THERE are three important facets of health service — prevention, cure and care. Whilst most of the time people talk about ‘’cure’’ — ‘care’ also is extremely important as often care is an essential adjunct of cure. Care, however, is the most expensive area, whilst ‘prevention’, where feasible, is the cheapest.

We all read and hear about the problems of ‘bed blocking’ within the acute hospital/cure sector due to the extreme shortage of services within the community which delays the discharge of ‘treated’ patients – especially the older/frailer ones.

Over the last few years, two important changes have taken place – hospital beds have been reduced along with the drastic reduction in community facilities eg domiciliary services, residential care etc. The idea, quite laudable, is based on the principles of ‘care in the community’. So far so good; but even community care needs facilities and staff. Many vulnerable, old and frail need help with basic hygiene and support — eg bathing, getting in and out of bed and dressing/undressing. And these activities cannot be undertaken by pills or injections – these require human beings – who are themselves caring, compassionate and have received some basic training.

Out of 2.3 million pensioners in need of basic service, almost half do not receive any help at all. A fifth who are unable to get in or out of bed do not receive any assistance and left in bed virtually all day. Sometimes individuals with feeding difficulties are left to struggle alone.

As mentioned earlier these so-called 'care' services may not need high tech equipment or high skills, but these need people – a commodity, most expensive of all.

Many need to go into care facilities for a longer period or even permanently. These days each and every patient referred for such care, are vigorously scrutinised and often rejected; despite that those who finally are accepted as genuine cases are also not receiving any service. Many residential care and nursing homes run by private sector have closed down. Incidentally, these days there are hardly any residential care provided by the local councils. Due to drastic cut backs and rationing, there is now extreme shortage of staff in the community and vulnerable people are suffering in silence and awaiting death.

The total scenario is very sad indeed. The state always says, ‘ we are providing more funds’ — I do not dispute that — more money has been provided but against the overall needs it is a drop in the ocean. And as mentioned already care is a very expensive entity.

Only rich individuals or with large savings can afford the upmarket private nursing homes; the so called ordinary ones are closing down rapidly – as they can no longer sustain the business. The regulations are strict and demanding (quite correct to maintain good standards) - they are handing over their contacts back to the authorities.

The figures supplied by the national charity Age UK suggest that 77 councils have seen at least one care home closing in 2015-16; there has been a total reduction of £160 million in social care. At the same time to make matter worse, majority of lay carers are getting old and infirm themselves – about half a million are over the age of 80 — the supply here is gradually dwindling.

Recently one council in the south of England had wanted to run a referendum for a 15% rise in council tax to pay for social care; for some odd reason that proposal was later withdrawn for some political reason.

Social care for the older and frailer people is about to collapse, the result is likely to be a total clogging up of the acute hospital sector and the A & E departments up and down the country.