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Edition No. 2 - December 2000

Introduction

There has been much activity since my last Care Standards Update, but little of any real conclusion until a speech given by the Minister, John Hutton, at the annual Laing & Buisson Home Care Conference on Thursday 30th November 2000.

This Care Standards Update will report on all that has happened since Edition No. 1.

Care Standards Act

Anne Davies Associates, who provide training for Registration Inspectors for both health authorities and social services, organised a conference on Thursday 23 November 2000 on the legal aspects of the Care Standards Act .

Amongst the speakers was one of our own solicitors, Peter Grose, of Lester Aldridge, whose brief was to address the providers' viewpoint. Peter and I spoke at some length prior to the conference to ensure that all of the concerns which we had were included in his speech.

The key note speaker was the Minister, John Hutton. Although most of his speech was simply a factual outline of what is included in the Care Standards Act, he did make some interesting comments.

In his introduction he outlined the aims of the Care Standards Act as being, "Together with the Health Act, the Care Standards Act will mean that the public can have greater confidence that care will be safe, will meet proper quality standards and will be delivered by skilled and competent staff".

It was his next sentence which I felt was somewhat optimistic when he said, "These objectives can now be achieved within a regulatory system that minimises bureaucracy, avoids unnecessary red-tape and is simpler and clearer for all concerned". As they say, "the proof of the pudding is in the eating", we will all welcome a reduction in all those things.

National Required Standards

He gave some indication of how the national required standards will impact upon regulations when he said, "for example, the regulations may require an establishment to provide adequate and suitable staff, meeting the required level of competence. The regulations may then be further defined in the standards to require a minimum percentage of care staff to be qualified to a particular level within a given time".

He also gave some indication of the interaction between national standards and local application in identifying, "the National Standards will also allow some flexibility, allowing for example, the regulatory authority and an individual provider to negotiate to find an appropriate solution to a temporary problem rather than being forced to take immediate enforcement action".

Single Category Home

The Minister dealt very minimalistically with this issue by simply stating, " another important difference between the Act and the current registration requirements is the introduction of a single registration category of care home. A care home will be any establishment that provides accommodation and personal or nursing care. This does not mean that a care home will be able to take any type of client whatever their needs. Providers will have to agree with the Commission (National Care Standards Commission) the types of care they will be registered to provide. But it will end the current need for dual registration of homes and will provide for greater flexibility in the provision of care, benefiting users, purchasers and providers alike.

General Social Care Council (GSCC)

The GSCC will be introduced in October 2001 and will be responsible for the registration of the social care workforce in a manner similar to that currently undertaken by the UKCC for the nursing workforce.

One of its first tasks will be the publication of codes of conduct and practice for all social care staff. It will also draw up a code of best practice for employers that will include good recruitment practices and rigorous checks on recruits so that unsuitable people do not enter the workforce.

Providers will have to ensure that their staff receive a copy of the GSCC code of conduct and the National Care Standards Commission will check compliance with the codes. It is not clear who the NCSC will take enforcement action against.

Paying for Nursing Care

Members will already have been advised by me that there has been a further meeting of the stakeholders group looking at determining how to identify the nursing needs of individuals.

The previous meeting had confirmed common agreement that the first step was a suitable assessment tool. A sub group had met to discuss some alternatives, including the RCN Assessment tool and Minimum Data Set (MDS). No conclusion had been reached on which tool was the most appropriate - or even if more should be looked at.

We were given something of an insight into a small part of the National Service Framework for Older People, which is to be published shortly. It would appear that the NSF will create a process of assessment of need for an individual. Once that need has been established then there will be a further assessment of the nursing needs of that assessment.

At present it all appears a little confusing, the repetition of the word assessment does not help. What does continue to give some concern was the answer to a direct question I put on who will benefit from 'free nursing care'. It was readily accepted that the government's view is that those in receipt of nursing home care paid for by the state in any way - Income Support or Local Authority contract - are already receiving free nursing care, it is only those who fund their own care who will benefit.

This does explain the figure of 35,000 beneficiaries at ?420m over three years as indicated in the NHS Plan, but, I am sure, does not reflect the general view that 'free nursing care' was expected to result in an increase in current fee levels.

The 80:20 Split

The lobbying undertaken by the Registered Nursing Home Association in the past few weeks appears to have produced results. John Hutton in his speech on Thursday 30th November 2000 accepted that the adoption of the 80:20 split is to be deferred until 2007.

The nursing , or healthcare, model acknowledges that there are other ways of ensuring privacy and independence other than only single rooms and, as such, shared and multi-occupied rooms have always been accepted. I did point out to the Minister that, unlike the independent acute sector, the NHS still operates on a multi-occupied room basis.

I am sure that none of us oppose the principle of a single room, all we were asking was that there was recognition of the particular problem facing nursing homes, more so than residential care homes, over the date of introduction of this new standard.

John Hutton said, "Our responsibility in Government is to ensure that we have sufficient capacity - both in home care and residential care - to accommodate in a planned way the numbers of older people requiring care. At the same time, we are strongly committed to improving the quality and standards of provision. We cannot allow the pursuit of one objective to compromise the other. I am conscious that the situation in some parts of the country has changed over the past year or so whilst we have been consulting on the national standards for care homes for older people (Fit for the Future). In certain locations, there is now a shortage of nursing home places. That is why I have decided to allow additional time for the standards affecting the physical environment to be reached. Multi-occupancy rooms will have to be phased out by April 2002, but the standard for double rooms will not be introduced until April 2007 corresponding to the timescale for the new room size standard

Victory for Commonsense

This announcement by the Minister is an acknowledgment of commonsense with regard to regulation. It is due to your support and our lobbying. It ensures that we now have seven years to achieve the 80:20 split and I firmly believe that the vast majority of nursing home owners will achieve that target before then.

We have always argued that there was no need for such a standard as market forces, which have already made a significant difference to the proportion of singles to doubles, will continue so to do.

Beware the Role of the Commissioners

But we should not overlook the fact that regulation is only half of the problem - we still have to sell our beds. The market forces already referred to take on a new significance when the purchaser is a local authority.

The performance of local authorities is monitored by Performance Indicators, the rationale for two of them is the reduction of residential and nursing home placements. A third relates to single room placements. The Minister has already made reference to the fact that despite double rooms being acceptable for registration, there is no compunction upon social services to purchase places in double rooms.

A New Concordat

The Minister also mentioned in his speech a desire to create a concordat with the long term independent sector similar to that recently agreed with the acute sector. He raised this issue with us in recent meetings, decisions have still to be made in relation to its format and composition. Members will be kept informed as to its progress.

National Required Standards

We still await the publication of the proposed National Required Standards, in the form of the draft Regulations. There will be a three month consultation period from whenever they are published. The Registered Nursing Home Association will keep member abreast of developments. I have reason to believe that they will focus on outcomes of care, rather than a 'tick box' approach to inputs. If so, this will be another victory for the R.N.H.A. and commonsense.