Care Home Closures

Question for Urgent Oral Answer — Health, Social Services and Public Safety – in the Northern Ireland Assembly at 3:30 pm on 30th November 2015.

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Photo of Robin Newton Robin Newton DUP 3:30 pm, 30th November 2015

Mr Chris Lyttle has given notice of a question for urgent oral answer to the Minister of Health, Social Services and Public Safety. I remind Members that, if they wish to ask a supplementary, they should rise continually in their place. The Member who tabled the question will be called automatically to ask a supplementary.

Photo of Chris Lyttle Chris Lyttle Alliance

Mr Lyttle asked the Minister of Health, Social Services and Public Safety to outline the action he is taking to assist the residents and staff affected by the proposed closures of local Four Seasons care homes.

Photo of Simon Hamilton Simon Hamilton DUP

First, I should say that Four Seasons Health Care has taken a business decision to close those homes. That decision was taken independently of the Department and the Health and Social Care Board, and we had no input to the analysis conducted by Four Seasons that led to the decision.

I fully appreciate that the closure of seven nursing homes by Four Seasons Health Care will impact on many residents and their families, and will cause great anxiety and uncertainty for those directly affected by the closures. My Department is working closely with colleagues in the Health and Social Care Board, the health and social care trusts, the Regulation and Quality Improvement Authority (RQIA) and Four Seasons Health Care in developing plans to manage the transition to alternative care arrangements. The aim is to ensure that any relocation will be managed, with minimal disruption to residents, and that they are able to remain as close to their original location as possible. The continued well-being of residents will be the priority in dealing with the transition to alternative care arrangements.

My Department has established a joint working group with the Health and Social Care Board, the RQIA and the trusts to monitor developments and oversee the resettlement of the residents affected by the closures. Within the trusts, multidisciplinary teams have been established to work through the detail of all the moves to identify new placements and to manage the terms of all the moves. You will appreciate that that is a complex and difficult task, and team members will therefore be drawn from across the trusts. Staffing is a matter for Four Seasons Health Care as their employer.

Photo of Chris Lyttle Chris Lyttle Alliance

I thank the Minister for his update, but given that we have had warnings of crisis in the care sector for some considerable time and people have cited declining trust aid, rising staffing costs and a shortage of nurses as main reasons to point towards a lack of adequate long-term planning and sourcing for care, should we conclude that the Minister has been caught asleep at the wheel on this issue? Most importantly, having met staff and residents at care homes whose primary concern is the impact that closures will have on the residents' health and well-being, I ask what options the Minister can actively pursue to avoid a need for residents to leave their homes, to prevent the detachment from staff on whom they rely and, at the very least, to limit the damage that that dislocation is going to cause for vulnerable people in our community, many of whom are dementia care patients?

Photo of Simon Hamilton Simon Hamilton DUP

Given the fact that it is an incredibly serious issue that affects 254 residents and their families, and, indeed, over 300 staff, it is disappointing that the Member, in his opening comments, chose to make a baseless political attack on me. It is absolutely disgraceful that, on such an important issue, the Member seeks to do that without any justification whatsoever.

I am aware that there is a range of issues facing the sector. The Member mentioned some of them around staffing issues and a shortage of nurses, which is something that that sector, all sectors in health and social care, and, indeed, all parts of the United Kingdom and far beyond, are facing. I am aware that there are concerns expressed by the sector about the impact, for example, of a national living wage, which has not been implemented yet and therefore had no direct bearing on this set of circumstances.

I was and am aware of the issues pertaining to this particular provider. That is why pointing the finger of blame in my direction, as the Member has sought to do, is completely baseless. A recent media report highlighted the fact that Four Seasons is a particularly indebted company, which, according to a recent report in 'The Guardian', is paying more than £50 million a year in interest on debts of £500 million. Paying over 10% on your debts is an incredibly high rate for any firm and makes it very difficult for a company of any size to deal with, even the biggest care provider in the UK. Particular issues with the company's finances and debt led it to take this decision.

My job is to work with Four Seasons as best I can and ensure that the whole health and social care family, as I outlined, works with the company to minimise the disruption that will be faced by the 254 residents and get them appropriate new accommodation as close to their current location as possible. I will make sure that the trusts, the board and the regulator all work together and closely with Four Seasons to make sure that what is a very difficult period of uncertainty and anxiety for those residents is not made any more difficult.

Photo of Robin Newton Robin Newton DUP

I remind the Minister about the two-minute rule.

Photo of Fearghal McKinney Fearghal McKinney Social Democratic and Labour Party

I am glad that the Minister has reflected on the financial nature of the company at the centre of all of this, because that only underscores that the Minister knew and knows intimately of the pressures on this company and, therefore, of the threat to the 254 residents and 300 staff. Will the Minister now reflect again on the perilous nature of the situation that those staff and patients face as a result of the continued mechanism, if you like, of private sector provision? Will he now begin to underscore that it is the public sector that can intervene most profitably for patients in this case?

Photo of Simon Hamilton Simon Hamilton DUP

Let us not conflate the issues. The homes looked at more recently by various trusts were, of course, residential care homes. These homes are more on the nursing care side, where a very different level of care is provided to meet the needs of residents. Last week, I took a decision to halt and review consultations on the potential closure of some statutory residential care homes. It was only right to do so in a period of obvious volatility in the market, when the biggest provider in the independent sector in Northern Ireland is in the difficulties that it is. I think that it was only right that I paused, reflected on and carefully considered the whole range of circumstances.

The Member's point about the care provided in the public sector is right, in that the public sector provides a very high standard of care, whether nursing or residential. However, that does not mean that the standard of care provided in the private sector is any less high quality. Unfortunately, debates such as this can sometimes be seen as knocking the private or independent sector. The Member is shaking his head, and I appreciate that he does not perhaps mean or seek to imply that, but we should acknowledge that our independent sector plays a vital role in providing care, whether residential or nursing, for many older people across Northern Ireland. It will continue to do so into the future. Many great people work in that sector to ensure that our older people get the quality and standard of care that they require.

Photo of Maeve McLaughlin Maeve McLaughlin Sinn Féin

I thank the Minister for the answer to the question. Specifically, does he agree now that this is perceived as a failure in planning for our ageing population by him, his predecessors or those with departmental responsibilities? Will he clarify whether the halt in the review process will allow readmissions to some statutory care homes?

Photo of Simon Hamilton Simon Hamilton DUP

I do not accept the premise of the first point about a failure by me or my predecessors. The issues with the particular provider that is closing the seven homes developed over the recent while. Although we have been aware of difficulties that it was facing, we were not aware until very latterly that, specifically, it was to close the seven homes indicated last Tuesday. I do not accept that there was much that I could have done, as Health Minister in a devolved region, to bail out a company paying over 10% on its debts and in such a difficult financial position.

There was probably very little that I could have done to arrest that.

In respect of reopening admissions, some of the consultations undertaken by the trusts on statutory residential care homes recommended that some of those homes be kept and reopened for admissions. I want to see that proceed, but I am open to the idea of reopening admissions in particular areas if that is the appropriate thing to do. It is not something that I can say authoritatively is the best thing to do in every case, but it is certainly something that I would like the board and the trusts to reflect on in the current circumstances with the volatility that there is in the market. If it is the right thing to do, I hope that they will do it.

Photo of Alex Easton Alex Easton DUP

Is the Minister aware of any outside providers showing an interest in taking over the homes?

Photo of Simon Hamilton Simon Hamilton DUP

While some might wish to use this example of a firm that has had well-publicised difficulties to have a go at the independent sector and say that it is not the best way to provide care for our elderly people, I understand from media reports in the immediate aftermath of the announcement by Four Seasons to close the seven homes that other firms have indicated a desire to look at them, take them over and run them as a viable business. That has certainly been in the public domain. I have also met other independent providers who are not in the Northern Ireland market but are expressing an interest in being in it. Whilst there has been an issue with one provider and its viability, there are others expressing an interest in the seven homes and in coming into the Northern Ireland market. Whilst we are very concerned about what is happening with Four Seasons and are keeping a watching brief on it, there are others in the independent sector who see opportunities in Northern Ireland.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

I thank the Minister for his answers. Being parochial, I must say that the closure of Donaghcloney Care Home in my constituency will affect 65 families — 24 residents and 41 staff — in the mouth of Christmas. What impact have the wage-rate bands for carers in the private sector and, as we said earlier, the difficulty in obtaining a sustainable supply of nurses had in the closure of the homes? Will you update the House on the discussions that you have had with Four Seasons, which, I gather, took place this morning, on these issues, which, if not addressed directly, could result in further disappointing announcements?

Photo of Simon Hamilton Simon Hamilton DUP

I have not yet met Four Seasons. The Department has been aware of issues with Four Seasons for some time and will continue to discuss them with the company on an ongoing basis, particularly the impact of closing the seven homes. The Member is right to highlight the impact that it has on very vulnerable individuals and the concern that that will cause their families; she is also right that it is a particularly difficult time of the year. That is why I want to see my Department working very closely with others in the health and social care family and directly with Four Seasons to ensure that the disruption that there will be is minimised and that people can be accommodated in suitable accommodation as close to their current location as possible.

In answer to the questions about the impact of wages and a shortage of nurses on this decision, I think that it has been minimal. The reality of the situation with this provider is as I have outlined, with well-publicised media reports on its indebtedness and the impact that that is having on its profitability, which gives us some cause for concern.

I do not for a second denigrate or seek to diminish the issues that the Member raises about the availability of nurses or about wages and the impact that a national living wage may have on this and other sectors in health and social care, but the direct impact on this issue has been minimal. What has driven the firm to announce these closures and other closures across the UK is the fact that it is a heavily indebted private company that is having to take these decisions to ensure its longer-term survival.

Photo of Stewart Dickson Stewart Dickson Alliance 3:45 pm, 30th November 2015

Thank you for your answers so far, Minister. Given your undertaking to the House this afternoon to work with relatives to ensure that residents are provided with the best possible care in alternative accommodation, can you assure the House that you will not oversee residents from these homes going into establishments that have been highly criticised by the RQIA, like Cherry Tree House in Carrickfergus? Will you undertake, as your predecessor failed to do, to meet me and get appropriate outcomes for the people who feel very let down by Cherry Tree House nursing home?

Photo of Simon Hamilton Simon Hamilton DUP

I know that the Member has an interest in that home. He has corresponded with me about it, and, I think, he met a previous Health Minister — I cannot remember which one it was — about it. Obviously, we want to see standards of care in all our residential homes and nursing homes, whether in the statutory or independent sectors, at the highest possible level. I want to see the 254 residents affected by the seven closures in the most appropriate accommodation for them, which is obviously accommodation of a high standard. I will look to my officials, as they work with Four Seasons, to ensure that the residents get the most appropriate accommodation and that that accommodation is as close to where they are currently located as possible. I do not think that anybody would want to see them in accommodation or homes that are not suitable for them or are not good homes providing good standards of care.

Photo of Robin Newton Robin Newton DUP

Rightly, there is a high level of interest in the matter. I ask Members, when they are called, to keep their question short so that we can get the maximum number of questions answered by the Minister.

Photo of Thomas Buchanan Thomas Buchanan DUP

How much does the health service provide for the care of individuals in these homes on a weekly basis?

Photo of Simon Hamilton Simon Hamilton DUP

A tariff is worked out on annual basis with the Health and Social Care Board and the sector. It differs between residential care and nursing care: £470 per week is provided for those in residential care and £593 per week is provided for those in nursing care. While there are perhaps some differences in other UK regions and some local authorities paying a little bit more, my understanding is that the rates compare pretty favourably with those provided across the United Kingdom.

Photo of Robin Newton Robin Newton DUP

I call Mr Cathal Boylan.

Photo of Cathal Ó hOisín Cathal Ó hOisín Sinn Féin

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. The Minister has said that he will endeavour to minimise the disruption to residents, staff and families, but I wonder how that is possible in places like Garvagh, where the nearest available nursing home spaces might be as much as 30 or 40 miles away.

Photo of Simon Hamilton Simon Hamilton DUP

Mr Boylan has changed somewhat in the last number of days. He may have become a ventriloquist, using somebody else and throwing his voice. I am sure that that is the question that Mr Boylan would have asked anyway.

I appreciate there will be difficulties in doing this. It is not an easy undertaking to move 254 residents in pretty short order. It highlights the difficulties that have arisen because of a decision taken by Four Seasons to do this for its own commercial reasons. All that I can say is that I will ensure that everything that can be done to minimise that disruption is done. It is in nobody's interest to have residents, who are vulnerable people, being caused confusion and anxiety by the fact that they have to move. Nobody wants to see them traumatised any further. We want to minimise the disruption and ensure that they are moved to appropriate accommodation as close to their current location as possible. I appreciate that that will be tricky in some cases, but the Member, the House and, more importantly, the residents have my categorical assurance that we will do our very best.

Photo of Pam Cameron Pam Cameron DUP

How does the Minister make assessments on the potential volatility of the independent sector market?

Photo of Simon Hamilton Simon Hamilton DUP

There are obviously concerns created by the particular circumstances of Four Seasons that raise issues around the current volatility in the sector. That is why it was important that I decided last week to halt and review the consultations in respect of statutory residential care homes.

I think that it is important that we go further than that and get a better picture. Given what has happened with Four Seasons, given what representatives of the sector have said in the media, without any substantiation, I might add, but worth listening to nonetheless, and given the issues that are looming around wages, a national living wage, and, indeed, the provision of appropriate nursing staff, it is only right and proper that we reflect on the current market position within residential and nursing care. As a result of that, I have asked officials to bring forward a detailed report on the care market in Northern Ireland, with an emphasis on the economic outlook and the longer-term sustainability of the current arrangements. That will be used to improve our understanding of the current challenges, and it will be used as a platform for developing our policy and operational responses moving forward. It is incredibly important that we undertake that work.

Given the issues with Four Seasons and the concerns that have been expressed elsewhere in the independent sector, it is only right that we get a view and an analysis of where the sector currently is.

Photo of Cathal Boylan Cathal Boylan Sinn Féin

Go raibh maith agat, a Phríomh-LeasCheann Comhairle. The Minister is aware of the situation in Armagh. The Hamilton care home in Armagh has 31 patients and provides 54 jobs. Will Minister give assurances that those people will be relocated, with proper care facilities, and that jobs will be retained? After all, Armagh has been renowned for the great skill sets in healthcare that have been provided down through the years, and it has seen nothing but closure and the relocation of jobs over the last number of years. I would like the Minister to give an assurance to those people and patients that he will care for them and cover the Hamilton care home.

Photo of Simon Hamilton Simon Hamilton DUP

Unfortunately, I cannot give the assurance on jobs that the Member is looking for, because they are not my jobs to save or rescue in the way that he is asking me to do. These are people who are employed by Four Seasons. I look to Four Seasons to act as a compassionate employer in such circumstances and to do its best to relocate the staff to jobs elsewhere in the group. I think that it has made some indications that that is the intention. Staff are, primarily, the responsibility of the employer, but I think that we all would want to see them treated with dignity and respect. Equally, we want to see residents treated with dignity and respect and, as I said in response to other Members, moved, with minimal disruption, to appropriate accommodation close to where they currently live. I know that that will be challenging, but that is certainly the aim, and it is certainly what I will be ensuring that officials from my Department, and others within health and social care, ensure happens.

Photo of Seán Rogers Seán Rogers Social Democratic and Labour Party

I thank the Minister for his answers thus far. There are many residents and staff in Oakridge, in south Down. You made an important distinction between residential care and nursing care, and the complex needs of nursing care. What extra support will be available for residential homes if they are to accommodate some of the people who will be moved from a Four Seasons home?

Photo of Simon Hamilton Simon Hamilton DUP

The Members is right; there is an important distinction. It is important that we follow that distinction through in terms of the question that he has asked about moving people with complex nursing needs into a residential care home. That would not be appropriate, particularly for those who have very, very complex needs. They would not get the standard of care that we all want to see them get. So, we need to be careful and mindful of the fact that the statutory residential care homes are not a solution for those who have complex nursing care needs. However, that does not mean that there may not be opportunities elsewhere in the state sector, or, indeed, the independent sector, to look after those who have complex nursing needs. That is why I think it is important to emphasise that we want to see these residents get the appropriate care that they need — in most cases, that will be nursing care — and to try to get that as close to their current location as possible. That is certainly what we will be working to, but it is not going to be a matter of moving people who have complex nursing care needs into residential care homes. That would not be right for them, and it would not be something that we could stand over with regard to quality.

Photo of Danny Kennedy Danny Kennedy UUP

I thank the Minister for his previous answers. What discussions can he indicate have taken place between the local health trust, the Southern Trust, and those who are in charge of Hamilton Court Care Home in Armagh, in my constituency, about priority being given to ensure the safe relocation of residents to other centres of care in the Armagh area, with full consultation with relatives, and that the Hamilton Court staff who are affected will be provided with realistic job opportunities either by Four Seasons or other healthcare providers in the Armagh area?

Photo of Simon Hamilton Simon Hamilton DUP

Working backwards; we will be looking primarily to Four Seasons to provide other employment opportunities for its staff. That may well be, as the Member says, elsewhere within that organisation or indeed there may be a possibility, given the staff shortages that there are in different homes in different parts of Northern Ireland, for people to move into other jobs with other providers. I cannot give him a categorical list of what communications the Southern Trust has had. I will write to the Member about that. The Southern Trust, like the other trusts, is involved in the joint working group that I outlined in my original answer and indeed the multidisciplinary teams that will be set up, so there will be involvement by the Southern Trust, particularly given the impact on the Member's constituency with the home in Armagh. Again, we are looking to the trust to work closely with the board, the regulator, the Department and indeed Four Seasons to minimise the disruption that will inevitably take place.

Photo of Jim Allister Jim Allister Traditional Unionist Voice

Can the Minister please clarify whether he is reviewing the weekly tariff that is paid to the independent sector? If not, and if further closures follow, could he remind the House what, in comparison, it costs to keep somebody with nursing needs within the National Health Service? Could he give us that figure?

Photo of Simon Hamilton Simon Hamilton DUP

I have not got that figure to hand, but I will provide it to the Member and copy it to other Members. I am aware that the independent sector, principally Four Seasons itself, as one would expect, has been making all sorts of suggestions about the suitability of the tariff. We have looked at and compared the tariff to other local authorities elsewhere in the United Kingdom, and it compares favourably. I am not saying that it is the highest or that others do not pay more in some cases, but what we pay compares favourably to what is paid by local authorities across the water. Independent sector care providers may make some suggestions about the level of the tariff and the impact that that is having. I do not think that we should take what they are saying at face value. That is why I have asked for a piece of work to be done to review the state of the whole sector in Northern Ireland with the impact of the range of challenges that they are facing, whether that is around the national living wage, the availability of nurses or indeed the payments that are made to them by government. What I am doing is getting that overall snapshot and picture of where the sector is and how stable or otherwise the market currently is, not a review of the tariff itself.

Photo of Gary Middleton Gary Middleton DUP

I thank the Minister for his answers so far. Can he outline whether residents or their families will be impacted detrimentally in their weekly contributions?

Photo of Simon Hamilton Simon Hamilton DUP

Obviously a tariff is paid and many residents and their families pay top-ups over and above that for a higher or different standard of care. One of the things that I said last week — and just to try to take away some of the concerns that may well be there from this week — is that I gave an assurance that residents will not be financially disadvantaged by any move that they might make. That is because it will be difficult enough for residents and their families to deal with the situation that has unfolded in the last week without having that added pressure and burden of worrying about the fact that they are moving from one accommodation to another and there might be slightly more to pay. It is important that we dealt with that last week. That is why I gave that assurance. If the trust finds a resident a new placement, it will not cost them any more than their current placement. However, personal choice is always a key element of decisions about where people want to go. Residents remain free to make their own arrangements about their new placement, though this may have financial implications for them. If they move to similar accommodation, we will certainly ensure that they are not out of pocket any more than they already are.

Photo of Robin Newton Robin Newton DUP

I ask the last Member, Mr Swann, to keep his question brief.

Photo of Robin Swann Robin Swann UUP

I thank the Minister for that last answer. I attended a meeting in Garvagh Care Home. I was invited by one of its north Antrim residents and their family. My question is specifically on the Minister's last answer that families will not be disadvantaged financially.

If a resident were to move from one Four Seasons home to another, could Four Seasons add a premium and, in doing so, get paid more for the resident being in the second home than it did from the resident being in the first?

Photo of Simon Hamilton Simon Hamilton DUP 4:00 pm, 30th November 2015

It depends. I know that the Member has taken an interest in the issue because he tabled a question for written answer to me about it.

Our job is to work with others, including Four Seasons, to get appropriate accommodation for residents. We will seek to find similar accommodation in the vicinity so that people can move with a minimum amount of disruption. As I mentioned in my response to Mr Middleton, it may be the case that, out of personal choice, some residents want to go somewhere that perhaps has a different or higher standard of care and, as such, attracts an additional payment. That is a matter for residents and their families to decide on. The assurance that I am giving is that, where they are moving to similar suitable accommodation, people will not be out of pocket as a result.

Photo of Robin Newton Robin Newton DUP

Before we return to the debate on the Public Services Ombudsperson Bill, I ask Members to take their ease, while we change the top Table.

(Mr Deputy Speaker [Mr Dallat] in the Chair)

Photo of Trevor Lunn Trevor Lunn Alliance

On a point of order, Mr Deputy Speaker. Last Tuesday, I was supposed to ask a question of the Minister of Culture, Arts and Leisure, but I was not in my place. I want to apologise to Mr Newton, the Principal Deputy Speaker, who was in the Chair; the Minister; and the House.