Memorandum by Westminster Health Care
Ltd (DD 26)
1. Westminster Health Care Ltdan
2. Hospital Dischargesour experience.
3. Intermediate Care.
4. The role of nursing homes.
1.1 Westminster Health Care Ltd is one of
the largest providers of nursing homes for older dependent people
in the United Kingdom. Whilst many of the residents in the homes
will pay the full cost of care (excluding nursing care) themselves,
the company is committed to providing high quality of care for
any older person, regardless of their financial position and whether
they pay directly themselves or are supported by a local authority.
The main criteria for admission must be the needs of the prospective
1.2 We support the need for full comprehensive
assessments, and support the scheme recently introduced by the
Department of Health in respect of assessment for nursing care.
We have adopted a nationally recognised and standardised assessment
process throughout all our homes, and are making this information
available to colleagues in the NHS and Local Authorities.
1.3 Through a comprehensive training and
staff development programme we aim to provide a high quality of
care which reflects the individuality of each resident.
1.4 Westminster homes generally meet the
new requirements of the Care Standards Commission, and we support
the aim of the Commission to raise standards.
2. HOSPITAL DISCHARGESOUR
2.1 We welcomed the Government attempts
to speed up discharges when acute hospital care is no longer needed.
The addition of extra funding in the form of the Intermediate
Care Grants to Health Authorities and Local Authorities was also
welcomed. However, our experience to date is that there have been
few attempts to involve the independent sector in providing additional
services, with much of the money going in reopening closed wards
with the new title of intermediate care wards. However, where
NHS Trusts have been working closely with the company we can point
to success in enabling people to move from hospital to nursing
home, and then following a planned programme of rehabilitation,
back to their own homes.
2.2 Because of the decline in the number
of places in nursing and residential homes, admissions to the
remaining homes are often at a point of crisis. Pressure is placed
on hospital based staff to move people on, thus totally ignoring
the concept of choice, and without proper planning for rehabilitation
being in place before the patient is discharged from hospital.
We do not believe this is good practise.
2.3 A few of the Trusts and Local Authorities
who have chosen to use the independent sector as part of their
rapid discharge strategy have failed to address the need for providers
to be able to recruit specialist staff such as O Ts and Physiotherapists,
which are an additional cost above the normal fee rate.
2.4 Only a very few local authorities have
involved company personnel in any planning processeswe
have some experience of being consulted once a plan has been agreed
by the statutory authoritiesand yet in many instances the
main provider of direct services for dependent older people is
the independent sector. We think this neither reflects the concept
of partnership working nor uses the full skill and knowledge base
which may be available in any community.
3.1 In anticipation of the introduction
of intermediate care schemes throughout the country the company
invested in adapting homes so that the full rehabilitation programme
could be provided. Whilst the scheme in Birmingham has worked
well, it has relied upon the enthusiasm of a few health personnel,
and has not been used as effectively as we had hoped. Elsewhere
only one off requests have been received, often of a short term
nature, and sometimes competing for places which would otherwise
have been taken by older people who were able to fund their own
3.2 The use of technology now opens up the
possibility of much more use of less expensive, community based
but skilled nursing homes for the ongoing treatment and rehabilitation
of patients, with the clinician still maintaining an overall monitoring
and care management responsibility.
3.3 Given the need to demonstrate best value
across the whole of the industry/care sector, it is to be regretted
that greater use has not been made of intermediate care facilities,
both in nursing homes and in the clients' own homes.
4. THE ROLE
4.1 Whilst we recognise that as more people
remain in their own homes, demand for the type of accommodation
which is not able to provide care for the most acutely frail elderly
people is likely to fall, we remain convinced that nursing homes
are a better provider of care for very dependent people rather
than long stay wards in hospitals, or more importantly acute wards
where places are needed for very ill people.
4.2 Many elderly people end up in the A&E
Departments in hospital because they have or are experiencing
a period of illness or physical decline. However, they do not
necessarily need the full range of hospital services. Nursing
homes could provide such accommodation, if there existed at a
local level plans for the use of accommodation in this way. In
other words, the only route to a nursing home should not be seen
as just via a hospital. The use of hospital places by some older
people could be avoided if the right agreements between the purchasers
and the providers were in place.
4.3 The aim of the company has always been
to provide care which is relevant to the needs of each individual
resident. We welcome therefore the changes in respect of registration
requirements which come into effect from next April, with staffing
levels based on the assessed needs of residents. By extending
this approach, coupled with the extension of the assessment process
to the full care needs of each resident, it is possible within
the existing framework to provide for many of the older people
who are currently blocking beds in acute wards.
5.1 We recommend that all Local Authorities
and Trust be required to publish a statement explaining how they
will involve the independent sector, who often are the major providers,
in their plans to tackle the problem of blocked beds in hospitals.
5.2 We recommend that the funding of hospital
discharge schemes be reviewed, so that it can be demonstrated
that local resources are being used as effectively as possible
before new services are introduced.
5.3 The need for appropriate staff and equipment
should be emphasised by the Government before any hospital discharge
scheme is approved.
5.4 Longer term planning is required if
the problem of blocked beds is not to reoccur each year. The statutory
authorities should be required to produce plans covering a minimum
of three years, with contracts with providers and earmarked funding
in place to ensure such plans will be implemented.
Westminster Health Care Ltd would be pleased
to outline further any of the points raised in this submission
at an oral hearing of the Committee.