Health and Social Care Committee

Consultation on terms of reference for inquiry into residential care for older people

RC20 ToR – Royal College of Physicians

Committee Clerk Health and Social Care Committee National Assembly for Wales Cardiff Bay CF99 1NA HSCCommittee@wales.gov.uk	From The Registrar     Patrick Cadigan MD FRCP Direct tel: +44 (0)20 1234 5678 julie.beckwith@rcplondon.ac.uk
14 October 2011

Dear Sir or Madam

Re: Inquiry into Residential Care for Older People

The Royal College of Physicians (RCP) plays a leading role in the delivery of high quality patient care by setting standards of medical practice and promoting clinical excellence.  We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers.  As an independent body representing over 25,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.

The RCP is grateful for the opportunity to respond to the above Inquiry. We would like to make the following comments.

General comments

It will be important to observe whether inequities in access occur at present on a geographical basis.

Is the legislative framework specifically excluded?  If not, it should be mentioned.

The interface between the NHS in Wales and residential care is very important. This is particularly true with regard to the transfer of patients from inpatient care in hospitals and the processes by which people in care can move back to their own home or family support if their health or circumstances change.  There might be a case for trial periods of admission to residential care perhaps accompanied by specialist medical management.

Specific comments

Suggested terms of reference

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:

- the process by which older people enter residential care and the availability and accessibility of alternative services

It will be important to clarify the nature of any assessment process and to make sure such has taken place before any admission to a residential home.

- the capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources and the number of places and facilities.

It would be appropriate to ascertain whether enforcement of stringent bureaucratic minutiae are discouraging perfectly reasonable organisations from contributing to expansion of residential care facilities.

- 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.

Patient and carer ‘stories’ are often helpful in evaluating quality.

- the effectiveness of the regulation and inspection arrangements for residential care, including the scope for increased scrutiny of service providers’ financial viability.

Inspectors will need relevant contemporary experience and background.

- new and emerging models of care provision

There is a need to clarify interaction with intermediate care arrangements in each area

- the balance of public and independent sector provision, and alternative funding and ownership models, such as those offered by the cooperative and mutual sector

Is it a level playing field?

Yours faithfully

Dr Patrick Cadigan

Registrar