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Care Standards Update
Edition No. 5 - July 2001
Introduction
There are a number of issues which continue to affect the provision of nursing home care and for which we are still awaiting further information. Such clear information as there is is minimal and I have delayed sending a further Care Standards Update until there was more concrete information to share. This issue is a collection of small updates on a number of subjects.
New Minister
As I identified in a recent letter, although John Hutton is to continue as a Minister in the Department of Health, he is to take on the responsibilities previously undertaken by John Denham. Jacqui Smith has been appointed to replace John Hutton. Her main duties are Social Care, long term care, disability and mental health, which include:
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Long term care for the elderly, including Older People's Taskforce and nursing and residential care
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Intermediate Care
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General Personal Social Services
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Care Trusts (shared responsibility with John Hutton)
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Mental Health Services, including Mental Health Taskforce
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Long term conditions, including Long Term Conditions NSF and diabetes and Renal Services
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Disability services including community equipment services
National Minimum Standards
Many of you will have seen the comments attributed to the Chairman of the National Care Standards Commission, Ann Parker, speaking at a recent conference, when she said that if home owners could not meet the new standards they should consider an exit strategy.
I believe that what she was really saying is that the consultation period is over and the standards have been published. Don't wait until next April believing that you will be able to negotiate new standards. You would hardly expect a Police Superintendent, when talking about a new speed limit, to indicate that the might be some leeway in its application.
Of course, the most difficult standards - those of size of room and singles v. doubles - do not apply to existing homes until 2007 and, therefore, we have time to implement those changes. The majority of the other standards are a reflection of good practice and are probably already being applied by each of us ... the main difference is the way in which we record this good practice.
In order to create this 'audit trail', the Registered Nursing Home Association is currently working on some standard documents which will be published shortly. The Blue Cross Mark of Excellence Quality Assurance Scheme will be available during July and details of our unique education and training scheme should also be available before the end of July.
Transitional Arrangements
The Department of Health have published a Health Service Circular (HSC 2001/011) giving details of the transitional arrangements for the National Care Standards Commission taking over the regulation functions from local and health authorities. Amongst the detail which affects home owners are:
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Check that all details on files held on regulated services are up to date and accurate, using inspection visits in 2001/ 02 for this purpose.
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Identify the appropriate future classification of each existing regulated service (including LA homes) under the Care Standards Act, in consultation with the service provider, and notify both the NCSC and the registered provider of the classification so identified. (scheduled to happen in the autumn).
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Assist all existing regulated services to prepare for the new regulatory regime by passing over documentation prepared by DoH/NCSC explaining how the new system will work and to assist registered services to prepare for registration under the Care Standards Act. This will take place in the autumn/winter of 2001/ 02.
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LAs and HAs to identify any applications for registration that will not be completed by 31 March 2002 and pass these tot he NCSC from 1 January 2002. They will then be processed under the Care Standards Act.
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During March 2002 local authorities and health authorities to transfer uncompleted casework on registrations and enforcement action to the NCSC and ensure that the NCSC is in a position to continue this action after April 2002.
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Local authorities and health authorities to collect full annual fees in 2001 / 02 for services registered under the Registered Homes Act and Children's Homes. Accrual principles will be applied to these fees, with any portion relating to 2002 / 03 being credited to the NCSC accounts.
There is a whole section in the transition plan devoted to "preparing the providers". Included in this chapter is an identification that, with regard to existing regulated services,: these services will have the benefit of being in touch with their regulators. Units will be expected to make the most of this and keep providers informed of developments during the transition year.
A 'welcome pack' is being prepared by the Department of Health. This will contain all the basic information and standards and regulations that apply to the various categories of providers. The units will be expected to distribute these packs. Units will also be expected to agree with each provider which category under the Care Standards Act will apply to them. (In the autumn)
Particular consideration may need to be given to nursing home managers and local authority homes managers who do not require registration at present but will under the Care Standards Act. Adequate time and notice should be given to those people who are required to register. Frank Ursell has written to Chris Hume, Project Manager, for the NCSC seeking clarification of this point.
Criminal Records Bureau
The NMS requirement for home owners to undertake police checks before appointing staff will be achieved by way of the Criminal Records Bureau.
The Criminal Records Bureau goes 'live' in July and in preparation information packs have been sent out by the CRB to employers who may have to use their service, including nursing home owners.
Registration with CRB costs £300, but representative bodies, such as R.N.H.A. can apply to be 'umbrella bodies' which would mean that individual employers would not need to register independently, and thereby pay the £300 fee. The R.N.H.A. has applied to be an umbrella body and information will be forwarded soon.
Free Nursing Care
The last meeting of the steering group was held on 1 May 2001 when more details of the assessment process and the banding were discussed. A further meeting was planned for early June, but this has been deferred.
Information has been made available on the DoH website and members were recently circulated with copies of the 'most frequently asked questions'. Enclosed with this update is an extract from Hansard of 27 June 2001 which details a question and answer session in the House of Lords which includes some useful information.
Free Incontinence Products
In order to ensure that the Health & Social Care Bill received the Royal Assent the Government had to make some concessions over incontinence products. The R.N.H.A. has already circulated details of these proposals, including the concern in the way the press release was worded implying that this will only apply to those who pay their own nursing home fees.
A committee has been set up to look into the practicality of how incontinence products will be provided to patients in nursing homes. Frank Ursell is a member of this committee which meets for the first time on Wednesday 18 July 2001.
V.A.T. on Care Services
The enclosed extract from Hansard also refers to V.A.T. on the cost of care. The provision of health care has always been exempt from V.A.T. The consequence has been that V.A.T. has never been chargeable in relation to residential home care or nursing home care.
To some extent the inclusion of residential home care could be considered to be an anomaly as the health care provision is via the district nursing service.
The recent V.A.T. Ruling appears to confirm that residential care should be subject to V.A.T. The Association believes that this decision will not affect the provision of nursing home care. We understand that an appear has been lodged and, therefore, until the appeal is heard the status quo must apply.
It should be noted that this very issue was investigated about four years ago in relation to the provision of domiciliary care, when it was decided that as long as a nurse had responsibility for the care of the patient then the service would not attract V.A.T.
Paul Burstow has submitted an Early Day Motion, number 37, asking that the Government remove any uncertainty by amending the V.A.T. regulations. You might consider asking your MP to support this Early Day Motion.
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