Does the contribution benefit
patients?
181. During our inquiry into Delayed Discharges,
the then Minister (Jacqui Smith) and the Chief Inspector of Social
Services (Denise Platt) both suggested that the money provided
through the RNCC should directly benefit the residents for whom
it was intended.[150]
However, our evidence suggests that when people are awarded RNCC
payments, some homes then increase their charges to residents
by sums at least equivalent to the RNCC payments, leaving the
resident no better off. Pauline Thompson of Age Concern gave us
an example of a man whose wife was moving into a care home who
was initially told that the fee would be £450 a week, and
then when it transpired that she would be receiving RNCC funding
of £125 per week, the fees went up by about £125.[151]
182. The Minister told us he had "no doubt"
that "some nursing homes have put their fees up in order
to exploit self-funders".[152]
However, he stated that as "Nursing care is delivered free
by the National Health Service and we reimburse nursing home owners
for it", no one should be charged for nursing care, and patients
and their relatives should ask for itemised bills to ensure that
they are not being charged.
183. In fact, the RNCC band payments, which are established
nationally, do not directly relate to the nursing care needs of
an individual, or their actual costs. The bands have no relationship
to the amount of time a registered nurse will actually need to
spend with an individual, and also have no bearing on the nurse
staffing levels required by the Commission for Social Care Inspection
(CSCI) as a condition of registration of the home. Independent
studies have demonstrated that across England as a whole, the
average gap between actual fees paid to homes, including the RNCC
element, and the fair fee for homes which are fully compliant
with CSCI staffing regulations, is of the order of £127 per
week for nursing care.[153]
184. It follows that the additional costs of nursing
care must somehow be recovered by care homes. The Minister's comment
that no one should be charged for nursing care does not adequately
reflect the current realities of the situation. Either the real
costs are shown on an itemised account, or they are included under
euphemisms such as "extra - personal care". As Martin
Green of the English Community Care Association told us, "we
need to get this assessment process really clear so that there
is a robust and accountable approach for both the care needs,
but also what those care needs cost".[154]
185. There is also anecdotal evidence to suggest
that if a self-funding resident in a care home becomes eligible
for continuing care, because of current rates of NHS continuing
care funding, the home may face a drop in the fees paid and the
resident may have to move to less expensive accommodation, or
be asked to top up the NHS contribution to their care costs. Ms
Thompson described the problem to us:
We have had people who were told - because there
is no choice of accommodation in the NHS in the same way as there
is in the social services clients - when they were first thinking
about asking whether or not they should get full funding, that
they will not be able to stay in the same home. That, I find,
really worrying because it meant that some people were still paying
for their care who could probably well be being fully funded who
have to decide that because of this risk of them having to move
they will not apply for it. I have had cases where the person
has been found to be needing full funding, and the particular
home was more expensive than the NHS was prepared to pay [155]
186. If this is happening, it could also potentially
lead to care homes being less willing to seek continuing care
assessment for residents if their condition deteriorates and their
needs increase.
187. Despite the
fact that Ministers have claimed that the value of the RNCC should
be passed on to residents, we have received evidence which indicates
that homes habitually increase their charges to residents by sums
equivalent to the RNCC payments, which leaves the resident no
better off. We urge the Government to take positive steps to
ensure that the value of the RNCC payment is passed on to residents;
it is unacceptable for Ministers to state that this should not
be happening but to do nothing to prevent it.
188. In addition
to this, we have also received anecdotal evidence suggesting that
if a self-funding resident in a care home becomes eligible for
continuing care, because of current rates of NHS continuing care
funding, the home may face a drop in the fees paid and the resident
may have to move to a different care home, or be asked to top
up the NHS contribution to their care costs. Not only does this
present huge upheaval for residents, potentially forced to move
from familiar surroundings to a different care home which is not
their first choice, it could also mean that care homes are less
likely to request continuing care assessments for their residents
(particularly for those who are self-funding) if their condition
worsens. We recommend that, as part of its review of continuing
care, the Government investigates this apparent perverse outcome
of its continuing care policy.
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