Examination of Witnesses (Questions 404
WEDNESDAY 24 APRIL 2002
404. Colleagues, can I welcome you to this session
of the Committee. Can I welcome our witnesses, and we are very
grateful that you have been able to join us today. Can I particularly
thank you for the written submissions that have been received;
we have found these very helpful. Perhaps I could begin by asking
you each briefly to introduce yourselves to the Committee; could
you, in doing that, say a word or two about the organisation that
you represent: Mr Lewis? I am sure we have seen you before, at
some point in the past?
(Mr Lewis) With different hats on. I
am currently Director for Public Private Partnership with Westminster
Health Care, which is one of the larger providers of nursing home
care, largely for elderly people but also other dependent people,
in England, Wales and Scotland. Prior to that I had been a director
of social services for rather more years than I care to remember.
(Mr McClimont) I am Bill McClimont. I am the Chair
at the UK Home Care Association, which is an association of about
1,300 offices of home care provision, providing about 50 million
hours of care annually. We cover members in the voluntary, `not
for profit', commercial and statutory sectors.
(Mr Rice) Hello. Tony Rice, CEO of Tunstall Group.
We are Britain and Europe's market leader in social alarms, Telehealth
technology and round the clock monitoring, and provide services
to 95 per cent of the local authorities in Britain, and indeed
the housing associations, and have an installed base of 1½
million in the UK whom we support.
(Mr Hassell) My name is Barry Hassell. I am the Chief
Executive of the Independent Healthcare Association. The IHA is
a registered charity, and we are the leading association for the
UK's important health and social care providers. Our members are
a range of providers, they are `not for profit' organisations,
mutuals, friendly societies, as well as, of course, `for profit'
organisations. If I can just say that the sector has about 443,000
beds across nursing and residential care homes, acute and mental
health facilities; it provides care for about 200,000 people in
their own homes each day, and is a major employer in the UK, employing
about three-quarters of a million people.
(Ms Adams) Hello. I am Sue Adams. I am from Care &
Repair England. We are a national charity, a small national charity,
and our primary concern is with older people living in their own
homes who need repairs and adaptations. We are what is called
a second-tier organisation, so our main concern is to encourage
new initiatives and services which help older people to stay independent.
And the main things that you will have heard of, that are related
to us, are Care and Repair and Staying Put schemes, and many of
these are now moving into the area of helping people leave hospital
more effectively and stay in their own homes.
405. Thank you. We have obviously invited you
because you represent a range of different perspectives on the
area that we are interested in. I would like to, if we could,
tease out some of the distinctions between your evidence, which,
in some respects, are quite marked. Perhaps I could begin, Mr
McClimont, with yourself, where your evidence suggests that this
kind of debate around care and delayed discharges, as I think
you say it, has been hijacked by the care home providers. What
do you mean by this, in particular?
(Mr McClimont) I think it is not just the care home
providers themselves, but it is also shorthand by policy-makers
and the media. It is very easy, when putting up a headline, to
say "Nursing home to be used," or something of the sort,
when, in fact, the policy that underlies it is far more to do
with getting the appropriate care for the right people at the
right times. I think that though, underneath that, there is a
mindset amongst the public and amongst policy-makers that presupposes
that an institutional setting of some sort, a building, is liable
to be the right solution, and I think that is a mistaken presumption;
and part of my evidence was to propose a reversal of that mindset,
if possible, by requiring a positive justification for admission
to any form of building in the way of care, because so much now
can be done in the home. It will not always be the right answer,
there will always be occasions when a care home will be right,
when a nursing home will be right, when a hospital, inevitably,
will be right and the only solution to the situation; but at the
moment the presumption goes, in my view, the wrong way round,
about how many people can we think of occasionally putting out
to home care, rather than starting the other way round.
406. So, presumably, you will be critical of
the debate in Parliament over the number of care home places that
may or may not have disappeared, in that that does not really
focus on the key areas that you believe we should be looking at?
(Mr McClimont) I think it is deficient, because although
that is a critical problem, it is a big issue, it is not an issue
that is restricted to care homes, it is also an issue that extends
to home care. And while we are a relative newcomer to the field,
we have not been around quite as long, and the problems have not
been severe until recently, the problem now is, I believe, just
as acute and in danger of just as much collapse as the care home
debate has illustrated for them.
407. In a sense, your criticism, presumably,
is of some of the organisations alongside you, and I will bring
in some of the other witnesses on this point. Specifically, can
I go to Mr Hassell, and your evidence is quite strong in talking
about the difficulties being faced by the institutional care sector.
If I can quote your evidence, on page 11, you talk about "independent
care homes have become unviable and have been forced to close
with tens of thousands of residents losing their homes."
Tens of thousands of residents losing their homes. "In all,
it is estimated that nearly 50,000 beds have closed in the independent
sector since 1996." Do you stand by that evidence?
(Mr Hassell) Yes.
408. On what basis has this estimate been made?
(Mr Hassell) Could I say firstly, you referred to
institutional care, I think that is an unfortunate term. We are
talking about meeting people's care needs; it happens to be in
a residential situation, and I think there is a lot of difference
between modern nursing and residential care homes and some of
the old-fashioned institutions you may be thinking of. I actually
would agree with Bill McClimont, in that what is important is
that people's needs are assessed and that whatever services they
require are provided in a timely manner, and that can cover the
complete spectrum. We have absolutely no problems, if it is right
for people to be assessed for home care, that is what they should
receive; if they require care in a nursing or residential care
home facility, or intermediate care, then that is equally right.
So I do not think there are any differences between our positions.
Regarding the issue of 50,000 beds, yes, since 1996, in fact,
there have been over 50,000 beds lost from the independent sector.
409. So who says that?
(Mr Hassell) That is independent research, from people
like Laing and Buisson and Help the Aged, and others.
410. So it is not your research?
(Mr Hassell) It is not our research.
411. You are basing this quote on somebody else's
(Mr Hassell) Absolutely. And I think the key thing
is that there have been over 50,000 deregistrations in the independent
sector; of course, there have been new homes opening elsewhere,
and you can play around, like all statistics, with gross and net
figures. The reason why we think that 50,000 is important is that,
of course, even though you have new services developing, they
may not be in the same area, or the same place. So what is important
is to recognise that 50,000 people have lost what, effectively,
has become their home, and the replacement homes may not be the
same services, or in the same geographical areas, and that is
an important point to remember.
412. The reason I am asking this question is
that we want to be clear that we are talking about the same figures,
because there are certainly serious questions that have been raised
with us by our Committee boffins, shall we say, that this figure
is inaccurate, that the figure that you are proposing in your
evidence actually includes losses from the local authority sector
and losses from NHS long-stay provision. So can you be absolutely
specific that you are basing this figure purely and simply on
losses in the independent sector, because certainly the figure
that we have is around 19,000, which is very different from the
50,000 figure that you are quoting to the Committee?
(Mr Hassell) I am aware of that net figure, but the
figure of 19,000 is a net figure, it is the deregistrations less
the new provision that has come on stream; that is quite a different
413. But, forgive me, that is the independent
(Mr Hassell) That is right, yes.
414. Are you saying that the 50,000 figure that
you are putting forward to the Committee in your evidence does
not include the local authority sector and does not include NHS
(Mr Hassell) That is my understanding.
415. That is your understanding?
(Mr Hassell) Yes.
416. Right. You may wish to go and check on
that though, because this has been looked at, Mr Hassell, in some
detail, and the figure, from the point of view of our independent
advice, is very different from that which you are giving; and,
obviously, this 50,000 figure has been the subject of intense
debate, questions to the Prime Minister, and I think it is important
this Committee, actually, gets to the bottom of exactly what we
are now talking about?
(Mr Hassell) If I could comment. In the particular
survey which I am sure your advisers have been using, the same
way as I have, there are different tables, with different ranges
of figures. There is one particular section that actually summarises
the deregistration of homes, and, of course, it is only the independent
sector facilities that are registered, so those numbers must relate
to the independent sector, unless, of course, there are errors
in the way in which the tables are presented. There are, equally,
of course, other tables which show some of the losses in the statutory
sector; like all stats, no doubt, you can carry on with reconciliations
for ever. But I am more than happy to talk to your officials and
compare notes with them, if that helps.
Dr Taylor: In your written evidence,
you do say, quite clearly: "The figure of 50,000 beds (see
Table 1) reflects the total loss of long-stay provision across
all sectors." And that squared it for me, because I thought
that was why Mr Duncan Smith is allowed to say 50,000 beds, and
yet Mr Blair says 19,000. Because I thought they were not comparing
the same thing, and your written evidence cleared that with me;
but what you have said has confused me again.
Chairman: The written evidence says the
independent sector, specifically.
Dr Taylor: No; no, on page 17: "As has
been described above, 50,000 beds (see Table 1) reflects the total
loss of long-stay provision across all sectors."
Chairman: The figure I used was the paragraph
38, on page 11, where the specific evidence says; "it is
estimated that nearly 50,000 beds have closed in the independent
sector since 1996."
Dr Taylor: Paragraph 38, on page 11,
of their evidence.
(Mr Hassell) Let me assure the Committee, if I may,
Mr Chairman, I was aware of the fact that this was an important
statistic and I have spent time today, actually, looking at the
summaries and tables, so certainly the information I was giving
you a moment ago is exactly the information that has been published.
If there is a variation in our evidence then that is something
I would like to look at very closely, obviously.
418. It may be we will need to come back on
this one, because it is a very important area, as I am sure you
(Mr Hassell) Yes; and, as I repeat, I am very happy
to co-operate with your advisers in looking at this.
419. For the figure to have any meaning, as
well, it has obviously got to be linked to the requisite capacity
in the market as a whole; and would you agree, or is there not
the possibility, that there was overcapacity in the residential
care sector in 1996?
(Mr Hassell) I think, when talking about the market,
it is difficult, this is not a national market, so there is not
one market; and certainly those suggestions have been made, that
there is overcapacity. We are talking about local markets, so
we could be talking about several hundred different local markets.
But, yes, in some areas, there may still be overcapacity, but
in others, of course, we have moved in the reverse direction,
supply/demand ratios have switched altogether.