15 January 2013
TYC Programme Team
Health and Social Care Board
12-22 Linenhall Street
Belfast BT2 8BS
Dear Sir/ Madam,
Reference: Transforming your Care: Vision to Action’ consultation
Further to the questionnaire attached to the ‘Transforming your Care: Vision to Action’ consultation document. Due to the restrictive nature of the format, I as a MLA for East Antrim and spokesman on health matters for the Ulster Unionist Party would make the following addition comments.
Firstly with regards to the nature of the Transforming Your Care consultation process:
The current consultation period which ends on 15th January is at the end of a very complicated process which began in December 2011 with the publication of the 213 page Compton Report- Transforming Your Care, a Review of Health and Social Care in Northern Ireland. This led to the individual Health and Social Care Trusts publishing in June of 2012 draft population plans, and a draft strategic implementation plan (October 2012). To understand the context of the Vision to Action document all the previous Compton TYC documents need to be understood. The task of reading all these documents is difficult one for the layperson. One could be forgiven for thinking that there was a deliberate policy decision made by Health Service management to make this consultation process as drawn out and complicated as possible, to discourage responses from the general public and to mitigate against opposition and dissension. Limited engagement with the public occurred at the consultation events.
In the vital area of elder care, incorporating domiciliary care, and institution care – in nursing and residential settings, the general direction of travel in terms of policy is not new. The idea of keeping people out of institutions and in their own homes with domiciliary care has been championed by many NHS Reviews and consultant’s reports.
However the associated policy of closing down Trust Residential Homes and giving the independent sector a monopoly on such provision has floundered on the rocks of public opinion. In 2008/2009 proposals put forward to the Department by the Health Trusts to close all of their Residential Homes were meet with such local opposition that the then Minister for Health would not accept them in their entirety.
All across Northern Ireland opposition to the closure of Trust Residential Homes emerged and was manifest in letter writing campaigns and Public Meetings. Opposition reached the floor of the Northern Ireland Assembly where the following motion was passed on 23rd February 2009: ““That the Assembly expresses its opposition to the proposed closure of residential care homes by a number of Health and Social Care Trusts; and calls on the Minister of Health, Social Services and Public Safety to intervene and listen to the concerns of the community and take appropriate action to minimise the pain, stress and anxiety that this uncertainty has created among elderly care home residents, their families and health workers.”
Opposition to the policy proposal coming from the Health Trusts at that time was summed up in the following excerpt from the debate. “Does the Member agree that, when a trust asks an elderly person whether he or she would prefer to live in his or her own home or in a residential care home, the question is loaded? It will almost always elicit a response in favour of living in one’s own home. For many people, who are not ready for a nursing home but who cannot stay at home, residential care is the only real and practical choice. If we go down the route of doing away with statutory residential care, we could end up with a situation similar to that in England, where care in residential private nursing homes is of a much lower standard than we would expect for our elderly people.”
[Official Report, Bound Volume 38, p134, col 1].
Ironically the MLA who made that statement is now the current Minister, presiding over what amounts to the same policy.
The Vision to Action document states; “During the next 3 to 5 years the current number of statutory residential homes, is likely to be reduced by at least 50% across Northern Ireland… The statutory sector currently provides about a quarter of all residential care homes in Northern Ireland. There are currently 56 statutory homes and this would mean that at least 28 homes could close. This equates to around 750 places. Many of the homes which may be considered for closure are already running with only a small proportion of residents. Looking beyond this timescale, there would need to be clear and specific reasons for the statutory sector to remain in this field.”
The present vacancies within statutory Resident homes are a result of the decision by the Trusts to stop placing new permanent residents into residential homes over a year ago. It is strange that this has happened under the stewardship of a Minister who previously lead the opposition to such closures and who did not present this issue in his manifesto as a candidate.
Given the significant number of Residential homes which are being ear marked for closure, I would wish to highlight the lack of options that would remain in many geographical areas should all these homes close. Already families have had to consider residential beds in locations over 40 miles away. Such a home located away from friends and family makes frequent visiting impractical.
Ultimately a political decision will be taken by whatever Minister is in charge of the Health portfolio when this process is completed. I would however question whether the Minister has any democratic mandate to implement this policy of closing half and then all of the Trust Residential Homes in Northern Ireland. The policy was emphatically rejected by the public during the previous consultation process in early 2009, and the Minister has neither sought nor received a mandate to revive a policy which, when not if office, he rejected.
Admittedly, the document does say that, “We are committed to ensuring suitable, safe alternatives are provided before any closures take place. Where closures are proposed this will be implemented in a planned and phased basis with residents, families and local communities involved in the local consultation processes. “ However what alternatives are in place for someone like the single woman constituent who came to my office recently deeply upset at the prospect of losing her home of 19 years, which is part of a statutory residential home complex. She has no family network to fall back on and feels extremely vulnerable at this time.
Again with regards to major changes envisaged in the number and distribution of Acute hospitals in Northern Ireland. The suggestion is to reduce from 10 to between 5 and 7. The Minister’s party made no mention of this possibility in their manifesto for the assembly elections in 2011. So, as in the area of Trust Residential Home closures, I would query what mandate has been sought and given to make these radical changes.
As this long, drawn out consultation process on Transforming Your Care comes to a close, focus will now come onto the Minister for Health, Social Services and Public Safety to take decisions based on recommendations arising from the consultation process. It is essential if the public are to have any faith in the democratic nature of the Assembly and its Executive that the Minister is open and transparent in accounting for his actions in the months to come.
Given the significant changes proposed in the document, additional “Invest to Save” funds may need to be committed to Health to sustain the heavily pressed existing services whilst enabling new services to be developed which may reduce pressures in the future.
Roy Beggs MLA