatisation, has cost us massive amounts of money – although the market repeatedly demonstrates failure in providing care (see the Centre for Health and the Public Interest’s report “The failure of privatised adult social care in England: what is to be done?”).
Meanwhile malnourished patients occupy beds that the government actually wants to cut, while other citizens have to wait longer for treatment.
The 44 sustainability and transformation plans for NHS England herald another major reorganisation. These lengthy (and suspiciously similarly worded) plans stress preventive work – but especially cost-saving. Some councils are refusing to sign up to them.
Why cut social care funding? We need an end to government “post-truth” on this subject – and for the Department of Health to publish spending on PFI payments, management consultants; meetings about NHS reorganisation, and commissioning meetings with doctors examining numbers instead of patients. Far more informative than minor contracts such as Age UK’s, incapable of having significant countrywide effect.
Winter is here. Why does the refrain “Hope I die before I get old” keep playing in my head?
Barbara Dresner
Tameside Keep Our NHS Public
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