Select Committee on Health Appendices to the Minutes of Evidence


Memorandum by the Continuing Care Conference (DD 27)


  The Continuing Care Conference (CCC) is pleased to have the opportunity to submit written evidence to the Committee's inquiry into Delayed Discharges.

  The Continuing Care Conference (CCC), which was established in 1992, is a unique coalition of commercial, charitable and public service organisations with a mutual interest in providing better care for current and future generations of elderly people. Members include care providers and commissioners, financial service providers, trade and professional bodies and providers of information, advisory and advocacy services. It has no political affiliation and does not seek to represent any single sectoral interest group.

  CCC's mission statement is: "We believe that all older people in Britain should live their lives in dignity, comfort and in a place of their choosing. We want all elements of society to make the necessary individual and social investment to ensure that happens. Our task is to ensure that policy-makers pursue this goal and to encourage the public to join with us in our mission to persuade them to do so".

  A list of members is attached, for the Committee's information. Individual CCC members will be responding separately and in more detail on several aspects of the inquiry, notably access to rehabilitation, intermediate care, home care and other social services interventions; inter-agency co-operation; telemedicine and telecare; appropriate alternatives to hospital admission; and the impact on patients, staff and carers of delayed discharges.


  CCC's evidence relates primarily to those matters of which CCC's members have experience and we cannot claim to offer a comprehensive policy overview or an overall solution. We would, however, suggest that when the Committee assesses the range of evidence presented, a distinction should be made between: systemic and organisational problems; difficulties relating to funding shortfalls; and specific local issues. We hope that the Committee will have its attention drawn to the "success stories", however local, that do exist across all sectors—examples of good or innovative practices, including good working relationships—and be able to make positive recommendations that encourage wider application of successful innovations. The ADSS and the IHA can provide good examples.

  The Committee is undertaking its Inquiry at a time of organisational change within social care. New policies, such as intermediate care and forthcoming changes in assessment, should be properly evaluated over time.


  CCC and its members have consistently advocated the development of initiatives that help to prevent dependency and provide effective rehabilitation, thus enabling individuals to live independently as long as possible and allowing resources—from whatever budget—to be used cost-effectively.

  Intermediate care schemes can improve the independence and health status of older people who might otherwise remain inappropriately in hospital or require long-term nursing care, paid for by the NHS. Effective intermediate care and rehabilitation can also help to prevent hospital re-admissions. Naturally, CCC's members have followed with great interest the development of policy, the announcement of resources for intermediate care and also the facilities and services that have been developed as a result. The Committee will no doubt have its attention drawn to examples of schemes that work well. We would urge the Committee to examine successful projects with a view to making recommendations.

  Regrettably, although evidence is anecdotal rather than objectively quantifiable, our members are concerned that NHS wards are being opened that are nominally new intermediate care wards but which, in practice, are either wards which have previously had to close or were about to close. So, "new" facilities are merely restoring the status quo in terms of resources.

  What is at issue is not just the amount of resources made available. Attention must be drawn to how effectively resources are being used. CCC's members also need to be persuaded that facilities are delivering the type of care envisaged within intermediate care.

  We have received heartening reports from our members about successful intermediate care schemes that they have carried out. Such schemes have enabled people to move from hospital to a nursing home and then back to their own homes, following a planned programme of rehabilitation. However, some of our members report that there have been few attempts to involve the independent sector in providing additional services. At a time that the Committee is currently also inquiring into the role of the private sector in the NHS, it is worth noting that the independent (voluntary or private) sector provision in the care sector is not new: it has provided the majority of residential and nursing home places for more than a decade.

  Any greater involvement of the independent sector, which we would support, will also have to reflect an appropriate cost structure (eg the additional employment of occupational therapists and physiotherapists) and providers' need and ability to recruit specialist staff.

  The impression is given that intermediate care, once "the great new idea", has "slipped down the policy agenda". We hope that the Committee's recommendations will lead to a re-examination of some practices in this area, and greater progress in developing true intermediate care schemes.


  CCC is hopeful that the implementation of the Single Assessment Process from April 2002 will help to reduce difficulties and delays in assessing people's care needs and consequently ease pressure on hospital beds. The Committee may wish to look at the lack of a national scheme. There is widespread interest in, and there would be benefit from, having a national scheme based on either MDS or Eazicare. Asking local social and health bodies to draw up their own based on national standards has resulted in slow implementation and difficulties for providers who work with a range of local authorities and therefore do not have consistent information.

  Although outside the remit of the Health Committee, the whole question of local authority funding and the lack of social workers must be considered in this context. Issues raised in the COI's report on the recruitment and retention of social workers, notably relating to pay, are relevant. They are also relevant in relation to occupational therapists, in particular the lack of professional training courses.


  Telehealth solutions have the potential to alleviate the problem of delayed discharges in several ways: by reducing the need for hospital admissions; by enabling earlier safe discharge; and by reducing the incidence of re-admission to hospital.

  For all age groups, telemedicine can help to provide care that safely meets patients' needs while taking up fewer hospital beds than conventional medical options. For older people in need of care, telecare options can enable people to remain at home and be independent, yet provide the security of regular but non-intrusive health or care monitoring. Clearly such solutions can work best if they are adopted by organisations as part of a wider strategy.

  Where the provision of health and care services has included telehealth solutions, it is noticeable that cross-boundary working between agencies has been encouraged. One CCC member can point to existing schemes where health, housing and social care professionals are working together to provide effective services. Opportunities for the effective joint funding of services have also been created.

  By reducing the risk to recently-discharged patients, technology can enable more hospital patients properly to be discharged to their own homes following a risk assessment.

  On the encouragement of good practice, Beacons could be established based in local authorities with community alarm schemes, as it would not be difficult to implement telecare on that basis. Local authorities would then be better enabled to identify the costs and benefits of such schemes.

  There is not yet a body of independent research into the contribution made by telecare and other assistive technologies towards providing support and maintaining independence at home. Every encouragement should be given to independent research in this area.

  Various services exist that assist in the finding of care home places. They make a welcome contribution, but the lack of an integrated IT base makes it difficult for individuals and authorities to access the information at the point of need. Any initiative that would enable local and other authorities to fund the development of such integrated databases would be worth exploring.


  Equity Release: the terms of reference of the Committee's Inquiry are entirely appropriate. Nevertheless one area of policy outside the Health remit may usefully be taken into consideration. The long-term care system is in need of additional funding and additional sources of funding if any real improvements are to be realised. It is also well known that, typically, older people find themselves in hospital, often in an accident and emergency ward, at a point of crisis. These are often the people whose discharge from hospital is delayed because they lack adequate support, or the financial flexibility to make choices about aids and adaptations without delay.

  A useful but limited preventative role could be played by encouraging properly managed equity release schemes that enable people to remain independent for longer at home, and prevent the crises that often arise when a person has been "getting by" without adequate support. It is a health and care truism that early intervention is desirable. Equity release schemes, while by no means a direct health measure, could help to deliver health benefits to older people, including preventing some inappropriate hospital admission.

  Changes in other service provision: changes to or weaknesses within any of the allied areas of care and service provision for older people can manifest themselves in changes in the pattern of hospital admission and consequently delayed discharges, as can severe market imbalances. For instance, a high rate of care home closure in any one area will result in the contraction of potential intermediate care partners. A downturn in the provision of sheltered housing or very sheltered housing may show up in an increase in hospital admission. It is important that account should be taken of significant changes in the various care-related services and structures that complement NHS healthcare provision, and appropriate action taken.

R J Lewis CBE

Chairman, Continuing Care Conference

January 2002

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