Select Committee on Health Minutes of Evidence

Examination of Witnesses (Questions 120 - 139)



  120. If you receive any further information would you come back to the Committee?
  (Ms Platt) Yes; indeed. We could perhaps link that with the protocol question.

John Austin

  121. You made reference earlier on to the fees issue in certain parts of the country and reduction or loss of beds. It has also been suggested to us that in some cases private care homes may delay admissions of publicly funded residents in the expectation that they might take self-paying residents at a higher rate of pay. Could I ask you what review of care home charges the Government have made? What conclusions have you come to about charge levels?
  (Ms Platt) We have commissioned the Personal Social Services Unit at the University of Kent to do a study of care home supply and the issues which are affecting the supply at the minute. The study is looking at costs, fees, profitability and reasons for closures. We hope we are going to be able to publish that within the next few weeks and during your inquiry.


  122. Will that study look at why we need care homes and other countries not dissimilar from our own do not?
  (Ms Platt) No, we did not ask that question.

  123. Is it not a fair question to ask?
  (Ms Platt) It is a good question, yes.

John Austin

  124. You specifically made reference earlier on, in responding to Mr Burns, to the increased funding which had gone in during the period to which he referred, which you said was really the transfer of funding from social security to fund the care in the community package and programme.
  (Ms Platt) Yes.

  125. If we go back to the period which led to that expansion of social security funding, when Rhodes Boyson was the Minister and the regulations changed, there was a period when the social security budget suddenly became responsible for purchasing the long-term care of people and that saw this massive expansion of 1981-82 in private care homes springing up all over the country. You also said in your earlier report that where there are beds you fill them. I raise the same question that the Chair has raised. Whilst I accept that a crisis is created if we suddenly lose beds we are relying on, was it not that policy in the early 1980s which led to what the Chairman and I refer to as World War Geriatrica being created instead of the provision of the care facilities, the domiciliary care support and the rehabilitation services? Have we not created the wrong kind of monster?
  (Ms Platt) The community care changes were brought in because of the level of expenditure in the social security system in care homes without a proper assessment of need and there is an issue about public funding being paid for services where there has not been an assessment of need and that public funding ought to follow the assessment of need into different sorts of services. The transfer of funding was to enable social services to use that money which had previously been in the social security system to try to develop more innovative domiciliary care packages. There have been closures in the residential care sector as some of those alternatives in the community have developed. The PSSRU study will show that it is the smaller homes which have probably closed, the smaller homes were probably the supply of homes which were created when people could get paid out of social security funding because levels of dependency were slightly different and the environment was slightly different. One of the challenges has been developing a sufficient range of community based domiciliary care services which are very intensive. We have seen an increase in that sort of package of care, but it is very staff intensive to develop and does need skilled staff to staff that sort of care. One of the developments we are hoping will come from the National Service Framework is a better balance of services in the community because more often than not people want to be in their own homes if they are safe to be there. I am not sure that we have created the monster since 1990. The expenditure has been held and social services have done what they were asked to do with the resources which was to do proper assessments and to support people.

  126. No, I am suggesting we are living with the consequences of what happened in the early 1980s. Would you agree with me that, notwithstanding Siobhain McDonagh's comments earlier about whether people can cope at home, many, many, many more people could be cared for in their own homes than are being at present if we were to develop adequate domiciliary services?
  (Ms Platt) It is not only the domiciliary services. We have looked at acute health and we have looked at domiciliary care. The whole issue is around recuperative care, rehabilitation and support for people, re-enablement facilities, support for people to regain their confidence in their own homes. We need that range of facilities as well as the care packages which will sustain people in an independent position in their own homes and that is the range of resources which even when the community care changes were brought in in 1990-91 had not been developed sufficiently to keep pace with the other policy. That is the gap we are trying to plug at the minute.

  127. We have changed the terminology from bed blocking to delayed discharge.
  (Ms Platt) We tried to change the words from bed blocking because older people have told us that the term is an insult. They have told us that it gives the impression that they are not entitled to be in hospital in the first place.

  128. I appreciate that. Bed blocking implies that it is the patient's responsibility whereas delayed discharge is the system.
  (Ms Platt) We have tried not to use the phrase all the way through.

  129. It seems we have gone from a double B to a double D which means we have a bigger problem.
  (Ms Platt) But it does not mean they should not have been there in the first place.

  130. You also refer in a comment earlier to inappropriate admission, which must be another part of the problem. Surely that is also due to the lack of the kind of community services you were referring to earlier.
  (Ms Platt) Yes. Not just domiciliary services but community health services. We know from the services which have been developed when we have had short-term winter money, the sort of rapid response team, which includes domiciliary care and nursing which can keep someone in their own home while they are ill rather than going into hospital, is very effective and we certainly know that the range of resources which keeps people in their own homes is perhaps sometimes even more effective than the intermediate care when people are coming out of hospital.

  131. We actually looked at some of those projects in our inquiry into long-term care, both in Northern Ireland and Scotland.
  (Ms Platt) I just want to emphasise that we are after the right care. In thinking about the sorts of services people need to sustain them in their own homes and prevent avoidable admissions, we are not looking for a second class service here, we are looking for the right service.

  132. The appropriate care in the right setting.
  (Ms Platt) That is right.

  133. We saw that in the schemes we made positive comments about when we were looking at the use of the additional winter money.
  (Ms Platt) Yes.

  134. If that use of the additional monies for those winter crises was shown to work in such an effective way, why now that funding has been consolidated has it not really fed through in the way one might have expected it to do?
  (Ms Platt) Some of it was one off and short term is the answer to that, so it was not a recurrent funding.

  135. When we asked Ministers about that, when my health authority and others said they had not had any winter funding this year, the reply from the Department was that it had been consolidated in their allocation.
  (Ms Platt) Yes; indeed. Certainly some winter funding was put into the base as an increased level of funding, but there were also some tranches of money which were short term, which were not carried forward. What we have tried to do in the building capacity grant is to give people certainty over two years while we continue to put in our representations through the spending review process so that this is a proper amount of money which really tackles the problem of capacity because that is what we have been talking about all afternoon.

  136. May I come onto another issue where it may appear I am arguing the other way round? Any dramatic change or loss of beds when you have a system which relies upon beds is going to have an impact.
  (Ms Platt) Absolutely.

  137. Whilst we would all have welcomed the care standards proposals, there is some worrying suggestion that some authorities and some areas may be closing homes as a result of the requirement to improve those care standards. We have been told that in Lancashire there is a proposal to close 35 directly managed care homes because they do not meet the standards. What is central government doing to stop that kind of action being taken?
  (Ms Platt) You will know that there have been discussions with the Care Standards Commission about how they introduce the standards to try to ensure that the standards are properly applied and support good quality homes so that good quality homes do not go out of business rapidly, quickly, because of an over-emphasis on particular standards in the short term. Care homes should be given a proper length of time to meet the care homes standards. Some of the more complex ones which proprietors have complained about are phased in over a seven-year period, which is quite a substantial amount of time for existing homes. We are suggesting that new homes should meet those standards from the start. The discussions we have had with the Care Standards Commission and the announcements which Ministers made were welcomed by the independent sector care home owners as being a sensible way forward. We are not here about sustaining poor quality. We are not wanting to sustain poor quality at all costs, just to keep capacity, but people should be given a proper opportunity to raise the quality of their care.

Mr Burns

  138. May I just clarify something? We have had evidence submitted to us and one sees it in the media and in the interested parties, that since 1996 about 50,000 care home beds have been lost. Do you think that is an accurate figure, give or take?
  (Ms Platt) The Department of Health figures show that the total number of beds has fallen by 6,400 and that is 9,500 nursing bed reduction and an increase of 3,100 residential care bed reduction. When people use the 50,000 we need to ask them what they do mean. Laing & Buisson announced that 50,000-plus care home beds had been closed, but that was not a net loss. In making that announcement they had not included the numbers of new homes which had actually opened. So we think the net loss will be 19,000 over the period concerned.

  139. So net loss 19,000.
  (Ms Platt) Over the period they were talking about.

previous page contents next page

House of Commons home page Parliament home page House of Lords home page search page enquiries index

© Parliamentary copyright 2002
Prepared 29 July 2002