Care of Older People: Mid Ulster

Adjournment – in the Northern Ireland Assembly at 4:00 pm on 24th November 2015.

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Photo of John Dallat John Dallat Social Democratic and Labour Party 4:00 pm, 24th November 2015

The proposer of the topic will have 15 minutes, and all other Members who speak will have approximately eight minutes.

Photo of Sandra Overend Sandra Overend UUP

I am grateful for the opportunity to bring this Adjournment debate to the House, especially on this important issue: care of older people in Mid Ulster. Indeed, I want to thank colleagues for their grace in allowing me to move the debate to today following the passing of my grandmother a fortnight ago. While the topic was not raised with my grandmother in mind, the care that she received both at home from her family members and from a great team of domiciliary carers, who called at her home regularly, certainly informed me of many issues and concerns on this matter.

Our older people are some of the most vulnerable people, both in Mid Ulster and throughout Northern Ireland. Some are cared for in residential homes, some by carers and some by family members. We have all been made aware of the problems faced by older people, especially through the stories of those who have come into our constituency offices. The patients for whom Westlands care home in Cookstown is their home, like so many others in so many other statutory care homes across Northern Ireland, know all too well about the impending closures and what that will mean for them. I presented a petition to one of the Minister's predecessors in July 2013, signed by almost 5,000 people from Mid Ulster who called on him not to close Westlands care home. The following consultation on care home provision in the Northern Health and Social Care Trust has closed for responses, but I wonder if those responses will make any difference to the outcome for residents who call places like Westlands home.

I was disappointed that the Minister refused to meet me on this issue. It would have been an opportunity to discuss the concerns of people in the area and the reality on the ground. We know that he was consulting to make Westlands care home into a community hub, despite much protest against that. I wonder whether that idea is going ahead following this consultation. If so, what exactly will that entail? How will that continue to help the older people in Mid Ulster? Those are questions that remain unanswered.

The problems are not confined to residential care homes under the control of the Minister. No, care homes in the private sector are also crying out for help due to a lack of nursing staff being trained, which is causing them great difficulties. Indeed, in the news this afternoon, we heard of seven care homes closing across Northern Ireland.

As the managing director of one private care home in Mid Ulster who contacted me said:

"There are critical shortfalls [in nursing staff] and unless this is made a priority by the Assembly in terms of future planning and funding, it will undoubtedly result in a much greater crisis."

One would imagine that, with the crisis threatening to develop further, the Minister would seek to address the problem by working with Executive colleagues to find a solution. When I asked the Minister in a question for written answer to detail discussions that he had with the Employment Minister regarding the number of nursing places at universities and colleges, he stated:

"Responsibility for the commissioning of student nursing places in Northern Ireland is entirely a matter for my Department therefore no discussions have taken place with the Minister for Employment and Learning."

The Health Minister, therefore, admits sole responsibility for the lack of numbers and student nurses coming through.

The problem is also being felt in the domiciliary care sector, where there is a severe lack of care staff to fulfil the needs of older people throughout Mid Ulster. The Commissioner for Older People for Northern Ireland recently published a report on 'Domiciliary Care in Northern Ireland'. In the report, she noted:

"there are high levels of inconsistency in the planning and delivery of services across Northern Ireland."

She also noted that receiving good quality domiciliary care in Northern Ireland has been become a "postcode lottery".

I have been contacted by many people whose families are being stretched to the absolute limit in their care for elderly and vulnerable family members. The Minister and his predecessors have continued with the policy of closing care homes across Northern Ireland, stating that older people staying in their own homes will ensure that they can retain their independence of living and receive care in a familiar and comfortable environment. I can certainly feel for that idea. In the report, the commissioner describes it as the "lynchpin of Transforming Your Care", noting:

"it is imperative that adequate support and resources are allocated and protected to plan, design, commission and provide high quality care in the home for older people."

However, as the Minister closes care homes in Mid Ulster, and as more and more people will now need specialist care in their own homes, he has failed to ensure that proper domiciliary care provision has been put in place.

One case that I have been dealing with through my constituency office concerns a lady who has been fighting to secure a care package for her uncle, who suffers from Alzheimer's and who requires multiple care visits per day. She has been fighting for that care package for over a year — that is 12 months in which she and her family have been stretched to their limits because the trust and the Department have been unable to find a suitable care package for her uncle. This state of affairs is simply not good enough. <BR/>Where carers and care packages are put in place, the carers are being stretched thin on the ground. However, that is hardly surprising when there are not enough care staff employed to cover the needs of older people in need in Mid Ulster. I have had discussions with district nurses and carers who have concerns over the levels of mileage paid for the journeys to and from patients and the difficulties faced by those who travel from one edge of the constituency to the other. The rural nature of Mid Ulster only exacerbates the problems felt by those carers and puts more pressure on the industry.

In the report, the Commissioner for Older People pointed out:

"The work they do is physically and emotionally demanding ... If high quality care is to be available at home for older people who need it, work must begin to address workforce issues to pay, support and enable people to provide this care."

I know from personal experience that these carers provide an excellent and necessary service to many people in Mid Ulster, and they must be given the resources and support to carry out their important work. The Minister is closing care homes under his control, leaving many older people with an uncertain future. He is not training enough nurses to staff private care homes and to provide domiciliary care packages, leaving older people without the care that they will need, now and in the future.

It certainly seems that the Health Minister's policies are not effective and he is failing older people in Mid Ulster and across Northern Ireland. Those are the people who need care and stability the most. I feel that it is not good enough. I appreciate the Minister's presence here this afternoon and I am keen to hear how he plans to rectify those problems and ensure that the older people of Mid Ulster are given the care that they so desperately need.

Photo of Ian McCrea Ian McCrea DUP

First, I welcome the opportunity to speak in this debate. I thank Mrs Overend for returning to the debate after the sudden passing of her grandmother. At the wake, I expressed my deepest sympathy to you and your family circle, and I do so again. I know that it was a shock. You spoke of the care that your grandmother got at home. Many older people and their families feel the benefit of getting that care and being able to spend those last moments at home with their loved ones. Many people would prefer that, rather than being in a home. I know that that was appreciated and, having spoken to some of your family members, I know the importance that they felt of having your grandmother at home.

When we look at the wider care of elderly people in the Mid Ulster constituency, it is important to put on record that excellent work is done by many staff who work in residential care or nursing homes across the constituency and across Northern Ireland in caring for our older people. Having spoken to many families who have loved ones and having worked alongside them to ensure that they got into the right care home, I know that they greatly appreciate the work and help that their loved ones received.

I suppose that a lot of this debate will be around the Westlands residential home. I join Mrs Overend in speaking positively about the excellent job that those staff do in looking after the residents. It is disappointing that the debate has got to the point where we are lambasting a DUP Health Minister for decisions and policies with no reference whatsoever to the fact that it was a DUP Minister, Edwin Poots, who stopped the decision to close the Westlands home as well as the other homes across Northern Ireland, and it was a DUP Minister, Simon Hamilton, who ensured that that decision did not continue.

I apologise for using my mobile phone, Mr Deputy Speaker, but it is just for the sake of today's BBC news. It is not often that I give the BBC a plug. I welcome today's announcement by the Health Minister that a number of statutory care homes that may have been facing closure have been given a reprieve due to the problems faced by a private care home firm. The Minister has, once again, stepped in and given further assurance to those care homes that have been under threat that he is stopping that, reviewing it and ensuring that no one is put in any difficult circumstances.

Having spoken to the Minister about previous decisions and since he made this one today, I know that it is not the case, as others would try to say, that this is just putting off a decision. There is a genuine desire to ensure that no one is put out of their home. As Mrs Overend rightly said, for Westlands, many of those who are left feel that it is their home. I commend the Minister for that recent decision. When he responds, maybe he will put some meat on the bones regarding his decision. I welcome the steps that DUP Ministers have taken. I believe that that sends out a positive message to the residents and staff in Westlands and, I hope, cements that for — I cannot say how long — the short to medium term if not into the long term.

I believe that the Minister is genuine when he says that no current resident of Westlands will be asked to leave. That was a very positive announcement in the past and is a very positive decision that the Minister has now taken. Different things always come down the road at us, but in respect of the decision by —

Photo of Sandra Overend Sandra Overend UUP

I welcome the Member saying that the Minister is giving a reprieve to some of those care homes, and I look forward to the detail on that. However, does the Member agree that the Minister should lift the non-admissions policy for the statutory care homes that are still here?

Photo of Ian McCrea Ian McCrea DUP

I was just about to come to that. The Minister and previous Ministers will know that I do not always agree with every decision that is taken. I welcome this decision and believe that it gives us an opportunity. On the back of the unfortunate circumstances for the private care home, the Minister has now announced that he is reviewing the decision that he might have taken. I do not know where he is on that point, but he now has an opportunity to look at admissions, whether full admissions or from a respite perspective. I have no difficulty joining the Member in encouraging, if not asking, the Minister to look again at that policy, specifically for the Westlands home.

I look forward to hearing what other contributors have to say, but I hope that the Minister can put some more meat on the bones, certainly for what it means for Mid Ulster and for Westlands.

Photo of Ian Milne Ian Milne Sinn Féin

Go raibh maith agat, a LeasCheann Comhairle. I thank Mrs Overend for securing the Adjournment debate. I also extend my sincere condolences to you and your family on the recent death of your grandmother.

We live with an ageing population. That is great news for all of us, but it also presents a number of challenges for older people and society as a whole if we are to make the process of growing older as positive and inclusive as possible. According to the 2011 census, almost 18,500 people in Mid Ulster were over the age of 65, and that figure is, thankfully, predicted to rise.

The key barriers for older people are well documented and include poverty, loneliness, fear of crime, ageism, poor health and access to services. Those factors are no different for older people in Mid Ulster, but the largely rural demographic of the constituency can intensify many of those issues. Older people in rural areas can feel very isolated. Limited access to public transport can prevent those who want or need to do so from accessing recreational, medical or other essential services, and severe weather conditions can leave them feeling extremely vulnerable. The impact of social isolation and loneliness on an individual's mental and physical well-being cannot be overestimated, and lack of contact can make it more difficult to identify and assist those in need.

I want to use this opportunity to commend our Minister Michelle O'Neill and her Department for the ongoing work in the tackling rural poverty and social inclusion (TRPSI) framework. That is implementing a package of measures to help to address a range of issues for vulnerable rural groups, including older people, right across the North. Successful initiatives that have benefited our older population in Mid Ulster include the connecting elderly rural isolated (CERI) programme, which aims to address social isolation and support independent living, the assisted rural travel scheme, and the maximising access in rural areas (MARA) project, which seeks to maximise benefit uptake and access to services.

There is plenty still to be done, but the recent review showed that a significant impact has been made. I acknowledge the contributions of the Rural Community Network and the Cookstown and Western Shores Area Network to that review.

Not all difficulties faced by older people in Mid Ulster are related to rural locations and can be addressed by this programme. Over the last number of years, the ability to access full entitlement to care packages has diminished, with options such as direct payments being offered on a more regular basis.

The focus on care in the community and increased demand on the service has led to shorter time slots, domiciliary care workers under increased pressure and many families feeling unsupported by the trust when an elderly relative leaves hospital. That needs to be addressed as a matter of urgency, and I met the health trust again recently to raise that issue. The option of nursing care leads to the worry of losing the family home, which is another issue that needs wider discussion.

The proposal to close residential homes has impacted on Mid Ulster and caused a lot of anxiety and worry for residents and families. The campaign to save Westlands care home continues, and I offer the residents and union organisers my full support.

On a personal note, I had several meetings with the Housing Executive to highlight the need for increased provision of sheltered housing for those who wish to avail themselves of that option. I have campaigned for a companionship service for carers of dementia patients using public transport.

I want to use this opportunity to acknowledge the many groups working to address these concerns and enhance the experience of our older population.

Photo of Ian McCrea Ian McCrea DUP

I am sure that the Member is, like others, aware that an event was held last week by Fold Housing Association in respect of the 58 homes that it is developing in Cookstown. Will the Member join me in welcoming that, given his point in respect of that type of accommodation? Will he join me in welcoming those much-needed homes? Hopefully, we will be able to accommodate some of our elderly population in them. Will he join me in welcoming that?

Photo of Ian Milne Ian Milne Sinn Féin

I thank the Member for his intervention, and I do welcome that. Anything that assists our elderly population there has to be welcome.

I acknowledge the community and voluntary sector, which runs a number of successful projects in local areas. I recently met Agewell, based in Magherafelt, which provides an invaluable "good morning" service that reassures people that they will be contacted daily, as well as providing a home maintenance and advice service, and I am aware of other local groups, such as Opportunities for Older People and the Mid Ulster Senior Network, to name a few that also do excellent work in this sector.

As an Assembly, we need to continue to break down barriers, listen to the needs and expectations of people advancing in years, and provide the necessary support to the community and voluntary sector, which provides a large portion of the on-the-ground service delivery. Again, I thank the Member for bringing this Adjournment debate.

Photo of Patsy McGlone Patsy McGlone Social Democratic and Labour Party

Go raibh maith agat, a LeasCheann Comhairle. Thanks very much, Mr Deputy Speaker. I thank Mrs Overend for bringing the motion, and I extend my personal and sincere sympathy to her and her extended family on the passing of her grandmother. Grandparents in particular can be a close and integral part of any family, so I am very sorry about that, Sandra.

I welcome the opportunity to speak in the debate, although it is a difficult subject to speak on. It is a debate that is not only worrying but disheartening at times. Today, I hope I can give voice to not only the elderly people of Mid Ulster but their families.

In Mid Ulster, as was said, we have felt the ongoing reduction of our health services and further closure of several residential care homes. Some of that has been abated. I have to say that the previous Minister did stand by his word and did that. However, there are pressures on local health provision, and that has created uncertainty amongst older people and their families. However, I pay particular tribute to the carers who look after them, often in very difficult and trying circumstances.

Just today, we heard the news that seven residential care homes are being closed by Four Seasons, right across the North. Indeed, Mr Deputy Speaker, one of them is in your constituency. I realise that the Minister has delayed the consultation on residential care home provision, but I ask him to give clear, unequivocal assurances that places will be found ASAP for people in those homes and that they and their families are not left high and dry. That would really put pressures on people.

Yes, we have the outlook of cutbacks on domiciliary care packages, but I have to say that I have encountered an increasing problem that does not involve cutbacks. In many cases that I have encountered where difficulties arise, resources and finance are there, but the carers — usually for private care — cannot be found. They cannot find people or employees, and that is becoming an intractable problem. People who are ready for discharge from hospital and taking up a hospital bed cannot return home because carers are not there to provide the care package to support them in their own home. That is becoming an intractable problem. You have only to do the maths. I am sure that the Minister, with both his financial accounting hat on and the facts that he has at his fingertips, will be able to outline how much a hospital bed and a care package costs health and social services per day. It is a no-brainer. The sooner we get people out of hospitals, the cheaper it is and the more applicable it is to others who deserve care in hospital.

We have significant reservations about the continual closure of residential care homes across the North when we do not have sufficient funding for home care services. A key aspect of Transforming Your Care was aimed at seeing our home care services properly funded and resourced. Funding and provision for that manpower and womanpower in home care settings is very important if we are to transform your care at all.

In September, the people of Cookstown stood alongside the staff of Westlands Residential Home to demonstrate against the closure of that institution. Westlands, which many MLAs have already said, has faced tremendous adversity over the years, yet staff and residents have remained firm in their support of the home and the people cared for in it.

At Stormont, a similar protest occurred, with about 200 care-home residents, relatives and trades unionists protesting on the steps outside Parliament Buildings. I, like others, stood alongside them and heard stories of how valuable residential care remains; how it factors into the lives of so many people; how the staff show support and dedication; and how they help to rebuild and support the lives of residents and their families.

When it comes to health concerns, my constituency office primarily deals with fears about the provision, or lack of provision, of home care packages, as I have outlined. Home care for the people of Cookstown, Magherafelt, south Derry, east Tyrone and, indeed, all the rural areas surrounding, remains definitely the preferred option. Care packages allow older people to live as independently as possible, for as long as possible, in the setting that they prefer: their own home. Put simply, home-care domiciliary packages allow for the provision of healthcare to the housebound and disabled; it takes away, or helps to alleviate, some of the strain and stress of travelling for many people. The SDLP believes that older people deserve a high-quality, well-funded service from care workers who are properly trained, committed and rewarded for the complex care that they provide to patients at home.

I recognise that the Health Minister must make difficult decisions in an uncertain economic climate, but, in the light of figures that suggest that there will be a 69% growth in the population aged over 75, it is only natural to be concerned about any major change to the delivery of domiciliary care in Mid Ulster or, indeed, across the North.

Northern Ireland's ageing population requires new approaches that accommodate older people and do not invalidate them as citizens. Financial responsibility is crucial, but to focus entirely on strict financial controls and cuts is to lose sight of the reality of patient and community needs.

I go back to my point: the longer someone who is fit for discharge is in a hospital bed, the greater the backlog of people who require those hospital beds and the smaller the chance of that person being looked after properly, and adequately cared for, in their home environment as a citizen. We need to bolster care in the community to reduce pressures, and strategies for the wider health service must be based fundamentally on patient needs and not exclusively on the financial bottom line. People in Mid Ulster and, arguably, all of Northern Ireland need clarity. If the Health Department remains committed to the ideals of Transforming Your Care, we must see continued support for domiciliary care packages. If, however, the ideals of the health service have shifted, local residential care must be supported.

The people of Mid Ulster — indeed, the people of the North — do not deserve half measures. I support the motion and, again, thank Mrs Overend for introducing it.

Photo of Simon Hamilton Simon Hamilton DUP 4:30 pm, 24th November 2015

I begin by joining others in passing on my condolences to Mrs Overend and her family on the recent loss of her grandmother.

I thank her for proposing the Adjournment debate. I have listened to the range of views expressed by Members — the hardy few who are in the Chamber at this time — and I will do my best to respond to most of the issues raised. I would also like to take the opportunity to outline and highlight some of the work being undertaken by my Department, the Health and Social Care Board and the trusts to provide care for older people across Northern Ireland.

The continuing growth in demand for services for our older people should not be and is not underestimated by my Department, and I believe that we are taking steps through Transforming Your Care and other initiatives to provide and improve those services. The growth in demand was also one of the main reasons why I recently outlined the need to significantly reform our health and social care system

It is widely recognised that Northern Ireland, like many other countries, has an ageing population, something that is very good. Projections from the Northern Ireland Statistics and Research Agency (NISRA) indicate that the population aged 65 and over will increase by 26% — 71,000 people — by 2022. While, of course, it is a significant achievement that people live longer than ever before, it is essential that government in Northern Ireland faces up to the challenges presented by an ageing population.

The process of reform to meet the challenges confronting the provision of health and social care in Northern Ireland did not start with Transforming Your Care. However, TYC identified in a single comprehensive document the serious pressures facing the health and social care system going forward. The review set out a very strong case for change, recognising that no change was simply not an option, and made proposals on where service changes would have most impact on those challenges.

TYC made the case that preventative approaches can deliver better outcomes and set proposals on supporting older people, including home as the hub of care for older people, with more services being provided at home and in the community; a major reduction in statutory residential accommodation for older people as a result of a focus on promoting healthy ageing, individual resilience and independence; and a diverse choice of provision to meet the needs of older people, with appropriate regulation and safeguards to ensure quality and protect the vulnerable.

Despite the financial pressures that have slowed the transition to the model of care envisaged in TYC, steady progress has been made in transforming health and social care service delivery. Projects directly addressing the need for services designed to meet the needs of older people include the adoption of a regional approach to the delivery of reablement services that help people to remain independent at home for longer; reviewing domiciliary care provision, linked to the work on reablement, with the aim of providing a consistent service across Northern Ireland; and the promotion of self-directed support, which empowers service users and carers to exercise more control over their social care services by giving service users as much control as they want over their personal budget, the amount of money identified and allocated by the health and social care trust to meet their assessed needs. That enables service users to make informed choices about how and when services are provided.

We have also established 17 integrated care partnerships (ICPs), which all have agreed action plans in place as well as funding for a range of service change initiatives. The initial focus of ICPs is on frail older people and those, regardless of age, with certain long-term conditions such as stroke, diabetes and respiratory conditions. Alongside the review of care pathways, they are engaged in risk stratification work to identify patients in the priority areas — stroke, diabetes, respiratory conditions and frail elderly — who are at significant risk of poor outcomes because of their condition. That work will enable GPs to identify patients who are at risk and therefore require proactive case management to help them to manage their condition effectively and to avoid unnecessary acute admissions.

I am aware that Members have in the past and this evening raised concerns about the proposed closure of statutory residential care homes in their constituencies, including the proposed closure of the Westlands nursing home in Cookstown. Trusts have been engaging in consultations, with three already complete and two still outstanding. When concluded, those proposals are to be forwarded to the board for consideration before they come to me for a final decision. To date, none of them has made it as far as the Department. In spite of what Mrs Overend said, I have not closed any homes.

I have been increasingly concerned about a range of pressures facing the independent sector and particular problems facing one of the largest independent providers of residential care in Northern Ireland. I have been keeping developments under constant review, and, as a consequence of those growing concerns and further negative developments today regarding plans by Four Seasons Health Care to close seven homes across Northern Ireland, I am asking the Health and Social Care Board to halt and review the proposed closures of statutory residential care homes. Given that many of the proposals are predicated on spare local capacity in the independent sector, it is only right and proper to pause, reflect and give careful consideration to issues arising in the independent sector.

Mr McGlone raised issues around the 250 or so people who would be affected, never mind the 300 or more staff who would be affected. However, he raised particular concern about what would happen to the residents in the seven homes that are proposed for closure. The board is working closely with my colleagues in the Department, the RQIA and the health and social care trusts. They are working together and will continue to work closely with Four Seasons to ensure that there is regional and local coordination in managing the process of moving people away from the homes that are earmarked for closure.

I also want to put it on the record that the continued well-being of residents will be the priority in dealing with any future transition to alternative care arrangements. The intention is to ensure that any relocation will be managed with minimal disruption to them, that they are able to remain as close to the original location as possible and that there will be no additional financial implications created by the move. All the organisations that I mentioned, including the owner of the homes involved, are committed to ensuring that there is clear, regular communication with residents and their representatives to address any concerns that may arise. I assure the Member and the House that, as Minister, I will, as far as I can in respect of a decision made by a private company, ensure that that is done as well as is possible.

Recently, the outgoing Commissioner for Older People highlighted her concerns about the domiciliary care sector at the Health Committee and in her report 'Domiciliary Care in Northern Ireland'. First, I assure Members that my Department is committed to providing a high-quality domiciliary care service to support our older people to remain in their homes. Although I was disappointed by the way in which the report was published, it is, as we have discussed today, clearly a crucial area. The Department recognises that the domiciliary care sector faces significant challenges, as so many sectors do. To address those issues, the Health and Social Care Board has published its report entitled 'A Managed Change: An Agenda for Creating a Sustainable Basis for Domiciliary Care in Northern Ireland'. It is intended that the review will shape the future of domiciliary care provision, taking into account the financial and other challenges facing the sector. My officials, in conjunction with colleagues in the board, are reviewing both reports, and I look forward to receiving their recommendations on the way forward.

My Department is aware that the independent sector providers are experiencing recruitment and retention difficulties as their need for registered nurses increases to meet the needs of a growing complexity of care in the sector. The Department recently completed a nursing and midwifery workforce review that included the independent, voluntary and private sectors, and officials are considering its implementation. It highlights evidence of a global shortage of nurses at present and emphasises the need to retain newly qualified nurses to work in Northern Ireland. One of the recommendations of the workforce review is that all employers review their recruitment processes and work to make their organisations employers of choice to encourage the retention and recruitment of nurses. A number of initiatives outlined in the workforce review are being considered to support the independent sector. A career pathway for nursing and midwifery in Northern Ireland has been developed and is intended to encourage nurses to see Northern Ireland as a place of opportunity. It has a section devoted to the independent sector.

In conclusion, I thank everyone for their contribution. I hope that Members can see from what I have said that, as Minister, I am aware of the concerns not just of those who are present today but of our older people and the people who care for them, whether they are family or friends or professional health and social care staff. I am also aware of the pressures, financial and other, on our statutory bodies and the independent sector, which provide important, valuable and professional services to our older people. Finally, I put on record my appreciation to everyone who provides support and assistance to our older community, as, without their dedication, a lot of our older people would be worse off.

Adjourned at 4.41 pm.