APPENDIX 24
Memorandum by the Commission for Social
Care Inspection (CSCI) (CC 38)
1. THE COMMISSION
FOR SOCIAL
CARE INSPECTION
(CSCI)
1.1 The Commission for Social Care Inspection
[CSCI] was set up in April 2004. Its main purpose is to provide
a clear, independent assessment of the state of social care services
in England. CSCI brings together into one body the social care
components of the work of the National Care Standards Commission,
the Social Services Inspectorate [SSI] and the SSI/Audit Commission
Joint Review Team. As such, CSCI combines inspection, review,
performance and regulatory functions across the range of social
care services in the public and independent sectors.
1.2 CSCI exists both to promote improvement
in the quality of social care and to ensure public money is being
well spent. It works alongside councils and service providers,
supporting and informing efforts to deliver better outcomes for
people who need and rely on services to enhance their lives. CSCI
aims to acknowledge good practice but will also use its intervention
powers where it finds unacceptable standards.
2. THE WRITTEN
MINISTERIAL STATEMENT
ON NHS CONTINUING
CARE ISSUED
BY DR
STEPHEN LADYMAN
ON 9 DECEMBER
2004
2.1 The Commission for Social Care Inspection
(CSCI) believes that a national eligibility framework for the
receipt of continuing care consistently applied, is essential.
2.2 However, having a national framework
is not, in itself, a guarantee that people will experience greater
consistency in the way their individual circumstances are dealt
with.
2.3 A national framework may not result
in criteria being consistently applied, since health and social
care systems need to take account of local circumstances. We aware
thst in some palces even where councils and their NHS partners
have entered into a formal partnership agreement under S.31 Health
Act 1999, they are sometimes unable to resolve funding disputes.
2.4 Evidence collected by the Social Services
Inspectorate (SSI) whose functions CSCI inherited in 2004 indicates
that, despite the 1999 Coughlan judgment, there is need for better
understanding of the arrangements for continuing care between
health and social services.
2.5 The lack of a co-ordinated approach
impacts adversely on outcomes for service users, especially in
regards for people leaving hospital with significant health problems.
2.6 In CSCI's "Leaving Hospital—the
price of delays" report over a third of the case sample
could not recall the details of any information given to them
while in hospital. These difficulties are compounded for patients
developing dementia or who have particular language and cultural
needs.
3. HOW THE
CHANGES WILL
BUILD ON
THE WORK
ALREADY UNDERTAKEN
BY STRATEGIC
HEALTH AUTHORITIES
IN REVIEWING
CRITERIA FOR
NHS CONTINUING CARE
AND DEVELOPING
POLICIES
3.1 As an NHS area of activity, CSCI does
not have a specific remit to assess performance in relation to
continuing care. However, information about how disputes over
eligibility criteria and provision of inappropriate services affect
people who use services can be brought to our attention through
our service inspection and performance assessment functions and
through special studies. We also monitor development of local
health and social care partnership arrangements.
3.2 The duty of partnership between CSCI
and the Healthcare Commission set out in the Health and Social
Care (Community Health and Standards) Act 2003 gives us the opportunity
to assess the impact on individuals who move through social care
and health systems. It will enable us to get a better overall
picture, therefore, of how far local partnerships are appropriately
taking account of local needs to promote the well being of local
people.
3.3 We expect that, by looking across systems
rather than focusing just on organisational performance, our joint
inspection activity with the Healthcare Commission and Audit Commission
on Older People's services will ensure issues in relation to continuing
care will be able to be identified more easily.
3.4 CSCI also regulates some NHS continuing
care services—eg care homes with nursing and domiciliary
care services and so is uniquely placed to pick up information
about how this is working.
4. WHAT FURTHER
DEVELOPMENTS ARE
REQUIRED TO
SUPPORT THE
IMPLEMENTATION OF
A NATIONAL
FRAMEWORK
4.1 CSCI believes that drawing upon people's
experience is key to understanding how well complex systems are
working to address their needs. This is particularly important
for people who use both health and social care services as they
are often in circumstances which makes it difficult to ensure
their interests are represented. People with social care needs
may experience multiple forms of disadvantage and face barriers
to inclusion—including access to health and social care
services. To promote good health and well being for people who
use social care, therefore, requires a broad perspective to understand
their experience in the context of the whole system.
4.2 There are a number of challenges and
dilemmas to be faced to ensure that the perspective of people
using health and social care services is adequately represented
in assessments and that information about these are fully accessible
to the wider public.
4.3 Concerns about continuing care are not
solely in relation to application of eligibility criteria. In
our Leaving Hospital study issues emerged about quality and consistency
of assessment—particularly multi-disciplinary assessment—appropriateness
of provision and supply to meet changing needs. For example, in
one of the sites, 15% (3/10) of the people in our case sample
were discharged from hospital into continuing care. All three
were from black and minority ethnic groups; one was assessed as
requiring EMI care. It is important that social care and health
systems plan appropriately and commission services to meet changing
demographic needs.
4.4 In some councils around a third of people
requiring social services support on discharge are making life
changing decisions from their hospital bed about where they were
going to live in future.
4.5 It is important to note that continuing
care in not just about institutional care and that a range of
services like domiciliary care services should be available to
these people. Care and support needs to be holistic and in line
with users' preferences.
"I remember being told they had
done all they could for me and it was best for me to go in a nursing
home. They said it was for me to decide but with the drugs I was
on I was in no fit state to do so."
— A patient discharged to a nursing
home, who, prior to hospital admission, lived in sheltered accommodation.
"They tried to talk me into a home
but I was having none of it."
— The view of one older person.
4.6 It is also important that the health
needs of the 30% of people who are self-funders are met and that
if these needs change people are not shunted between health and
social care services.
4.7 Attention needs to encompass carers
and supporters who themselves may present challenges to services
eg carers who have a learning disability.
4.8 Pressures to free up acute beds should
not, in turn, pressurise older people into making long-term decisions
about where they live. People are at their most vulnerable in
hospital, information to guide decision making is not easily absorbed,
and the potential for improvement can change markedly. Mentally
confused people and people with complex needs were found to be
most at risk.
4.9 Evidence from CSCI's Leaving Hospital
report into delayed discharges indicates that joint working between
health and social care can be achieved and that the divisiveness
that some feared does not seem to have materialised. Managers
across successful services talked in terms of "our problem"
as opposed to "your problem".
February 2005
| 
