Examination of Witnesses (Questions 140
- 159)
WEDNESDAY 13 FEBRUARY 2002
MS DENISE
PLATT, CBE, MR
DAVID GILROY,
MR RICHARD
HUMPHRIES, MS
MARGARET EDWARDS
AND PROFESSOR
IAN PHILP
140. Which was what, 1996-2001?
(Ms Platt) Yes. We think if you take what opened into
account you are talking about 19,000 care home beds as a net figure.
141. Net care home beds lost.
(Ms Platt) Net care home beds lost. They also use
other figures in other areas.
142. Yes, but if we talk about care home beds
in residential homes, 19,000 have been lost. Can you explain something?
Obviously in your position you advise Ministers. Why is it that
every time a 19,000 figure is used or sometimes, and erroneously
in light of your evidence, 50,000 figure is used Ministers emphatically
say that none has been lost? Why should there be a discrepancy
between what you think, which is 19,000 net loss, and Ministers
on the floor of the House of Commons consistently saying—a
number of Ministers, not just one—that the figures are all
wrong and that there have not been losses, there has actually
been a little gain?
(Ms Platt) What I was referring to was the Laing &
Buisson figure. If you do the exercise which they did using their
figures, then their estimate is around 19,000. The Department
of Health figures, which we collect, show that in 1996-97 the
total number of beds had fallen by 6,400. That was 9,500 nursing
bed reduction and an increase of 3,100 residential care beds.
143. So if we use your figures it is 6,000.
(Ms Platt) Our figures are based on the returns which
come to us from local authorities.
144. You do not get a 100 per cent return, do
you?
(Ms Platt) I do not think Laing & Buisson got
a 100 per cent return either.
145. Do you know what Laing & Buisson's
figures are derived from? What did they do to get those figures?
(Ms Platt) I should need to go back to get that.
Mr Burns: It would be quite interesting. Even
if your figures show 6,000, why do Ministers try to claim it is
a slight increase? John Hutton, for example, talked about somewhere
round about 1,000 to 2,000 more. It just seems odd as you advise
and your figures —
Chairman: That is a question we ought to put
to Ministers. You are asking a question about what Ministers are
saying and the Department are not responsible for that.
Mr Burns
146. Yes, but it is interesting from the advisers'
point of view as well.
(Ms Platt) May I make a point on what will be happening
in the future on these figures? The National Care Standards Commission,
which is going to take over the regulation and inspection of all
care homes and nursing homes no matter what sector they are in,
will be required in future to produce an annual report of the
state of the market in care homes and nursing homes and they will
have the complete picture across the piece.
Mr Amess
147. I have been listening very carefully to
what you have all been saying and everything all of you have said
is marvellous and I applaud you and I am terribly impressed. But
certainly in the area I represent your comments are aspirations.
It is not happening in the area I represent. The number of beds
blocked ranges from between 56 to 72. I have a huge number of
elderly people in the area I represent, many of them end up with
MRSA then it is a spiral downwards. Could one of you or some of
you tell me how much money you think these care homes reasonably
need to support one of these elderly people? What would you say
the figure is on average?
(Ms Platt) That is difficult to do on average. We
know that the state of the market for labour in different parts
of the country is different and we know from the unit cost indicators
that we collect in social services that the commissioning rates
are very different. It is difficult to say that this is what the
average should be because it depends on the type of nursing home,
the mix of staff and what the labour market is in that particular
area.
(Mr Gilroy) May I add to that? I hope this does not
seem too much like ducking the question but that is very precisely
why we asked the personal social services research unit at the
University of Kent to do a study for us of the supply side of
residential and nursing home care. We doubt very much if they
are going to come up with a national figure. Costs vary so much,
employment costs vary so much and so on. There have to be answers
to those sorts of questions at local market level that give value,
give the right outcomes in policy terms and provide an appropriate
rate of return on capital invested which reflects the local conditions
in local environments. Those are the sorts of answers that we
need to start working with.
148. A frustration for me is that we are not
in one of these targeted areas and yet all your figures show that
our area is among the worst and this continual argument which
goes back and forwards is not new. It has gone on for a while.
They say the £210 or whatever it is they get just is not
enough to sustain the home and make tiny profits. The next thing
I was going to move on to say, and I did serve on the Care Standards
Bill when we really threw all these arguments about, was that
none of it is original. In my area we have a huge number of these
homes. I do not think this has been handled terribly well. I am
not saying you are not handling it well but you, Ms Platt, said
that they were going to be given seven years to meet these standards.
We have any number of homes which are really good homes, no smell
of urine when you go into the homes, the love, care and family
are there. Now even they are saying to me that they cannot carry
on any more. Somehow this message that they do not have to panic
that the room is not the right size or they do not have a lift
in is not getting across. In my area where we have a concentration
of homes they are panicking. What is worrying me is that if they
are going to throw it in—and now they are putting in for
planning permission for bed and breakfast, people with learning
difficulties—what on earth is going to happen? We are going
to have care beds blocked.
(Ms Platt) The Care Standards Commission, as part
of the announcement which was made, is preparing an information
pack for all care home providers so that they should know what
would be expected of them. For the care home providers who are
in difficulty and have questions to be answered a special help
line is being set up. Advice is going to be available directly
from the Care Standards Commission who will be the regulatory
body from 1 April for people to talk to if they are worried about
where they stand. The Care Standards Commission has said that
it does not want to drive out of business good quality homes which
are providing a real service and that was why we have set up all
these arrangements so that care home owners who do have the difficulty
you are describing, can talk to someone about the application
of standards of care.
149. Here we go again. During the course of
the Bill we were lobbied. All these issues were shared with Ministers.
Why are we now saying that it is going to be set up and all this
information will eventually be ready?
(Ms Platt) Because we have heard what has been said.
150. I am sorry. People were not listening when
all these messages were conveyed. I think it was a tragedy and
this is what is happening now. The final point is that in the
East End of London where I come from the idea that Grandpa and
Granny would eventually be sent to a home just would not happen.
Times have changed tremendously. What Mr Austin said about looking
after people in their own home I support entirely. In my area
we have lots of people with no relatives at all but why do you
think that even when there is a family structure people no longer
rally round but automatically contact the council, contact the
MP, try to get them into a home. Perhaps the person wants to go
into the home, but I somehow doubt it.
(Professor Philp) There are two mythologies at work
here. One is the golden era of family care that never was. Historical
records show that older people in England have never traditionally
shared a home with their children after the children have left
home. They might move to be nearby, or a flat might be built in
the garden, but there never really was that golden age.
151. There was in the East End of London.
(Professor Philp) There are particular communities
where family structures, family bonds are particularly strong,
but even in communities such as that, the idea of cohabiting late
in life as the solution to long-term care was very rare. The other
mythology that is about is that families do not care any more
now. In fact there is a lot of research which shows that families
do care. Family structures are different with divorce and with
economic migration, but new family structures emerge with stepchildren
and step-grandchildren which can create quite a rich pattern of
potential family support to older people. The challenge for services
is to recognise the different ways in which families are able
to and wish to continue to care for their older relatives or their
spouses and find the appropriate means to support them in that
role. The key then is a partnership with the families, not the
state supplanting family care, because it no longer exists, because
it still does exist, nor the state relying on the families to
provide care because that is what families do. It has always been
and continues to be the challenge to find the ways in which you
can enable families to continue in their care giving role. I have
just finished editing a book on family care for older people in
11 European countries and the remarkable thing is that in the
United Kingdom we have, compared with many other European countries,
quite well advanced systems, recognition of family carers, assessment
as a right for a carer, which provide us with the building blocks
to provide better support to family carers. I know we have a long
way to go from that start of the recognition to being really effective,
but throughout the National Service Framework for Older People—and
this was on the advice of Carers UK—we have embedded the
principle of partnership in each of the standards rather than
having a separate standard. You are right to pick the issue. It
is a very important issue, but the analysis is that there was
never a golden age.
152. There was never a golden age.
(Professor Philp) Except perhaps in the East End of
London.
Chairman
153. May I say that I think I worked in a golden
age, the 1970s, when we were actually moving away from the dependence
on institutional care for older people? Something very interesting
happened, to which John Austin referred. In 1981 the market moved
in and you say we should not use the words "bed blockers"
but the policy debates we have in the House of Commons about elderly
people are to do with bed fillers, we must push these people into
care homes because there are all these empty beds and homes are
going to close. It may be inappropriate provision but we have
to fill these beds. My question is, bearing in mind that the Government
are increasingly interested in involving the market in health
care: are we going to end up with a situation like we have now
where the debates are focused on filling care homes that nobody
really wants to go in anyway and that leaves a void in development
of alternative policies? Will the same thing happen in the Health
Service with the use of the private sector? The market will provide
inappropriate provision, which is what has happened since the
1980s? You may wish to go away and think about that one.
(Ms Platt) You may wish to ask the question of Ministers
when they return. The nature of the market is different in the
private sector for health care than the private care home sector.
154. The point I am making is use of beds and
in my view inappropriate use.
(Ms Platt) The purchasers are different too. There
are very many independent purchasers in the care home domiciliary
care sector. There is not that range of purchasers in the private
health care sector as far as I am aware. The NHS will still be
the monopoly purchaser of care. In some parts of the country part
of the problem that social services face is that they are not
the monopoly purchaser of care in the residential and nursing
home care sector. There are many more private payers, which was
a point being made over there.
Andy Burnham
155. I have constituents who have not received
the funding for free nursing care. The private nursing homes quite
openly say that they are not passing on the money to the individuals
concerned. What is your view of that practice? What is the Department
doing to ensure it gets to the individuals?
(Ms Platt) We want to know about it because we want
to find out what the systems are on the ground.
156. I can give you names.
(Ms Platt) If you do have information about that we
want to know about it.
157. I shall send it to you.
(Ms Platt) Tell us because we want to know.
158. May I move on to the cash for change grant
which we touched on before? I want to ask you generally how the
grant is being used to develop capacity in care homes and in community
services to reduce delayed discharges? More importantly, what
were the criteria used to choose the 55 councils who got extra
help? I ask this because in my own area Wigan Council have been
very pioneering over the years in their work with the Health Service.
It is fair to say that people locally feel quite aggrieved that
they have trail blazed and got good services on the ground yet
the grant has quite strict conditions that they cannot fund existing
services. Their argument is that it is the worst performers in
terms of developing intermediate care and home support who are
getting the funding and they are in the position where they will
not be able to sustain the innovative services they have set up
five or six years ago. Is that a fair point?
(Mr Gilroy) The grant is for all of the things you
have just referred to, provided they are additional and not substituting
for existing provision already in the system. It is possible to
attribute some of the spending to new innovative services where
judgements are made that the market rates for either private domiciliary
or residential or nursing care are not right and so on. There
is a view about that in choosing 55 hot spots, if I might use
that expression, we are rewarding failure and we are putting the
money into places where the difficulties have arisen because of
management weaknesses, lack of management grip or whatever. We
actually refute that. We do not think that is what we have done.
The way we identified the 55 councils we thought needed weighted
resources was on a straight analysis of the delayed transfer data
across the country as a whole, not just the snapshot at one moment
but an historical look as well.
159. We have an extremely low number of delayed
discharges precisely because we invested before we were told to
invest. The bizarre and perverse thing that might happen, because
of the very strict conditions you referred to, is that might start
to creep up. They are saying they will have to withdraw services
if they cannot use money to sustain them. Do they have a point?
(Mr Gilroy) It was a balance we were trying to strike.
This is not a grant which has only gone to 55 councils. This has
gone to all 150. A weighting of the overall grant has favoured
55 of them.
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