Personal budgets 'forcing closure of residential care homes'
Published by Jon Land for 24dash.com in Health and also in Central Government, Housing
Personal budgets 'forcing closure of residential care homes'
Personal budgets and people 'voting with their feet' are forcing the closure of residential care homes across the country, Norman Lamb has acknowledged.
The Minister for Care and Support (pictured) was responding to concerns raised by Labour MP Gavin Shuker over the disabled charity Scope's decision to close eight care homes.
Shuker also raised the fact that government policy was forcing other housing and care providers to review their current approach, including the Guinness Partnership, the Home Farm Trust and some smaller charities.
Here are the key excerpts from Hansard of Norman Lamb's response: "The hon. Gentleman suggested that, in a way, Scope was closing the home because of government policy. Government policy, as enshrined in the Care Act 2014, is to put people in charge—to focus on well-being, which is the central theme of the Care Act. As far as possible, it should be the individual who determines where they want to be.
"I have spoken to Richard Hawkes, the chief executive of Scope. Scope is very clear that this is its decision: it wants to do it and is doing so for what it regards as a good purpose. However, the Government’s focus is simply on the individual—on ensuring that, as far as possible, we enable people to make the decision that is right for them, recognising, however, the conflict that can arise.
"Care homes often look after some very frail people, but also individuals with quite complex needs. It is understandable and reasonable that, should there be a possibility of a care home closing, residents and their families will be extremely concerned about the future, particularly with the upheaval of having to move. It will inevitably be an unsettling and potentially stressful time.
"Homes may close for a variety of reasons, including lack of financial viability and/or insufficient demand for places, retirement of the owners, the sale of premises for alternative use and even the de-registration of unsuitable or unsafe services as a result of the Care Quality Commission’s intervention.
"In the case of Scope, the organisation is looking to redesign the services it provides to support people. It is important that people who need care and support are accommodated in appropriate settings that are based, critically, on their choice as far as possible. It is clearly not desirable if someone has to move from a care home where they are settled and happy and where their needs are being met.
"I must emphasise that, should a home have to close, local authorities have a statutory duty to arrange suitable alternative accommodation for those residents who are assessed as being in need of residential care, so it should never be the case that someone who needs residential care will not be provided with it. I fully appreciate, however, that that does not reassure someone who regards a particular building and set of care workers as their home and their home environment.
"I am aware that some providers of residential care for disabled people — including Scope — are reviewing their residential services and are consulting users of services and their families. I appreciate, as I have said, that this can be an extraordinarily worrying time and a stressful situation both for the people in those homes and for their families. Parents of adult disabled people are often themselves quite elderly, which can cause additional stress. The hon. Gentleman touched on that when he talked about his constituent. I would encourage the residents and their families fully to engage with the consultation process and ensure that their views are taken into account.
"Scope has given an assurance to the Department of Health that it is committed to ensuring that all users of its services who may be affected are properly consulted and supported. It has promised to provide any individual who needs it with advocacy so that every resident of its homes can understand what the proposals mean for them and can make it clear what they want for the future.
"Richard Hawkes made the point to me that more people are taking on personal budgets — a concept substantially and rightly developed under the previous Government and one that is continued by this Government and now legislated for in the Care Act 2014.
"The concept was designed to put the individual in charge, so that they can determine how the money available for their care is spent to meet their particular priorities. As people take on personal budgets, according to Richard Hawkes, they are increasingly voting with their feet and choosing not to go into larger care homes, which often have long corridors, shared bathrooms and so forth. They are increasingly choosing to remain in supported living if possible with a package of care built around their individual needs. Scope is reviewing its services now, so that decisions can be made and, if need be, homes closed in a controlled, planned manner before vacancy levels make them unviable.
"Richard Hawkes also told me about an experience that Scope has been through in Southampton. It proposed to close a care home, leading to the same totally legitimate anxieties and concerns. It went through the process and all the individuals in the home have been relocated in circumstances that suit those individuals, with their having a central say in where they are going to go.
"He tells me — I base my comments just on what he says — that all now appear to be happier with their new circumstances and are finding a new sense of freedom that they did not experience in the past. Although these changes to circumstances can be traumatic and difficult, the end-result, as demonstrated in the experience of Southampton, can sometimes be a good one for the individuals involved. I realise, though, that elderly parents in particular will sometimes find that quite hard to recognise.
"It is worth taking a moment to look at the history of this issue. Many traditional, large residential care homes are quite old now. A number of Scope’s homes date back to the 1970s. They were developed in — and designed to suit the needs and demands of — a different era.
"By modern standards, they lack privacy, and they do not allow residents the degree of freedom, choice and control that we rightly expect and demand nowadays. As a result, many Scope homes are under-occupied. The increasing availability of new models and types of care, support and accommodation means that traditional large care homes are no longer the default or only option when it comes to providing care and support for people with disabilities.
"Innovations and developments in supported living, and the various types of housing with care that are available these days, offer disabled people far more choice than they ever had in the past, and control over their lives. I am sure that, ultimately, we should all welcome that. Scope has informed us that, owing to the newer options that have become available, local authorities do not automatically make routine new placements in residential care, and it expects the number of empty places in its older homes to continue to rise. In the long term, it can only be a good thing that people have so many more choices when it comes to the care that is available to them, but, as I have said, I entirely appreciate that, as with any change, the process is not without its short-term challenges.
"The government want to give people more control over their health and social care services, and, therefore, over their lives. That is the central ambition of the Care Act. Personalisation means building support around individuals and providing more choice, control and flexibility in the way in which they receive care and support, regardless of the setting in which they receive it. There is no central policy, incidentally, that says care homes are bad: absolutely not. It is a question of what is right for the individual involved."