Select Committee on Health Minutes of Evidence

Memorandum by Westminster Health Care Ltd (DD 26)

  1.  Westminster Health Care Ltd—an introduction.

  2.  Hospital Discharges—our experience.

  3.  Intermediate Care.

  4.  The role of nursing homes.

  5.  Recommendations.


  1.1  Westminster Health Care Ltd is one of the largest providers of nursing homes for older dependent people in the United Kingdom. Whilst many of the residents in the homes will pay the full cost of care (excluding nursing care) themselves, the company is committed to providing high quality of care for any older person, regardless of their financial position and whether they pay directly themselves or are supported by a local authority. The main criteria for admission must be the needs of the prospective resident.

  1.2  We support the need for full comprehensive assessments, and support the scheme recently introduced by the Department of Health in respect of assessment for nursing care. We have adopted a nationally recognised and standardised assessment process throughout all our homes, and are making this information available to colleagues in the NHS and Local Authorities.

  1.3  Through a comprehensive training and staff development programme we aim to provide a high quality of care which reflects the individuality of each resident.

  1.4  Westminster homes generally meet the new requirements of the Care Standards Commission, and we support the aim of the Commission to raise standards.


  2.1  We welcomed the Government attempts to speed up discharges when acute hospital care is no longer needed. The addition of extra funding in the form of the Intermediate Care Grants to Health Authorities and Local Authorities was also welcomed. However, our experience to date is that there have been few attempts to involve the independent sector in providing additional services, with much of the money going in reopening closed wards with the new title of intermediate care wards. However, where NHS Trusts have been working closely with the company we can point to success in enabling people to move from hospital to nursing home, and then following a planned programme of rehabilitation, back to their own homes.

  2.2  Because of the decline in the number of places in nursing and residential homes, admissions to the remaining homes are often at a point of crisis. Pressure is placed on hospital based staff to move people on, thus totally ignoring the concept of choice, and without proper planning for rehabilitation being in place before the patient is discharged from hospital. We do not believe this is good practise.

  2.3  A few of the Trusts and Local Authorities who have chosen to use the independent sector as part of their rapid discharge strategy have failed to address the need for providers to be able to recruit specialist staff such as O Ts and Physiotherapists, which are an additional cost above the normal fee rate.

  2.4  Only a very few local authorities have involved company personnel in any planning processes—we have some experience of being consulted once a plan has been agreed by the statutory authorities—and yet in many instances the main provider of direct services for dependent older people is the independent sector. We think this neither reflects the concept of partnership working nor uses the full skill and knowledge base which may be available in any community.


  3.1  In anticipation of the introduction of intermediate care schemes throughout the country the company invested in adapting homes so that the full rehabilitation programme could be provided. Whilst the scheme in Birmingham has worked well, it has relied upon the enthusiasm of a few health personnel, and has not been used as effectively as we had hoped. Elsewhere only one off requests have been received, often of a short term nature, and sometimes competing for places which would otherwise have been taken by older people who were able to fund their own care.

  3.2  The use of technology now opens up the possibility of much more use of less expensive, community based but skilled nursing homes for the ongoing treatment and rehabilitation of patients, with the clinician still maintaining an overall monitoring and care management responsibility.

  3.3  Given the need to demonstrate best value across the whole of the industry/care sector, it is to be regretted that greater use has not been made of intermediate care facilities, both in nursing homes and in the clients' own homes.


  4.1  Whilst we recognise that as more people remain in their own homes, demand for the type of accommodation which is not able to provide care for the most acutely frail elderly people is likely to fall, we remain convinced that nursing homes are a better provider of care for very dependent people rather than long stay wards in hospitals, or more importantly acute wards where places are needed for very ill people.

  4.2  Many elderly people end up in the A&E Departments in hospital because they have or are experiencing a period of illness or physical decline. However, they do not necessarily need the full range of hospital services. Nursing homes could provide such accommodation, if there existed at a local level plans for the use of accommodation in this way. In other words, the only route to a nursing home should not be seen as just via a hospital. The use of hospital places by some older people could be avoided if the right agreements between the purchasers and the providers were in place.

  4.3  The aim of the company has always been to provide care which is relevant to the needs of each individual resident. We welcome therefore the changes in respect of registration requirements which come into effect from next April, with staffing levels based on the assessed needs of residents. By extending this approach, coupled with the extension of the assessment process to the full care needs of each resident, it is possible within the existing framework to provide for many of the older people who are currently blocking beds in acute wards.


  5.1  We recommend that all Local Authorities and Trust be required to publish a statement explaining how they will involve the independent sector, who often are the major providers, in their plans to tackle the problem of blocked beds in hospitals.

  5.2  We recommend that the funding of hospital discharge schemes be reviewed, so that it can be demonstrated that local resources are being used as effectively as possible before new services are introduced.

  5.3  The need for appropriate staff and equipment should be emphasised by the Government before any hospital discharge scheme is approved.

  5.4  Longer term planning is required if the problem of blocked beds is not to reoccur each year. The statutory authorities should be required to produce plans covering a minimum of three years, with contracts with providers and earmarked funding in place to ensure such plans will be implemented.

  Westminster Health Care Ltd would be pleased to outline further any of the points raised in this submission at an oral hearing of the Committee.

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