?

Edition No. 1 - November 2000

Introduction

From all parts of the country we receive calls at Head Office enquiring about what is happening with regard to Fit for the Future and the new Regulations. This void in information is causing more concern than anything else at present.

In an attempt to bring some light into this darkness, the Registered Nursing Home Association intends to produce a regular Care Standards Update for members to keep them abreast with what is happening. This first edition outlines some of the background and the latest meetings held with Government.

Care Standards Act

The year 2000 was expected to be one which would have significant consequence to the long term care sector in general and nursing homes in particular.

The year started with the Committee Stage debate in the House of Lords on the Care Standards Bill. The Registered Homes Act of 1984, with separate parts dealing with residential care homes and nursing homes is to be repealed and in its place is the introduction of a Registered Care Home. It was in the Care Standards Bill that we first discovered the fate of nursing homes.

Every definition of nursing care included in Part II of the Registered Homes Act, with the exception of that definition which predominantly includes older people, has been re-defined as an Independent Hospital in the new Act. Even palliative care has been recognised and homes which principally provide palliative care are to be registered as Independent Hospitals.

The Future of Nursing Homes

During the passage of the Bill in the House of Lords there was confirmation by Lord Hunt that nursing homes would continue, and that they would still be called nursing homes. The detail will be found in the Regulations which will follow the Act. This is, however, a very fundamental principle, there is a lot in a name and there have been many restrictions applied to using the name 'nursing home'.

The Act received the Royal Assent in July and the draft Regulations were promised for the 'end of the summer'. Those draft Regulations have not yet been published and the continuing delay has added to the pressure being felt by nursing home owners across the country. This is very definitely one of those situations were no news is not good news.

The NHS Plan

The NHS Plan was widely promoted as being the blueprint for the future and contained some reassuring words about the involvement of the private sector.

Sadly, there was no instant solution and the resolution of who pays for nursing care, regarded by everyone - including the Government - as an inequity, requires a change in primary legislation and this will not be possible until autumn 2001.

The definition of 'nursing care' was discussed at a Government run seminar prior to the announcement of the NHS Plan where there seemed to be a consensus of opinion as to what was precisely meant. The starting point being that it would be a nurse who undertook an assessment of a patient.

During the plenary session at the conclusion of the day, however, doubt came into the minds of some of us when we realised that what might be the government's target was trying to define what it was that ONLY a nurse could do, rather than a more embracing definition which includes all that takes place in a nursing environment.

A Matter of Confidence

A variety of factors have combined together to cause a lowering of confidence in the nursing home sector;

• low funding,
• low occupancy levels,
• uncertainty on what Fit for the Future might introduce,
• the question of what a single Registered Care Home might mean and, finally,
• doubt over what is meant by nursing care and who will provide it.

All of which have lead to the current situation where nursing homes are closing across the country.
Who pays for nursing care ?

All of a sudden the government appeared to be galvanised into action. A small group of stakeholders were called to a meeting chaired by the Chief Nurse, Sarah Mullally, to discuss how the NHS will fund nursing home care.

This first meeting was chaired by the Minister, John Hutton, who stated in his opening remarks that the Government had made its response to the report of the Royal Commission, which it felt it was a generous response and it was certainly not open for renegotiation.

At the meeting it became clear that there is a realisation that nursing home owners will have to be paid for the provision of nursing care and that a process has to be determined to do that fairly. Uppermost in the minds of the officials is the dichotomy of providing a funding structure which meets the needs of patients but at the same time does not induce greater dependancy. One of the criticisms of the American MDS system is that there are consultants available to home owners to re-assess patients to get the maximum funding by keeping them dependant.

This group is to meet two or three times more before the end of the year (the next meeting is 21 November 2000) and there is a clear determination to arrive at a solution, rather than a simple answer. It is considered that an assessment will be undertaken by a nurse, probably the nurse attached to a GP practice, who will identify the number of registered nurse hours per week that a patient needs. Payment would be made to the nursing home owner for these hours. A lot more work has to be done by this group.

Crisis, what Crisis ?

Health Minister, John Hutton, called a meeting of a number of representatives of providers of long term care in his office on Thursday 26 October 2000. Although the Minister was insistent that there was not a crisis, his introduction did identify that the Department of Health are aware that there has been a loss of 10,000 nursing beds in the past year.

The Minister was very open in his dialogue with us, admitting that the Department of Health had not consulted with the private sector sufficiently in the past. He was insistent that this would change in the future. He did, however, identify that he did not have a cheque book with him and that he was not in a position to pay over vast sums of money.

He said that the Government cannot afford to have wild swings in relation to available capacity, neither could it expect the system to run at 100% occupancy, there is a need for flexibility. Somewhat surprisingly, there was an acceptance that in order to survive we must be allowed to make a profit, this was linked with a statement that indicated that the Government have now realised that they cannot survive without the private sector provision.

In response we identified that the lack of confidence which the Minister had recognised was due to two factors: insufficient funding and the continued doubt over National Required Standards. This latter point is causing further concern where local regulators are imposing their own views on what might be included in the regulations. The Minister promised to write to regulators on this issue.

We succeeded in convincing the Minister that at the heart of the problem was the cultural difference between the public and the private sector and that there was a need for some positive statements from the Government supporting the private sector.

The conclusion from this meeting was that there is a need for better co-operation with the private sector and that this could lead to an overall improvement. It was identified, by the Minister, that this would take three to four years to achieve.

The 80 : 20 Split

A third meeting in less than two weeks with the Minister was to address the issue of the 80 : 20 split. There was considerable consensus amongst those of us invited to the meeting that this had some connection with the previous meeting about capacity in the sector.

The Minister was, again, quite open in his exchange with us. He is trying to balance any consequential loss in capacity by the introduction of the 80 : 20 split in 2002 with the pressure he receives from many quarters over an individual's right to privacy.

Although we did not secure a decision on the day from the Minister, we did succeed in impressing upon him what the consequences might lead to in some areas of the country. Also, that it is the uncertainty which is plaguing the sector at present and that we do need a definitive decision without any more delay.

We left the meeting with a feeling that the 80 : 20 split would not be introduced in 2002, but neither would it benefit from the five year transitional period for the other physical requirements. Best guess seems to be some point after 2002, perhaps 2004 ?

It is clear that, after almost a year of inactivity, at last, there is some movement in matters which effect our sector. Further editions of Care Standards Update will be regularly circulated to members.