With the nursing and residential home sector is in trouble. Jim McCall, the MD of Four Seasons Healthcare takes us through the challenges and opportunities
In Northern Ireland, health and social-care services face a challenging agenda over the next few years. The Government minister, Edwin Poots, has to manage the provision of services, which have grown over several years, with a significantly reduced annual budget. While statutory-sector services have to address an unforgiving agenda of efficiency savings and budget cuts, the agenda facing private-sector providers of nursing and residential care homes is equally challenging. The majority of nursing and residential homes in Northern Ireland are locally managed businesses. While there are a number of UK companies present in Northern Ireland, most are SMEs, owned and operated by individuals and families. It is important to note that a nursing home providing 60 beds will represent around £1m of expenditure in jobs and services to the local economy.
Mr Poots has made it clear that he will give leadership and direction to the provision of health and social care and, importantly, he appears to be willing to make hard decisions. Budget reductions, a real cut of circa 2.7% by 2014/15 on the health and social care economy, will impact services. Professor John Appleby, of The King’s Fund, believes health and social care is facing the most severe funding situation since the Second World War.
Demographic Time Bomb
The ageing population of Northern Ireland presents a major challenge. Projections indicate that while the overall population will see a modest rise of 11%, the increase for people over the ages of 65, 75 and 85 will be 63%, 80% and 143% respectively. The number of people older than 75 will increase from 7% to 11% over the next 20 years.
The ageing population will have more complex needs, including a significant increase in the number of people with dementia, and this will place greater demands on the health and social-care budget.
For many private-sector care-home providers, of which there are 490 in Northern Ireland providing 14,000 places, the inexorable increase in costs, the restriction of the fee rate paid by health and social-care trusts for nursing and residential beds and a contemporaneous planned reduction in the volume of beds commissioned, is placing a considerable pressure on home owners who are seeing margins compressed on a monthly basis.
For 2011-2012 the Health and Social Care Board has advised providers that there will be no increase in the weekly tariff, which is already acknowledged to be less than the true cost of care, paid by health and social-care trusts to purchase carehome beds. Home owners still have to meet increasing costs for utilities, staff, food, etc. In essence, private-sector businesses have had to accept a de facto cut in income.
While the private sector has to contend with the challenging agenda and the financial constraints of a reduced health budget, it is also faced with a loss of confidence. The problems associated with Southern Cross, the largest provider of nursing-home care in the UK does not augur well for a hesitant and risk-averse health and social-care sector collaborating with private-sector businesses, particularly large corporate bodies, which are ostensibly unstable. Added to this loss of confidence in the private sector was the controversy created by Panorama’s expose show on the residential facility run by a private company for people with learning disabilities. The failure of the company to care for and safeguard residents shocked. Many families are now quite correctly anxious about the ability of private-sector organisations to provide care and safeguard vulnerable people in nursing and residential homes.
For many nursing-home providers the financial challenge is considerable but this has to be placed in the context of maintaining and indeed improving quality of care.
Nursing home and residential care homes are regulated by the Northern Ireland Regulation and Quality Improvement Authority (RQIA). Providers must adhere to standards governing levels service. They must also ensure compliance with the standards set out in the legislation and inspected by the RQIA. Proprietors of nursing and residential home businesses also have to adhere to the contractual obligations of the local Health and Social Care trusts, Environmental Health, the Fire Authority, Public Health Agency, Human Rights Commission and occasionally the Northern Ireland Commissioner of Complaints. With all of these bodies inspecting and regulating services provided in nursing homes it is interesting to note that there has been no diminution of expectations from statutory bodies to correspond with the 0% increase in income for services.
In Northern Ireland where our dependence on statutory-sector employment is so significant and our economic prospects for growth are so uninspiring, private-sector nursing and residential-care providers will struggle to maintain standards for their residents.
The private sector, if nothing else, is resilient. Many local proprietors provide the highest level of care for their residents. It is important that within the broadest sense of the Northern Ireland health and social-care economy, including statutory-sector interests, the voluntary sector and the private sector, that an increased level of collaboration be considered to release resources to support people in the community rather than in hospitals.
A move away from statutory-sector silo thinking in service design and delivery is essential if better use is to be made of the existing scarce resources and there is to be an improvement in the quality of care for individuals in nursing and residential-care settings. Embracing the capacity within the private sector to reshape and enhance the quality and range of services for the population of Northern Ireland should be a key consideration for the Health and Social Care Board and the Health and Social Care trusts in Northern Ireland.