Examination of Witnesses (Questions 120
- 139)
WEDNESDAY 13 FEBRUARY 2002
MS DENISE
PLATT, CBE, MR
DAVID GILROY,
MR RICHARD
HUMPHRIES, MS
MARGARET EDWARDS
AND PROFESSOR
IAN PHILP
120. If you receive any further information
would you come back to the Committee?
(Ms Platt) Yes; indeed. We could perhaps link that
with the protocol question.
John Austin
121. You made reference earlier on to the fees
issue in certain parts of the country and reduction or loss of
beds. It has also been suggested to us that in some cases private
care homes may delay admissions of publicly funded residents in
the expectation that they might take self-paying residents at
a higher rate of pay. Could I ask you what review of care home
charges the Government have made? What conclusions have you come
to about charge levels?
(Ms Platt) We have commissioned the Personal Social
Services Unit at the University of Kent to do a study of care
home supply and the issues which are affecting the supply at the
minute. The study is looking at costs, fees, profitability and
reasons for closures. We hope we are going to be able to publish
that within the next few weeks and during your inquiry.
Chairman
122. Will that study look at why we need care
homes and other countries not dissimilar from our own do not?
(Ms Platt) No, we did not ask that question.
123. Is it not a fair question to ask?
(Ms Platt) It is a good question, yes.
John Austin
124. You specifically made reference earlier
on, in responding to Mr Burns, to the increased funding which
had gone in during the period to which he referred, which you
said was really the transfer of funding from social security to
fund the care in the community package and programme.
(Ms Platt) Yes.
125. If we go back to the period which led to
that expansion of social security funding, when Rhodes Boyson
was the Minister and the regulations changed, there was a period
when the social security budget suddenly became responsible for
purchasing the long-term care of people and that saw this massive
expansion of 1981-82 in private care homes springing up all over
the country. You also said in your earlier report that where there
are beds you fill them. I raise the same question that the Chair
has raised. Whilst I accept that a crisis is created if we suddenly
lose beds we are relying on, was it not that policy in the early
1980s which led to what the Chairman and I refer to as World War
Geriatrica being created instead of the provision of the care
facilities, the domiciliary care support and the rehabilitation
services? Have we not created the wrong kind of monster?
(Ms Platt) The community care changes were brought
in because of the level of expenditure in the social security
system in care homes without a proper assessment of need and there
is an issue about public funding being paid for services where
there has not been an assessment of need and that public funding
ought to follow the assessment of need into different sorts of
services. The transfer of funding was to enable social services
to use that money which had previously been in the social security
system to try to develop more innovative domiciliary care packages.
There have been closures in the residential care sector as some
of those alternatives in the community have developed. The PSSRU
study will show that it is the smaller homes which have probably
closed, the smaller homes were probably the supply of homes which
were created when people could get paid out of social security
funding because levels of dependency were slightly different and
the environment was slightly different. One of the challenges
has been developing a sufficient range of community based domiciliary
care services which are very intensive. We have seen an increase
in that sort of package of care, but it is very staff intensive
to develop and does need skilled staff to staff that sort of care.
One of the developments we are hoping will come from the National
Service Framework is a better balance of services in the community
because more often than not people want to be in their own homes
if they are safe to be there. I am not sure that we have created
the monster since 1990. The expenditure has been held and social
services have done what they were asked to do with the resources
which was to do proper assessments and to support people.
126. No, I am suggesting we are living with
the consequences of what happened in the early 1980s. Would you
agree with me that, notwithstanding Siobhain McDonagh's comments
earlier about whether people can cope at home, many, many, many
more people could be cared for in their own homes than are being
at present if we were to develop adequate domiciliary services?
(Ms Platt) It is not only the domiciliary services.
We have looked at acute health and we have looked at domiciliary
care. The whole issue is around recuperative care, rehabilitation
and support for people, re-enablement facilities, support for
people to regain their confidence in their own homes. We need
that range of facilities as well as the care packages which will
sustain people in an independent position in their own homes and
that is the range of resources which even when the community care
changes were brought in in 1990-91 had not been developed sufficiently
to keep pace with the other policy. That is the gap we are trying
to plug at the minute.
127. We have changed the terminology from bed
blocking to delayed discharge.
(Ms Platt) We tried to change the words from bed blocking
because older people have told us that the term is an insult.
They have told us that it gives the impression that they are not
entitled to be in hospital in the first place.
128. I appreciate that. Bed blocking implies
that it is the patient's responsibility whereas delayed discharge
is the system.
(Ms Platt) We have tried not to use the phrase all
the way through.
129. It seems we have gone from a double B to
a double D which means we have a bigger problem.
(Ms Platt) But it does not mean they should not have
been there in the first place.
130. You also refer in a comment earlier to
inappropriate admission, which must be another part of the problem.
Surely that is also due to the lack of the kind of community services
you were referring to earlier.
(Ms Platt) Yes. Not just domiciliary services but
community health services. We know from the services which have
been developed when we have had short-term winter money, the sort
of rapid response team, which includes domiciliary care and nursing
which can keep someone in their own home while they are ill rather
than going into hospital, is very effective and we certainly know
that the range of resources which keeps people in their own homes
is perhaps sometimes even more effective than the intermediate
care when people are coming out of hospital.
131. We actually looked at some of those projects
in our inquiry into long-term care, both in Northern Ireland and
Scotland.
(Ms Platt) I just want to emphasise that we are after
the right care. In thinking about the sorts of services people
need to sustain them in their own homes and prevent avoidable
admissions, we are not looking for a second class service here,
we are looking for the right service.
132. The appropriate care in the right setting.
(Ms Platt) That is right.
133. We saw that in the schemes we made positive
comments about when we were looking at the use of the additional
winter money.
(Ms Platt) Yes.
134. If that use of the additional monies for
those winter crises was shown to work in such an effective way,
why now that funding has been consolidated has it not really fed
through in the way one might have expected it to do?
(Ms Platt) Some of it was one off and short term is
the answer to that, so it was not a recurrent funding.
135. When we asked Ministers about that, when
my health authority and others said they had not had any winter
funding this year, the reply from the Department was that it had
been consolidated in their allocation.
(Ms Platt) Yes; indeed. Certainly some winter funding
was put into the base as an increased level of funding, but there
were also some tranches of money which were short term, which
were not carried forward. What we have tried to do in the building
capacity grant is to give people certainty over two years while
we continue to put in our representations through the spending
review process so that this is a proper amount of money which
really tackles the problem of capacity because that is what we
have been talking about all afternoon.
136. May I come onto another issue where it
may appear I am arguing the other way round? Any dramatic change
or loss of beds when you have a system which relies upon beds
is going to have an impact.
(Ms Platt) Absolutely.
137. Whilst we would all have welcomed the care
standards proposals, there is some worrying suggestion that some
authorities and some areas may be closing homes as a result of
the requirement to improve those care standards. We have been
told that in Lancashire there is a proposal to close 35 directly
managed care homes because they do not meet the standards. What
is central government doing to stop that kind of action being
taken?
(Ms Platt) You will know that there have been discussions
with the Care Standards Commission about how they introduce the
standards to try to ensure that the standards are properly applied
and support good quality homes so that good quality homes do not
go out of business rapidly, quickly, because of an over-emphasis
on particular standards in the short term. Care homes should be
given a proper length of time to meet the care homes standards.
Some of the more complex ones which proprietors have complained
about are phased in over a seven-year period, which is quite a
substantial amount of time for existing homes. We are suggesting
that new homes should meet those standards from the start. The
discussions we have had with the Care Standards Commission and
the announcements which Ministers made were welcomed by the independent
sector care home owners as being a sensible way forward. We are
not here about sustaining poor quality. We are not wanting to
sustain poor quality at all costs, just to keep capacity, but
people should be given a proper opportunity to raise the quality
of their care.
Mr Burns
138. May I just clarify something? We have had
evidence submitted to us and one sees it in the media and in the
interested parties, that since 1996 about 50,000 care home beds
have been lost. Do you think that is an accurate figure, give
or take?
(Ms Platt) The Department of Health figures show that
the total number of beds has fallen by 6,400 and that is 9,500
nursing bed reduction and an increase of 3,100 residential care
bed reduction. When people use the 50,000 we need to ask them
what they do mean. Laing & Buisson announced that 50,000-plus
care home beds had been closed, but that was not a net loss. In
making that announcement they had not included the numbers of
new homes which had actually opened. So we think the net loss
will be 19,000 over the period concerned.
139. So net loss 19,000.
(Ms Platt) Over the period they were talking about.
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