Respite Care

Oral Answers to Questions — Health – in the Northern Ireland Assembly at 2:45 pm on 16th January 2017.

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Photo of Keith Buchanan Keith Buchanan DUP 2:45 pm, 16th January 2017

1. Mr K Buchanan asked the Minister of Health what provision is made for emergency respite care for adults with severe learning difficulties and challenging behaviour. (AQO 889/16-21)

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Respite care, now known as "short breaks", is a vital form of support, particularly for those in our society who play an invaluable role in caring for people with a learning disability. Short breaks are available on a planned basis in all health and social care (HSC) trust areas as well as in emergency situations, and they are provided in a variety of forms, depending on the needs of those accessing them, which are often complex and varied.

With the introduction of other forms of support, however, such as crisis response teams, the demand for emergency respite is expected to reduce. Other sources of vital support for those caring for someone with a learning disability and challenging behaviour include community-based behavioural support services, which have been established in all five trust areas.

Funding for short breaks and respite provision is not separately identified in trusts' financial returns. However, the demand for short breaks is increasing, due in part to the continuing rise in the number of adults with a learning disability, especially older adults whose parents face increasing challenges in coping as they enter their later years, and the increase in the number of people with complex needs coming through from children's services.

In light of that and given the challenging times we find ourselves in financially, we need to make sure that we are getting the best value for the money we already spend. I am committed to working with everyone in the HSC and with the people who use these services to ensure that, where necessary, we make changes to how we do things so that resources are targeted where they are most needed. Clearly, while we have made progress on developing supports for carers and people with a learning disability — for example, through short breaks — there is still much to do. For my part, I am committed to doing all that I can to ensure that the services that we provide are effective in securing the best outcomes for people with learning disabilities.

As I have said before, where that requires us to change how we do things, we have to be prepared to do that if we are to move beyond short-term responses and crisis management. That applies as much to services for people with a learning disability as it does to other parts of the health and social care system.

Photo of Keith Buchanan Keith Buchanan DUP

I thank the Minister for her response. Will she clarify the position with Hollybank in Magherafelt? Normally, it is closed on 25 and 26 December, but, over this festive season, it was closed for five days, which caused stress, particularly for those requiring emergency care.

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

Obviously, the Northern Trust provides a variety of short breaks to over 500 adults with a learning disability, some of whom may have complex health needs or challenging behaviour. Those are provided at Ellis Court, which is a six-bedded residential unit in Carrickfergus, and Hollybank, which, as you said, is a five-bedded residential unit in Magherafelt. Those services are pre-booked so that families can have a planned break from caring. The trust also has contracted bed-based services from the independent sector — namely, two beds in a residential setting in Coleraine, which specialises in the management of service users with highly challenging behaviours. Those services are also pre-booked.

I will respond to the Member in writing on any potential issues with Hollybank, but, needless to say, it is important that we plan those services in conjunction with families and carers because they know their needs and what they need from Health and Social Care. If there are any particular issues with Hollybank, I am happy to write to the Member, but, as I said, it is key that we listen to the views of families and carers and make sure that we design appropriate services. That is certainly how I conduct my business as Health Minister.

Photo of Jo-Anne Dobson Jo-Anne Dobson UUP

Does the Minister recognise the immense pressure on private residential nursing homes? If even a small number closed, as has happened in my constituency of Upper Bann, the number of respite places available would be greatly reduced. I want to learn more about the actions that she is considering to reduce those pressures. Does she bear in mind the heartache that closures bring to elderly residents and their families?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I absolutely understand the heartache, and I have met many families and carers who have lived experience of supporting their loved ones and friends. As I said in a previous answer, it is so important that we listen to the views of those people and design services that meet their needs. Whilst providing residential care is one element of the type of support that you can provide to people, there are other ways in which you can support people. It is important that we tailor support to the needs of the individual as opposed to trying to impose a blanket approach. That is very much what we need to do. We need to invest more to make sure that support is in the communities and help people in their homes without them having to move if that is what their families want. It is important that we continue to provide services in conjunction with those people who use them.

It is also really important that we continue to support our carers, because they are absolutely stretched to the limit. They do such fantastic work to support family members or the friends whom they might care for. We need to continually drive home the message that carers are also entitled to be cared for. They need to have their carer's assessment, and we need to be able to meet the needs identified as a result of that. I absolutely believe that carers provide invaluable work that the health service could not provide, and we need to recognise that. I believe that I have done so through meeting carer representative groups and engaging with carers over the last seven months.

Photo of Ian Milne Ian Milne Sinn Féin

Agus mo bhuíochas leis an Aire fosta as a freagraí go dtí seo. Will the Minister update us on any progress made in learning disability services in the Western Trust?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I have repeatedly made clear my commitment to ensuring that the issue is resolved. Actions are being taken forward to facilitate that, and I have met the families involved. I have made arrangements for the appointment of an independent facilitator to work with the trust and the families to restore relationships so that a plan for further investment in adult community learning disability services in the area can be developed as a matter of priority. The terms of reference for that work have been finalised, going initially to the chief executive of the Western Trust in December. They require me to approve the appointment of a facilitator, which I will do following further engagement with representatives of the families in the area. I have also appointed a senior official from my Department to oversee progress and act as the point of contact for the families. Arrangements are being made to facilitate a meeting between the Health and Social Care Board and the families to discuss the capitation formula, because this is a complex subject, and I know that the families are keen to understand and know more about it. I am happy to facilitate that.

Photo of Chris Lyttle Chris Lyttle Alliance

Why are only six adult learning disability respite care beds available in east Belfast and only 23 in the Belfast Health and Social Care Trust that are often displaced for emergency use? What is the Minister doing to address the unacceptably poor provision of much-needed respite for families living with learning disability?

Photo of Michelle O'Neill Michelle O'Neill Sinn Féin

I do not have the breakdown for east Belfast, so I cannot give you information on that, but I am happy to provide it for you in writing. As I said previously, we need to recognise that it is not just about the residential facility; we need to have in place a combination of measures and appropriate supports because everybody has different needs and requirements. We have more adults with a learning disability and more families under an awful lot of pressure as the people providing the care get older. Respite care, which is now more commonly known as "short breaks", is something that we need to continually keep under review. One of the things in the review of learning disability services in the Bamford evaluation is looking at where we should target supports. It very much points to the need to look towards more care in the community, making sure that we provide support close to people and, in an ideal situation, in their home, if that is possible. Short breaks or residential care, as you call it, are a crucial component of the continuum of comprehensive support services, but we need to make sure that we provide every possible opportunity for people to receive care in the manner in which they need it. I believe that, like everything else right across health and social care, it is about bringing care closer to people and closer to their home.