APPENDIX 16
Memorandum by the Continuing Care Conference
(DD 27)
INTRODUCTION: CCC
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.
OVERVIEW
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.
INTERMEDIATE CARE
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.
PLANNED CARE:
ASSESSMENT OF
CARE NEEDS
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.
COMMUNICATIONS INCLUDING
TELEMEDICINE AND
TELECARE
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.
OTHER ISSUES
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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