Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 404 - 419)




  404. Colleagues, can I welcome you to this session of the Committee. Can I welcome our witnesses, and we are very grateful that you have been able to join us today. Can I particularly thank you for the written submissions that have been received; we have found these very helpful. Perhaps I could begin by asking you each briefly to introduce yourselves to the Committee; could you, in doing that, say a word or two about the organisation that you represent: Mr Lewis? I am sure we have seen you before, at some point in the past?

  (Mr Lewis) With different hats on. I am currently Director for Public Private Partnership with Westminster Health Care, which is one of the larger providers of nursing home care, largely for elderly people but also other dependent people, in England, Wales and Scotland. Prior to that I had been a director of social services for rather more years than I care to remember.
  (Mr McClimont) I am Bill McClimont. I am the Chair at the UK Home Care Association, which is an association of about 1,300 offices of home care provision, providing about 50 million hours of care annually. We cover members in the voluntary, `not for profit', commercial and statutory sectors.
  (Mr Rice) Hello. Tony Rice, CEO of Tunstall Group. We are Britain and Europe's market leader in social alarms, Telehealth technology and round the clock monitoring, and provide services to 95 per cent of the local authorities in Britain, and indeed the housing associations, and have an installed base of 1½ million in the UK whom we support.
  (Mr Hassell) My name is Barry Hassell. I am the Chief Executive of the Independent Healthcare Association. The IHA is a registered charity, and we are the leading association for the UK's important health and social care providers. Our members are a range of providers, they are `not for profit' organisations, mutuals, friendly societies, as well as, of course, `for profit' organisations. If I can just say that the sector has about 443,000 beds across nursing and residential care homes, acute and mental health facilities; it provides care for about 200,000 people in their own homes each day, and is a major employer in the UK, employing about three-quarters of a million people.
  (Ms Adams) Hello. I am Sue Adams. I am from Care & Repair England. We are a national charity, a small national charity, and our primary concern is with older people living in their own homes who need repairs and adaptations. We are what is called a second-tier organisation, so our main concern is to encourage new initiatives and services which help older people to stay independent. And the main things that you will have heard of, that are related to us, are Care and Repair and Staying Put schemes, and many of these are now moving into the area of helping people leave hospital more effectively and stay in their own homes.

  405. Thank you. We have obviously invited you because you represent a range of different perspectives on the area that we are interested in. I would like to, if we could, tease out some of the distinctions between your evidence, which, in some respects, are quite marked. Perhaps I could begin, Mr McClimont, with yourself, where your evidence suggests that this kind of debate around care and delayed discharges, as I think you say it, has been hijacked by the care home providers. What do you mean by this, in particular?
  (Mr McClimont) I think it is not just the care home providers themselves, but it is also shorthand by policy-makers and the media. It is very easy, when putting up a headline, to say "Nursing home to be used," or something of the sort, when, in fact, the policy that underlies it is far more to do with getting the appropriate care for the right people at the right times. I think that though, underneath that, there is a mindset amongst the public and amongst policy-makers that presupposes that an institutional setting of some sort, a building, is liable to be the right solution, and I think that is a mistaken presumption; and part of my evidence was to propose a reversal of that mindset, if possible, by requiring a positive justification for admission to any form of building in the way of care, because so much now can be done in the home. It will not always be the right answer, there will always be occasions when a care home will be right, when a nursing home will be right, when a hospital, inevitably, will be right and the only solution to the situation; but at the moment the presumption goes, in my view, the wrong way round, about how many people can we think of occasionally putting out to home care, rather than starting the other way round.

  406. So, presumably, you will be critical of the debate in Parliament over the number of care home places that may or may not have disappeared, in that that does not really focus on the key areas that you believe we should be looking at?
  (Mr McClimont) I think it is deficient, because although that is a critical problem, it is a big issue, it is not an issue that is restricted to care homes, it is also an issue that extends to home care. And while we are a relative newcomer to the field, we have not been around quite as long, and the problems have not been severe until recently, the problem now is, I believe, just as acute and in danger of just as much collapse as the care home debate has illustrated for them.

  407. In a sense, your criticism, presumably, is of some of the organisations alongside you, and I will bring in some of the other witnesses on this point. Specifically, can I go to Mr Hassell, and your evidence is quite strong in talking about the difficulties being faced by the institutional care sector. If I can quote your evidence, on page 11, you talk about "independent care homes have become unviable and have been forced to close with tens of thousands of residents losing their homes." Tens of thousands of residents losing their homes. "In all, it is estimated that nearly 50,000 beds have closed in the independent sector since 1996." Do you stand by that evidence?
  (Mr Hassell) Yes.

  408. On what basis has this estimate been made?
  (Mr Hassell) Could I say firstly, you referred to institutional care, I think that is an unfortunate term. We are talking about meeting people's care needs; it happens to be in a residential situation, and I think there is a lot of difference between modern nursing and residential care homes and some of the old-fashioned institutions you may be thinking of. I actually would agree with Bill McClimont, in that what is important is that people's needs are assessed and that whatever services they require are provided in a timely manner, and that can cover the complete spectrum. We have absolutely no problems, if it is right for people to be assessed for home care, that is what they should receive; if they require care in a nursing or residential care home facility, or intermediate care, then that is equally right. So I do not think there are any differences between our positions. Regarding the issue of 50,000 beds, yes, since 1996, in fact, there have been over 50,000 beds lost from the independent sector.

  409. So who says that?
  (Mr Hassell) That is independent research, from people like Laing and Buisson and Help the Aged, and others.

  410. So it is not your research?
  (Mr Hassell) It is not our research.

  411. You are basing this quote on somebody else's research?
  (Mr Hassell) Absolutely. And I think the key thing is that there have been over 50,000 deregistrations in the independent sector; of course, there have been new homes opening elsewhere, and you can play around, like all statistics, with gross and net figures. The reason why we think that 50,000 is important is that, of course, even though you have new services developing, they may not be in the same area, or the same place. So what is important is to recognise that 50,000 people have lost what, effectively, has become their home, and the replacement homes may not be the same services, or in the same geographical areas, and that is an important point to remember.

  412. The reason I am asking this question is that we want to be clear that we are talking about the same figures, because there are certainly serious questions that have been raised with us by our Committee boffins, shall we say, that this figure is inaccurate, that the figure that you are proposing in your evidence actually includes losses from the local authority sector and losses from NHS long-stay provision. So can you be absolutely specific that you are basing this figure purely and simply on losses in the independent sector, because certainly the figure that we have is around 19,000, which is very different from the 50,000 figure that you are quoting to the Committee?
  (Mr Hassell) I am aware of that net figure, but the figure of 19,000 is a net figure, it is the deregistrations less the new provision that has come on stream; that is quite a different figure.

  413. But, forgive me, that is the independent sector specifically?
  (Mr Hassell) That is right, yes.

  414. Are you saying that the 50,000 figure that you are putting forward to the Committee in your evidence does not include the local authority sector and does not include NHS long-stay provision?
  (Mr Hassell) That is my understanding.

  415. That is your understanding?
  (Mr Hassell) Yes.

  416. Right. You may wish to go and check on that though, because this has been looked at, Mr Hassell, in some detail, and the figure, from the point of view of our independent advice, is very different from that which you are giving; and, obviously, this 50,000 figure has been the subject of intense debate, questions to the Prime Minister, and I think it is important this Committee, actually, gets to the bottom of exactly what we are now talking about?
  (Mr Hassell) If I could comment. In the particular survey which I am sure your advisers have been using, the same way as I have, there are different tables, with different ranges of figures. There is one particular section that actually summarises the deregistration of homes, and, of course, it is only the independent sector facilities that are registered, so those numbers must relate to the independent sector, unless, of course, there are errors in the way in which the tables are presented. There are, equally, of course, other tables which show some of the losses in the statutory sector; like all stats, no doubt, you can carry on with reconciliations for ever. But I am more than happy to talk to your officials and compare notes with them, if that helps.

  Dr Taylor: In your written evidence, you do say, quite clearly: "The figure of 50,000 beds (see Table 1) reflects the total loss of long-stay provision across all sectors." And that squared it for me, because I thought that was why Mr Duncan Smith is allowed to say 50,000 beds, and yet Mr Blair says 19,000. Because I thought they were not comparing the same thing, and your written evidence cleared that with me; but what you have said has confused me again.

  Chairman: The written evidence says the independent sector, specifically.

  Dr Taylor: No; no, on page 17: "As has been described above, 50,000 beds (see Table 1) reflects the total loss of long-stay provision across all sectors."

  Chairman: The figure I used was the paragraph 38, on page 11, where the specific evidence says; "it is estimated that nearly 50,000 beds have closed in the independent sector since 1996."

  Dr Taylor: Paragraph 38, on page 11, of their evidence.


  417. Yes.
  (Mr Hassell) Let me assure the Committee, if I may, Mr Chairman, I was aware of the fact that this was an important statistic and I have spent time today, actually, looking at the summaries and tables, so certainly the information I was giving you a moment ago is exactly the information that has been published. If there is a variation in our evidence then that is something I would like to look at very closely, obviously.

  418. It may be we will need to come back on this one, because it is a very important area, as I am sure you understand.
  (Mr Hassell) Yes; and, as I repeat, I am very happy to co-operate with your advisers in looking at this.

Andy Burnham

  419. For the figure to have any meaning, as well, it has obviously got to be linked to the requisite capacity in the market as a whole; and would you agree, or is there not the possibility, that there was overcapacity in the residential care sector in 1996?
  (Mr Hassell) I think, when talking about the market, it is difficult, this is not a national market, so there is not one market; and certainly those suggestions have been made, that there is overcapacity. We are talking about local markets, so we could be talking about several hundred different local markets. But, yes, in some areas, there may still be overcapacity, but in others, of course, we have moved in the reverse direction, supply/demand ratios have switched altogether.

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