Northern Ireland Forum

for

Political Dialogue

~~~~~~~~~

COMMUNITY CARE

&

THE HOME HELP SERVICE

- An examination by Standing Committee C

(Health Issues)

~~~~~~~~~

Presented to the Northern Ireland Forum for Political Dialogue

on 24 April 1998

Adopted CR28

Note

DRAFT REPORTS

This report has been prepared by Standing Committee C for

the consideration of the Northern Ireland Forum for Political

Dialogue. Until adopted by the Forum in accordance with its

Rules, this report may not be reproduced in whole or in part

or used for broadcast purposes.

ACKNOWLEDGEMENT

The Committee is indebted to those organisations and

individuals who willingly and generously gave of their

time and expertise to make this inquiry possible and we

extend our appreciation to all concerned.

CONTENTS

Section Page

1. INTRODUCTION 1

2. BACKGROUND 3

3. PRESENT SITUATION 5

The Home Help Service - A Perspective 5

Regional Strategy 6

Care at Home - Range of Services 6

Care Management 7

Domiciliary Care Services 7

Day Care 9

Nursing Homes 9

Training of Home Helps 10

Fire Lighting 10

Royal Commission 11

4. LIST OF CONCLUSIONS AND

RECOMMENDATIONS 12

APPENDIX

Page

Committee Membership 16

1. INTRODUCTION

1.1 This is the sixth and final report of Standing Committee C (Health

Issues) of the Northern Ireland Forum for Political Dialogue. All of the

Committee's other reports were concerned with Health issues of one

sort or another. This document deals with Community Care. In so

doing it is fair to say that the Committee has now touched upon every

aspect of its original remit. The now discharged remit is:

To examine the health needs of the community in

Northern Ireland with particular reference to health

care administration, acute hospital services,

community care services and access by the rural

community and report to the Forum.

1.2 This report is not so full as we would have liked but in the dying days

of the Forum neither can it be an interim report. The nature of our

findings and recommendations reflect the effort we have made in the

limited time available to us. We would have liked to have spent more

time on this subject but this was not to be. Bearing this in mind we

offer it primarily to the reader as a discussion document that hopefully

will begin a useful debate on this whole area. Clearly there is much

more to be said on what is really a very big and very fundamental

subject.

1.3 Evidence was taken from a number of Community Care providers,

namely:

1

Sperrin Lakeland Trust

Down Lisburn Trust

Newry & Mourne Trust

North & West Belfast Trust, and

Craigavon and Banbridge Trust

1.4 In addition we heard from Help the Aged, representing to some extent

the customer, and from UNISON - the trades union that, inter alia,

represents the Home Helps.

1.5 For the first time in any of our reports we have not printed the

evidence. This is entirely due to the time constraint imposed by the

impending closure of the Forum.

2

2. BACKGROUND

2.1 In the past families were responsible for caring for those unable to care

for themselves, but societal changes have brought about the move

towards the provision of domestic help under the statutory provision of

the 1949 Welfare Services Act.

2.2 The original service was meant to be a part-time or neighbourly help

service for the elderly and handicapped.

2.3 A New Model Scheme was introduced in Northern Ireland by DHSS in

1980. Health and Social Services Boards are required, under the new

provisions, to provide a service in their areas that assists the elderly to

maintain independent lives in their communities for as long as possible.

2.4 Boards contract with the Community and Combined Trusts who

provide the bulk of services on the ground, but it is a mixed economy

which includes the use of privately run Domiciliary Care Agencies.

2.5 Allocation of home help hours to clients takes place under the Model

Scheme which is interpreted in each case by social workers or care

managers who also review the client needs regularly.

2.6 Home helps themselves, we were told, have conditions of service that

are similar to those enjoyed by Social Services staff.

3

2.7 As a result of the People First legislation there are now less people in

institutional care, more people are being discharged from hospital and

more geriatric and psychiatric wards are closing down. More attention

is now focused on individual needs at home. Monies were transferred

from Social Security budgets to the Boards to fund this policy change.

2.8 At the same time however there has been a steady increase in the

number of emergency admissions to hospitals. One possible

explanation for this is that the burden of work placed upon GPs as a

result of People First has meant that they can barely contain the

demand for their services and are referring more people to hospital.

This development accentuates the ongoing tug-o-war for funds between

the community and acute services.

2.9 At least one Trust has developed a 24-hour responsive nursing service

to prevent unnecessary medical admissions. Under the scheme patients

could be admitted to Residential Home beds. It is often more

expensive to keep people at home but the whole idea is that choice

should be offered to the client within certain financial constraints.

Most Trusts, for example, will not provide Domiciliary Care that is

more costly than a Nursing Home bed. Other Trusts have different

yardsticks but the idea is the same.

4

3. PRESENT SITUATION

The Home Help Service - A Perspective

3.1 UNISON believes that the Home Help Service is the cornerstone of

any community care package and that its client base should be

extended.

3.2 The Union would also like to see the service becoming better

structured and trained and consisting of permanently employed staff,

although they admit that this is not a cheap option: "you cannot deliver

proper packages of care without proper funding".

3.3 They also believe that the Home Help Service could be extended to

looking after people with learning disabilities and helping families

generally, for example, instead of taking children into care they could

be left in their home and certain practical support mechanisms put in

place. This would in some cases be better for all concerned.

3.4 Some 15,000 women work in the Home Help Service. Most work on a

casual basis with no real security of employment. Happily some of this

is changing with some of the Trusts taking positive action to improve

the conditions of service of their Home Help staff.

5

Regional Strategy

3.5 The Northern Ireland Regional Strategy Document on Health and

Well-being in the Community is entitled 'Well into 2000'. One of its

aims is to ensure that elderly people, insofar as this is possible, should

be given assistance to remain at home. The document has set targets

for this. The Boards have also produced their own strategy documents

based on regional strategic requirements.

3.6 Care in the community is delivered via the Community Care and Home

Help Services of Trusts and by the voluntary and private sectors. It is

a patchwork that has no central co-ordination.

3.7 UNISON, during its evidence, made the point that time allocations for

elderly clients were insufficient and people were having to make

choices between having the house cleaned and having a meal made for

them. There was also the not to be understated question of human

dignity in all of this.

Care at Home - Range of Services

3.8 Care at home involves the provision of a whole range of domiciliary

services of individual packages of care provided, as has been said, by

directly employed staff or the voluntary and private sectors. The

number of directly employed home helps has fallen to around

two-thirds of the total as a result of the policies of the previous

government.

6

3.9 Trusts also offer respite and residential services for those who can no

longer remain with their families and the services of District Nurses

and Area Wardens.

3.10 Increasing numbers of frail elderly who are entitled to be in a nursing

or residential care home are opting to remain at home and be looked

after with intensive care packages. The home helps are being drawn

into this work.

Care Management

3.11 This is a process of individual needs assessment whereby

multi-disciplinary teams including doctors, nurses and allied

professions are set up to assess an individual's needs in terms of the

services and care they require. The credo it seems is "not just about

adding years to life but adding life to years".

3.12 UNISON, it must be said, feels that clients are not being properly

assessed when Social Services have to make "cuts".

Domiciliary Care Services

3.13 Generally domiciliary care services would include any of the following

or a variant thereof:

Home Care Support Workers/Home Helps

7

Nursing auxiliary visits where they provide input to the social care

package

Night sitting/day sitting

Night Warden Service

Domiciliary outreach

Domiciliary laundry services

Domiciliary meal service

Provision of emergency alarm systems

Any other support services provided in the home excluding those

offered by professionally qualified staff.

3.14 Trusts are always looking at new services that might assist in giving

people a better quality of life.

3.15 It will be seen that the Home Help Service operates within the

domiciliary care umbrella. Home Helps undertake the following tasks:

Personal care of clients, including dressing, toileting etc

Fire lighting

Making breakfast

Making mid-day meal

8

Shopping

Pension collection

Cleaning

Laundry

3.16 The Government follows a policy of 'best value' and we understand is

considering charging where feasible for the provision of domiciliary

services. There is already a means testing for the provision of Home

Help services in certain circumstances.

Day Care

3.17 There is an additional category of service - Day Care. This is provided

outside the home and its objectives are to relieve carers, improve or

maintain the functioning of attenders, or to slow down the rate of their

deterioration.

Nursing Homes

3.18 In the early 1990s some 18% of the elderly population was housed in

Nursing Homes but as a result of reforms funds were allocated to allow

people to stay at home. This figure has now halved.

3.19 We were told that by the year 2000 nearly 11,000 elderly people will

require nursing home accommodation at public expense. This

represents a financial time-bomb which will be difficult to diffuse. In

cost terms additional money of the order of £30m will be required

9

annually. Resources currently are having to be moved from the funding

of domiciliary services to fund residential and nursing home beds.

Training of Home Helps

3.20 Training of home helps varies from Trust to Trust but generally there is

a need for courses in basic food hygiene, lifting and handling, first aid,

control of substances and the specific needs of clients.

3.21 Some Trusts are also opting for paper qualifications for their home

helps, eg NVQ2 in Social Care. Others have produced handbooks for

their staff.

Fire Lighting

3.22 Traditionally one of the first tasks of many home helps is to light the

coal fires of their clients. We have heard evidence to suggest however

that in some areas where alternative means of heating is available

Trusts insist that these be used thereby saving on home help time and

effort which can then be channelled more usefully.

3.23 We are also very aware that electricity charges are still considerably

higher here than in the rest of the UK. Moreover, the cheap and clean

alternative - natural gas - is not available here.

10

Royal Commission

3.24 A Royal Commission on Long Term Care has been set up and is

currently taking evidence. Its terms of reference are:

"To examine the short and long-term options for sustainable

systems of funding of long-term care for older people, both in

their own homes and in other settings, and in what

circumstances the cost of care should be apportioned

between public funds and individuals."

3.25 The Commission will visit Northern Ireland (Queen's University) on

22 June to take evidence.

11

4. LIST OF CONCLUSIONS AND

RECOMMENDATIONS

4.1 We would urge the Government to bear in mind that the Royal

Commission on Long Term Care will report in approximately one

year's time and that no precipitant action is therefore advisable at

this time on the question of charging for services.

4.2 The Royal Commission is visiting Northern Ireland on 22 June.

We urge all those interested in Care of the Elderly to avail of the

opportunity of giving evidence at this time.

4.3 We recommend that those providers of home help services who do

not already do so, work in conjunction with Housing Authorities,

particularly the Northern Ireland Housing Executive, to ensure

that the homes of those who require, or are likely in the near

future to require, the services of Home Helps are equipped with

modern and automated modes of clean heating.

4.4 We call upon Government to take steps to bring fuel costs here

into line with the average for all United Kingdom regions so that

the frail and elderly of Northern Ireland cease to suffer from

'comparative disadvantage'.

4.5 We recommend that there should be greater contact between

Social Services and carers and between the Trusts, perhaps

through the establishment of a regular structured Forum whereby

best practice, ideas and approaches can be exchanged. It strikes

12

us that the needs of clients are assessed in different ways by

different Trusts and even by different social workers or care

managers within the same Trusts. This lack of uniformity creates

inequities and whilst some of these cannot be helped we believe

there is scope for improvement.

4.6 We recommend that where possible the fullest use is made of

'meals on wheels' services and lunch clubs across the Province in

order to release home help time used for food preparation for

more appropriate use. Meals on wheels in some areas is being

developed to cater for breakfast and evening meals and this is to

be encouraged provided it is done to the client's satisfaction.

4.7 Under the present system funds are allocated by the Boards to the

Trusts for community care services. Allocations vary in different

areas. In the case of Combined Acute and Community Trusts it is

possible that the Community side will suffer in order to better

fund the Acute side. An example of this can be seen within the

newly amalgamated Community Care and Acute Services in the

North Down and Ards area. This is a problem which Government

needs to tackle because it inevitably leads to differential treatment

within the Province's client base for reasons that bear no relation

to community need.

4.8 We were impressed by the quality assurance systems introduced

by Down Lisburn and North and West Belfast Trusts and would

urge all Trusts to contemplate similar arrangements.

13

4.9 The Committee was told that there are different charging regimes

for nursing and community care. If a person is assessed for the

former and their family is able to pay for the care then they are

charged at full cost. In the case of the latter, ie the assessment is

for a community care purchase whereby the patient remains at

home, there is no charge. This practice seems to us to be

indefensible and we recommend that the Department examines the

situation with a view to developing a consistent policy.

4.10 The Committee understands that it is usual for Trusts to restrict

house cleaning to what has been described as "health-related

cleaning" ie the cleaning of toilets, kitchen areas etc. This is done

in order to effect cost savings. However we feel that consideration

should be given to some relaxation of this guideline in the interests

of basic hygiene and that house cleaning should be carried out at

least on an occasional basis.

4.11 The Committee is aware of an anomalous situation whereby

charges are levied in certain circumstances to clients for the

provision of in-house home help services, but where services are

provided by private contractors, through the Trusts to other

clients in similar circumstances, no charges are made. We

understand that DHSS is aware of the anomaly in the guidance to

Trusts and is considering how this might be dealt with. It is an

intolerable administrative inequity and we look to DHSS to take

prompt action.

14

4.12 We learned of the low uptake of benefits by senior citizens in

Northern Ireland and wonder whether it might be possible for

closer liaison between Social Services and Social Security staff in

an effort to tackle the problem.

15

APPENDIX

16

APPENDIX

STANDING COMMITTEE 'C'

(HEALTH ISSUES)

Committee Members who were Active at the Time of Study

Mrs M Beattie DUP

Mr C Calvert DUP

Mr G Campbell DUP

Mr S Foster UUP

Mr S Gardiner UUP

Mr P King UUP

Mrs M Marshall Alliance*

Dr H McKee Labour*

Mrs J Parkes DUP

Mrs G Rice Alliance*

Mr T Robinson UUP

Mr H Smyth PUP

* Attend Committee on behalf of the Party under Rule 14(4)(a)

17

18

• Community Care and the Home Help Service - An examination by Standing Committee C (introduced on 1998-04-24 00:00:00 - CREATE - e841584) [This document] [view current proposal at this moment]
  • None (introduced on 1998-04-24 00:00:00 - REPORT_PROPOSAL - e841585) [view current proposal at this moment]