In the context of a sector that has scarcely enjoyed a crumb of good news for years, February 2003 represented a veritable feast both for care homes and many of their current and potential inhabitants.
The loudest cheers came from the care home owners on 18 February. Thanks to a Governmental U-turn they were relieved of the cost of having to meet a range of new physical environmental standards to assist with the implementation of regulations resulting from the Care Standards Act 2000.
The first report to Parliament of the Health Service Ombudsman Ann Abraham made two days later could, in due course, result in rejoicing of equal magnitude from numerous families who find themselves eligible for compensation, although for the time being there remains more confusion than celebration.
Sadly, however, all this propensity for merrymaking is the direct result of a compost heap of incompetence that claims to manage the health needs of our elderly population.
The physical standards fiasco
It is certainly hard to understand the logic involved in the original proposals to make care homes comply with physical standards such as room sizes, door widths and the percentage of beds allowed in shared rooms. When choosing a home how many residents take out a tape measure and studiously measure the doorway? Surely they are more concerned with trying to find an accommodating and friendly environment!
The new standards, some of which had already come into effect in April 2002 and others of which had been postponed until 2007, will not apply to homes that existed prior to April 2002.
Sheila Scott, chief executive of the National Care Homes Association, says: “The dramatic change of tack shows that the Government didn’t originally have enough information when it made the decision. We had always said it wouldn’t work and that it would be too expensive.
“Does the size of a room really improve the quality of care? Laying down physical size requirements made the job easier for care home inspectors by giving them a tick list but inspectors should be in a position to judge quality of care.”
The fiasco has already caused significant damage, contributing to the closure of hundreds of care homes during the last three years as owners decided to sell up rather than meet the alteration costs. Others spent heavily on meeting standards that are not now actually required.
Hopefully the change of policy should result in a slowdown in the rate of home closures during 2003 but the impact is unlikely to be that dramatic.
This is partly a reflection of the fact the recent news has not come as a total shock to those in the industry. Hopes of a change of policy had been raised as long ago as last July when Health Secretary Alan Milburn announced that the standards should be subject to a consultation exercise.
Problems with the local authority
Furthermore, the problem of inadequate local authority funding continues to have a far greater impact on the rate of care home closures than the proposed standards ever did.
Peter Fermoy, spokesperson for the Independent Healthcare Association (IHA), says: “Over the last three years local authorities have been given £400m in addition to their annual settlements but the money doesn’t seem to be getting through to the care homes across the board.
“We would highly recommend that the funding should be ring-fenced but the Government has said categorically that it is not in the business of taking such an approach. It is trying hard to decentralise authority and therefore doesn’t want to be seen to be dictating to local authorities.”
The Ombudsman’s report also highlighted considerable room for improvement in relationships between central and local authority.
Each NHS area or “health authority” has its own eligibility criteria with regard to who has their care costs paid in full by the NHS because they qualify for “continuing care” and who is only entitled to have “nursing care”.
Nursing care is free on the NHS for everyone but when someone doesn’t qualify for continuing care – as is the case with 95% of those needing care – their other care costs such as accommodation and personal care must be paid for either by themselves or, if they satisfy the means test, by their “local authority” – ie: local council or county council but not to be confused with local health authority.
In 2001 the Department of Health had issued local health authorities with guidance on the subject after a certain amount of confusion had resulted in the aftermath of the Coughlan test case in 1999.
But this guidance was found by the Ombudsman to have been misinterpreted in four cases, each involving different health authorities (see Box 1 inset). These health authorities were recommended to make appropriate compensation and to reconsider past cases where similar errors may have occurred. The Ombudsman also advised that the Department of Health should review and clarify its guidance and become more pro-active in checking that local criteria follow it.
Experts are unanimous in anticipating that clearer guidance spelling out the distinctions between continuing care and nursing care will be forthcoming, but opinions vary widely regarding the extent to which other cases requiring compensation will come to light.
Tim Ward, director of national public help and information organisation CareAware, says: “Our help-line is currently getting hundreds of calls from people who are confused and worried and my own view is that there will be further cases where compensation is received. Where appropriate we are advising callers to look into whether they have a case, particularly when nursing home residents are concerned.
“But cases from residential care homes could also qualify because residents of these can suffer from quite severe dementia and two of the four complaints looked into by the Ombudsman were dementia related. One in four people aged over 85 suffers from dementia, so the implications are mind boggling.”
The most dramatic estimate of the potential costs comes from NHSCare.info, a website which aims to inform the public about their lawful rights. It describes the episode as a “£10bn story”, estimating that it could involve as many as 360,000 families receiving compensation payments of around £30,000 each.
William Laing, director of London based independent health sector analyst Laing & Buisson, feels these figures are far too high, pointing out that there are currently only around 110,000 private care home residents. Nevertheless, he acknowledges that it is far from clear what the correct figures could be.