University of Warwick institutional repository: http://go.warwick.ac.uk/wrap A Thesis Submitted for the Degree of PhD at the University of Warwick http://go.warwick.ac.uk/wrap/75017 This thesis is made available online and is protected by original copyright. Please scroll down to view the document itself. Please refer to the repository record for this item for information to help you to cite it. Our policy information is available from the repository home page. Research Thesis for the Degree of Doctor of Philosophy in Law LEGAL AND REGULATORY ISSUES OF ELDERLY CARE IN ENGLAND Michael Stephen Keeler March 2015 ACKNOWLEDGEMENTS I am immensely indebted beyond words to Professor John McEldowney of the University of Warwick School Of Law who, despite enormous demands on him for other academic and university business during the construction of my thesis nevertheless devoted enormous energy in a most tireless way towards the bringing about of a conclusion to my work. School of Law personnel who deserve collectively much credit for the variety of ways that they assisted me are Professor Roger Leng, David Salter, Dr. Jane Bryan, Carol Hughes, Jennifer Mabbett and Dr. Michael Hart. My invaluable personal assistant at my law practice, Sarah Carless, has rendered very significant practical support, as have my daughter Michelle Mikulsky and my son Stephen Keeler, and on the moral support side my wife Ella Keeler and daughter Angela Keeler have been truly without precedent. DEDICATION To my late mother, Bridget Keeler, whose advancing dementia and other health issues caused the family to yield her care to the care home system (and who died rather suddenly of suspected care home neglect); and to my late father, Hugh Keeler, who benefitted from the domiciliary care delivery system (overseen by the writer who lived next door) until successive strokes and associated rehabilitation leaving him in need of constant wheelchair assistance, caused the family to surrender him to a far better care home than my mother. Both parents selflessly facilitated my access to modern education opportunities not available to their generation. DECLARATION I, Michael Stephen Keeler, declare that this thesis is my own original work and that it has not been presented and will not be presented to any other University for a similar or any other degree award Signature: .................................................. ABSTRACT ................................................................................................................................................ 9 CHAPTER 1: Introduction ...................................................................................................................... 12 1.0 Introduction ........................................................................................................................ 12 1.1 Elderly care in contemporary Britain: an overview ............................................................ 16 1.2 Elderly care and the financial crisis ..................................................................................... 23 1.3 Historical perspectives on elderly care ............................................................................... 27 1.4 The aims and objectives of the thesis on regulating elderly care....................................... 32 1.5 Research methodology and sources used in writing the thesis ......................................... 39 1.6 Organisation of the thesis ................................................................................................... 43 CHAPTER 2: An introduction to the history of elderly care .................................................................. 52 2.0 Introduction ........................................................................................................................ 52 2.1 Medieval elderly care: religious values and beliefs ............................................................ 55 2.2 Early Jurisdictional Development........................................................................................ 61 2.3 Further statutory intervention ............................................................................................ 66 2.4 The Reformation period 1534 and its impact on the administration of elderly care ......... 69 2.5 Institutional impact on elderly care .................................................................................... 71 2.6 Private Trust Provision ........................................................................................................ 72 2.7 State intervention and religious organisations: The Hospitals for the Poor Act 1597 ....... 77 2.8 Conclusions ......................................................................................................................... 79 CHAPTER 3: Elderly care in the 19 th century to the development of the National Health Service....... 82 3.0 Introduction ........................................................................................................................ 82 3.1 The 19 th Century philosophical ideas and Influences on elderly care ................................ 83 3.2 The Poor Law Amendment Act 1834 .................................................................................. 95 3.3 Conclusions ....................................................................................................................... 100 CHAPTER 4 - Elderly Care, the Beveridge Report and its aftermath ................................................... 102 4.0 Introduction ...................................................................................................................... 102 4.1 The Victorian legacy and the road to Beveridge in 1942 .................................................. 104 4.2 The National Health Service Act 1946 and the National Assistance Act 1948 ................. 119 4.3 Local Government ............................................................................................................. 123 4.4 Conclusions ....................................................................................................................... 126 CHAPTER 5: Elderly Care, the National Health Service 1948 to the Community Care Act 1990 ........ 129 5.0 Introduction ...................................................................................................................... 129 5.1 State and private provision of elderly care - setting the framework after Beveridge ...... 131 5.2 Benefits for the elderly and frail since the 1990s ............................................................. 136 5.3 The role of the family and others – informal care to the elderly ..................................... 145 5.4 Conclusions ....................................................................................................................... 146 CHAPTER 6: Regulating Elderly Healthcare: The setting up of the Care Quality Commission (CQC) . 149 6.1 Introduction ...................................................................................................................... 149 5 6.1 The Royal Commission on Long Term Care 1999.............................................................. 150 6.2 The Commission for Healthcare Audit and Inspection- The Healthcare Commission ...... 152 6.3 The Commission for Social Care Inspection (CSCI) ........................................................... 155 6.4 The Care Quality Commission: Setting up and rationale .................................................. 159 6.5 The Care Quality Commission (CQC): Early years ............................................................. 163 6.6 The Care Quality Commission: learning from mistakes ................................................... 166 6.7 Conclusions ....................................................................................................................... 173 CHAPTER 7: Elderly Care and the Francis Report 2013 ....................................................................... 177 7.0 Introduction ...................................................................................................................... 177 7.1 The Findings of the Francis Reports: Placing Patient Care as a Priority ............................ 178 7.3 Managing patient care ...................................................................................................... 180 7.4 Elderly care- Professions and their responses to the Francis Report ............................... 181 7.5 The Care Act 2014 - Principal Components and Structure ............................................... 187 7.5.1 Care Standards ............................................................................................................ 191 7.5.2 Health .......................................................................................................................... 191 7.6 Conclusions ....................................................................................................................... 192 CHAPTER 8: Elderly care accountability and human rights................................................................. 194 8.0 Introduction ...................................................................................................................... 194 8.1 Accountability and Transparency: Making elderly care patient led ................................. 195 8.2 Accountability under the Care Act 2014 ..........................................................................