The Stormont Committee on Health, Social Services and Public Safety received a briefing from Health Minister Edwin Poots and senior officials including John Compton- Chair of the Health and Social Care Board on “Residential Homes — Proposed Closures”.
Ulster Unionist Party MLA Roy Beggs asked the following questions:
Mr Beggs: I want to talk about this issue of being surprised at the speed at which the trusts wish to close residential care homes. Given that four or five years earlier some of the trusts wanted to close all the homes, why did it surprise you that some of them wanted to go to the max of their capability in TYC?
Mr Compton: We thought that because we had process that had worked locally in the South Eastern and Belfast Trust areas, where we closed homes that tended to be very local and have a very local debate about the particular issue, we agreed that the closure of homes would be handled on a local level. That was clearly what was said. We should have been more regionally co-ordinated; that just is a fact of life.
I was not surprised that people wanted to close elderly persons’ homes. I was at most of the consultation meetings across Northern Ireland, and 70% of the discussion was about future services for older people. Most people considering the consultation document made it quite clear that they wanted to be able to remain at home for as long possible or something close to home if they had to move away. Residential care or nursing home care was their last choice.
It is important to differentiate between residential care and nursing home care because, in the eyes of the press and the public, the two are sometimes seen as synonymous. They are not; they are very different services. There is no particular change in nursing home care here. It is a change in residential care, and that is because there is falling demand. The falling demand is not a consequence, exclusively, of a restriction for entry. In the Southern and Western Trust areas they do not have that; they still have a large number of places.
Mr Beggs: You have acknowledged the sensitivity of the issue. Given that, why did you not manage it better?
Mr Compton: We set out to manage it in the best way possible, which was how we had done it previously. We had done it successfully nine times in the past four years, so there was nothing to suggest immediately that it would not happen successfully or correctly. In the Northern Trust area, for example, in the two stages, as I am sure you are aware, there has been quite a degree of consultation about the facilities in Ballycastle and Greenisland and housing with care. There has been extensive work with residents and their families over the past couple of years. There was no reason to suggest, for example, that that would not have continued and that that consultation would not deliver a successful transition.
Mr Beggs: ‘Transforming Your Care’ states that “at least 50%” would close within three to five years. That gives the impression of half the homes being closed, which is how most people read it. However, as has been pointed out, it could mean between 50% and 100%. What figure do you think you will deliver within that range?
Mr Poots: I honestly do not know. There are options for people who have become frail. They could be placed in a private residential care home, they could have the option of supported living when they move into a facility, or they could have greater support in their home. We need to start focusing on how we provide care for people in their homes, rather than a carer calling four times a day for 20 minutes each time. We need to look at the options that we can provide. As we provide them, the requirement for statutory residential care will diminish. Does that have an impact on the staff in those places? It does, to the extent that they are no longer working in those facilities. However, I have absolutely no doubt that, within the statutory sector, we will be able to offer alternative employment that will involve similar types of employment in domiciliary care with elderly people or other people with care needs. However, I have absolutely no doubt that we can support people who are currently our employees and treat them with respect.
As we look to the future, I cannot say definitively, Roy, that it will be 60%, 70% or 80% — or 51% or 50%, for that matter, or indeed slightly less. I can say that we need to work very hard to ensure that people have as wide a range of options as possible so that they can make the best possible choice for themselves. That is what I want for my family and, in due course, what I will want for myself. I do not want to be in a second- or third-rate facility.
Mr Beggs: Do you think that it was a mistake to use the term “at least 50%”, or would it have been better to have stated “no more than 50%”?
Mr Poots: I do not have an issue with the term. The trouble that we had was not with the document; the trouble was with its implementation. We have held up our hands on that one.
Mr Beggs: You mentioned that residents could be in small rooms, and so on, and your plan is to provide bigger rooms and en suite accommodation. However, for people’s well-being, it is also important for facilities to be within easy reach of family and friends. I am aware of some families in Carrickfergus being offered alternative residential accommodation 40 miles away. I am also aware of families in Larne for whom no residential alternatives were available, and the alternative residential accommodation that does exist does not have en suite facilities and much of it comprises shared rooms. What planning has gone into ensuring that there is practical alternative accommodation, whether that be residential or supported housing?
Mr Poots: That is one reason why I think that the regional planning element has potential. John will pick up on that.
Mr Compton: Quite a bit of work has been done. We now have a joint forum with the Housing Executive, and I am on record here in Committee as saying that, over the same period of time, we are expecting about 500 places to be developed on supported housing, about half of which will be for older people: that is, 250 places or thereabouts throughout Northern Ireland. We work very closely on the planning, locations and geography of those facilities and places. You are right that that is one of the issues on a regional level. There is a tension point here. These services are inevitably very local, and there needs to be a strong local flavour to the way in which you think about and provide alternatives. However, you need much more assertive regional control, which the Minister has now put in place as far as all that is concerned.
The objective is that we will not allow people to go from one standard of care to a reduced standard of care. Our position is that if people move, the standard of care should be at least equivalent to their current one. We hope that, in many instances, they would move to an improved standard of care. So this is not about saying to someone, “You are in home X, and the only alternative for you is home Y, and, by the way, you used to have your own room but now you are in a shared room” or something of that nature.
Clearly, we have to talk about those issues and establish regionally what is best practice, what is assessed need, how families and individuals are being dealt with and whether there is an equivalence about how that is happening across Northern Ireland. There will be a lot of local debate and discussion because the solutions are often local ones for individuals and their families. As a principle, it is about an improved, not a reduced, service. A material factor when a decision is being made to move an individual or to open or close a facility will be whether there is a realistic alternative.
Mr Beggs: Will you allow existing residents to determine whether what they are being offered is better than what they already have? In other words, will they be able to decide voluntarily whether to move or remain where they are?
Mr Compton: I go back to past performance. Have we closed units successfully in the past? I believe that we have. That was because we listened and talked to individuals and spent time with them. We have not been driven by a timescale to close a particular facility on a given date. If a given date has to move because it does not suit individuals, it will move. We want to establish clearly, and be driven by, those principles. In the past, that is what has happened. I believe that it happened successfully in a range of areas across Northern Ireland. I have no reason to believe that we cannot do that. We may have started out badly, and things may have gone wrong in one or two places. However, I believe that the vast majority of staff who handle such situations do so with a lot of sensitivity. They are skilled in listening to and working with families.
Mr Beggs: I want to go back to supported housing, which has been presented as one of the alternatives that will enable people, with support, to live longer in their home. Certainly, Barn Halt Cottages, which you visited, Minister, is a good example of that. However, the Lisgarel residential home, scheduled for closure in 2016-17, provides supported housing in its annexes. Why on earth was a document issued proposing its closure without presenting the vulnerable adults there with any alternatives? As far as I am aware, there are no supported housing alternatives in Larne.
Dr McCormick: We will have to come back to you on the specifics of that.
Mr Poots: That is a perfectly reasonable question, Roy, and the trust is probably best placed to answer it. I think that we are looking at a supported housing facility in Greenisland if things proceed.
Mr Beggs: People want their friends and families to be able to visit them.
The Chairperson: Will you come back to us in writing on that?
Mr Poots: You are asking why a facility, which provided supported care in mixed use with residential care, is being closed. That is a perfectly reasonable question.
Mr Beggs: The issue —
The Chairperson: You did very well to get a constituency issue in, Roy.
Mr Beggs: Indeed.
Mr Poots: That was highly unusual.
Mr Beggs: On trying to work on a regional basis, has there been buy-in from the Department for Social Development (DSD) to ensure that capital funds are available in the future to facilitate the widespread provision of supported housing and alternatives? I am aware that there was quite a fight to get Greenisland House on to the capital build schedule. It got on to the schedule only last year, even though its closure was announced three years ago, and it still does not have planning permission. Is there buy-in from DSD to ensure sufficient capital funds to provide alternatives in every local area where they are needed?
Mr Compton: Yes, there is. We have a very strong planning arrangement. Obviously, every Department’s budget has its parameters and limits, but we have no issues with how we work with the Housing Executive. Its desire is to work jointly with the health sector and provide the maximum amount of supported and sheltered housing across Northern Ireland. There will, of course, be limits, just as there are limits to the services that the Health Department can provide. However, I do not detect any lack of willingness or commitment on the part of DSD. As I said, planning for the 500 places over the next three to five years is a very significant commitment and will mean a very significant investment.
Mr Beggs: I did not ask whether DSD was willing. Is the budget there, and has it been earmarked for this?
Mr Compton: My understanding is that the budgets have been earmarked for the schemes that I am talking about.
Mr Beggs: I think that we should pursue the matter, Madam Chair.