Health and Social Care Committee

Inquiry into residential care for older people

RC74 – Pembrokeshire County Council

Pembrokeshire County Council

Adult Community Care Services

WA Inquiry into Residential Care for Older People

The National Assembly for Wales’ Health and Social Care Committee is undertaking an inquiry into residential care for older people. The terms of reference for the inquiry are as follows:

To examine the provision of residential care in Wales and the ways in which it can meet the current and future needs of older people, including:	Comment
The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.	How residential care is funded, and how it is funded differently from non-residential care makes it difficult to fund new models of care. The care plan should be defining the route of the care, how that is delivered could be a variety of difference ways.  How the care sector is set up makes this difficult – it makes service provision difficult and inflexible.  Continuing Health Care funding has brought its own added complication which has had a dramatic impact on provision.  Alternatively based services need to be funded.    The process of how people enter into residential care is often externally driven or by a hospital admission.
The capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources, including the skills mix of staff and their access to training, and the number of places and facilities, and resource levels.	How many Residential Care providers employ Occupational Therapists and/or Physio Therapists?  This type of service facility within the Residential Care setting should be a part of the established staff base.  Without these services, residential care homes are not meeting the requirements of CSSIW. Residential care homes do not have the skills to manage dementia.  Local authorities do not have the skills to manage delivery of dementia services in residential care settings  - therefore NICE guidance is urgently required.
The quality of residential care services and the experiences of service users and their families; the effectiveness of services at meeting the diversity of need amongst older people; and the management of care home closures.	The quality of service provision is often reliant upon the registered manager of the home. A person is safe when receiving a residential care service so when there are limited numbers of communities’ staff, they do not prioritise people in residential care for a variety of different services.
The effectiveness of the regulation and inspection arrangements for residential care, including the scope for increased scrutiny of service providers’ financial viability.	This is a tick-box process and does not pick up on social activities and/or social inclusion.
New and emerging models of care provision.	It is cheapest to “warehouse” people in a residential care home.  We have to be careful not to be financially driven to “warehouse” people.  How the financial assessment is undertaken can impact on setting up/commissioning new models of care. It would help all local authorities in Wales if the Welsh Government were to take on responsibility as to how much local authorities pay.  This has been set up in Scotland whereby the Scottish Government have taken over the control of this process.  We are funding venture capitalists and entrepreneur’s lifestyles.
The balance of public and independent sector provision, and alternative funding, management, and ownership models, such as those offered by the cooperative, mutual sector and third sector, and Registered Social Landlords.	Please refer to Pembrokeshire County Council’s recent judicial review.