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Local authorities have a central role in arranging and funding social care, Scottish health minister James Douglas-...
Local authorities have a central role in arranging and funding social care, Scottish health minister James Douglas-Hamilton told a conference hosted by the Registered Nursing Home Association today.

'We have achieved much in the field of community care since 1989, and there has been considerable change in the environment in which nursing homes operate.

'The flourishing of your sector has had a positive effect. The nursing homes run by your members are often better sited and more closely integrated into the communities they serve than the large long-stay hospitals which, historically, may have been the only alternative for many of your residents.

'In addition, the quality of the accommodation offered in your nursing homes is a vast improvement on the ageing accommodation offered by many of the large long-stay hospitals which they are, in part, replacing.

'I believe we can only succeed in meeting the needs for continuing care if health and social work services collaborate and plan jointly at local level and most importantly at the level of the individual and family. Health needs cannot be viewed in isolation from social needs.

'Research shows that most elderly people wish to remain in their own homes where practicable, and partnerships between primary care teams and social workers and between home helps and community nurses are essential if we are to achieve our objective of supporting them in this wish. An increased emphasis on needs-led services and an expansion in domiciliary care means that most vulnerable people can, and will continue to be cared for in their own homes.

'However, for some, the continuation of care at home becomes impractical for a number of reasons, and they need the more intensive care provided by residential and nursing care homes.

'It is a growing issue - in 1980 there were fewer than 47,000 men and women over the age of 85 in Scotland, last year there were nearly 75,000 and, by the turn of the century, it is projected that there will be some 92,000.

'The challenge for us is that when these people do have to leave their own home, they want to move into local, homely surroundings. We need to support this wish to move away from large institutions, whether provided by the statutory or independent sectors.

'The independent sector has risen magnificently to this challenge and there has been a significant increase in nursing home places since the introduction of our community care reforms. In April 1993 there were approximately 15,000 occupied beds in independent sector nursing homes. By April this year there were 17,350.

'There is no doubt that the regulatory framework within which your industry works is an effective mechanism in protecting the welfare of the residents. As community care becomes firmly established we believe it is important that the welfare interests of residents should also be promoted to greater effect.

'As our community care policy develops and increases the requirement for high quality care in the community, we wish to see consistently high standards of continuing care in the residential and nursing care sectors. That is why, as you may know, my officials are involved in facilitating the work of two very important working groups which are considering national core standards for nursing homes, and residential care home registration procedures.

'Standards should be measured in a way which is consistent over time and between and within the authorities charged with these statutory responsibilities. Openness is the key. There are complaints procedures in place in nursing homes and I know that some involve the local community through voluntary group representation. This is to be encouraged.

'All home owners and matrons must work hard to encourage input to their homes from the relatives and families of residents and from local voluntary and other groups.

'The public are rightly concerned to ensure that your potentially vulnerable clients receive the care they themselves hope they can expect when they become your potential clients. Our national standards will therefore be subject to public consultation and I have asked the working group to consider how we can involve the public in the inspection process.

'The report drawn up by nursing home inspection teams are important in terms of checking and monitoring the agreed standards. There are arguments, therefore, for making these reports provided they are fair and factually correct, public and available to residents, their families, and to purchasers of care and to the wider public. It is in the interests of all of us that the public have the fullest confidence in the care provided by the registered nursing homes sector. Once again this is something I have asked the working group to consider.

'Joint working and joint registration should inevitably lead to the setting of jointly agreed standards of care and the arrangement of joint inspection visits by health board and local authorities and eventually, to consideration of joint regulation. I have been encouraged by developments in this area but there is still a long way to go in the area of joint registration and standard setting throughout Scotland.

'We must look at the needs of people and fit our services to their needs, rather than fitting people to the services which we find the most convenient to provide. That is why we are encouraging the nursing home sector to become involved in the provision of domiciliary nursing, in collaboration with general practitioners and the other statutory providers of domiciliary health care services.

'To enable more vulnerable people to live in the community, there is a need for appropriate respite care to be available. While the NHS will continue to meet people's short-term health care needs, hospitals are not the appropriate place to offer respite care to people whose needs are primarily social.

'I believe nursing homes can make an important contribution to the provision of respite care, offering a break for carers and providing a positive experience for those being cared for in a homely setting, but with the support of appropriately trained staff.

'The Scottish Office will shortly issue guidance to local authorities and health boards on the planning and provision of respite care services. The guidance will encourage authorities to adopt contractual arrangements which will assist private and voluntary sectors in the provision of respite care.

'Local authorities have a central role in arranging and funding social care. Ministers and officials have consistently emphasised the enabling role of local authorities in encouraging the involvement of providers from across the sectors within the mixed economy of care.

'One of the concerns I sometimes hear expressed about our community care programme is that it is underfunded. This view simply is not justified. Since the inception of the reforms, local authorities have benefited from substantial new resources which now stand at a cumulative £241m.

'This includes the transfer of £158m from the department of social security which has enabled authorities to assume overall responsibility for the purchase of social care particularly with regard to the placements in the residential sector, including nursing homes. This is £18m more than the DSS would have spent on those in the independent sector under the former funding arrangements.

'Together with other resources in respect of the elderly and disabled people which existed before the community care reforms came into effect, a grand total of £621m has been allowed in the current year for authorities to spend on their broad range of community care responsibilities.

'So to summarise, there is a vital and continuing role for good quality nursing home care in local, homely surroundings, there is an increasing demand, you have access to community care plans, and we have made available an unprecedented level of resources.'

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