Show some age concern

We all expect the newly elected government to deliver an improved system of NHS care, and we want to assist in the further development of the NHS.

To meet such aspirations, ministers must get real and not be protected by sycophants who disguise the many problems.

The conference season exposes us all to colleagues who behave like aristocrats before the French Revolution. Such people, when asked about the failures of their service, offer impossible proposals to disguise the fact they are out of their depth. Their corruption gives health secretary Alan Milburn and his ministers a biased view of reality, which encourages their evidence-free blatherings about the promised land of a 'modernised'NHS.

Those trusts with bed-blockers have to handle the build-up of old folk on busy wards where death is all too familiar. Instead of pleasant nursing homes, they live amid the mayhem of acute wards. Staff become frustrated as surgical and other elective procedures are cancelled, and senior managers are exposed to the wrath of a regional Gruppenführer who demands obedience, not mere excuses, for failing to hit waitingtime and activity targets.

Relatives may also conspire to delay discharges because NHS care is free. Transfer to a care home may seriously damage your inheritance.

What media attention there is tends to focus on acute blockers in district hospitals.However, the problems in the psychiatric sector are considerable. Demand is rising as more elderly people survive into a confused old age.

Beds become blocked due to a lack of local government finance and the inadequacy of private sector provision. Respite care disappears with this blocking and people descend into acute need, becoming emergency admissions unlikely to return to their homes.

In the acute psychiatric sector, the absence of community facilities blocks beds, and new patients end up in hospitals miles from home. Such conditions alienate staff, patients and carers - and do not help recovery.

All these well-chronicled events go largely ignored, as the sycophants tell Mr Milburn and his mandarins all is well and such problems are a 'blip'.

What to do? The first policy issue for ministers and society is:

'do you care about all this avoidable distress?'All the sycophants will, of course, say yes and rush off to write another national service framework (with inadequate funding). Those who really care emphasise the need for better management of patient caseloads, better management of quality, and improved financing.

In some areas, the bed stock in nursing and residential homes is shrinking: fees paid to the owners do not make the business viable.

Aunt Molly uses up her assets and then becomes a local government 'burden'. The home owner may price-discriminate, charging Molly a higher price when she self-finances, and shifting her to an inferior room when local government pays a lower fee.

Some private owners offer extraordinarily good care by, in effect, taking little or no return on their capital. But you do not get 'owt for nowt'. Government has to revise fees to ensure the supply of good care in nursing and residential homes.

Of course, Whitehall mandarins will claim that 'intermediate care' beds will solve all our problems. If this can be implemented quickly, it will help - but at a price.

The nit-wits in the Treasury who want to waste taxpayers' money say such beds (and increases in the acute bed stock) must be funded by the private finance initiative. This is a loony right-wing policy (inherited from Thatcher, Major and Ken Clarke), which requires the NHS to finance capital from more expensive private sources. Its rationale is that it facilitates a confidence trick - PFI does not count in public expenditure targets. Prudence Brown is really Profligate Brown, who makes sure his City friends profit from the taxpayer by providing expensive finance for the NHS.

This is the economics of the madhouse. So we need better regulation of the private sector's fees and quality, along with abolition of PFI, to show we care about elderly people.

Better management of the primary care trust-trust-local government interface is also essential. Geographical variations in the way 'blocking' is managed demonstrate differences in funding and entrepreneurial skill.MPs should demand action.

So who cares about vulnerable elderly people? Politicians do in theory but, in practice, Tory and Labour politicians have fiddled for decades as elderly people have experienced avoidable misery.

Come on, Age Concern. Come on, Mind. Boil the sycophants and complacent ministers in the oil of their smooth denials.