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abcd. The 2002 Healthcare Conference. 29 September-1 October 2002 Scarman House, The University of Warwick, Coventry. Long Term Care - Where is the new Government Regime leading us?. Richard M Thomas FCII Managing Director, RED ARC Assured Ltd.

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the 2002 healthcare conference


The 2002 Healthcare Conference

29 September-1 October 2002

Scarman House, The University of Warwick, Coventry

long term care where is the new government regime leading us

Long Term Care - Where is the new Government Regime leading us?

Richard M Thomas FCII

Managing Director, RED ARC Assured Ltd

1990-1998 : Managing Director, Hambro Assured Care plc - Specialist Long Term Care distribution company

Chairman of the ABI’s Long Term Care sub-committee for 3 years

Gave evidence on LTC to:

Health Select Committee

Royal Commission

1998 to present : Managing Director, RED ARC Assured Ltd - Independent Care Advisory Service


Where is the Government going?

Legislation, Reform and Guidance

Importance of Assessment

Single Assessment Process

Registered Nursing Care Contribution

Intermediate Care and Rehabilitation

Early Intervention and Prevention

Equipment and Assistive Devices

Early Signs and Premature Conclusions

Discussion and Questions

We will focus on England

Devolution has allowed each country to develop its own policies


all care in nursing homes is free

no distinction between nursing and personal care


flat £100 allowance towards the cost of nursing care in nursing homes

N Ireland

still to decide

Legislation and reform envisage major change

timeframes typically run from 2001-2006

it will be some time before we can make judgements about outcomes

where is the government going
Big changes in commissioning and delivery of care

NHS and Social Services more closely aligned

multi-disciplinary teams

pooling of budgets

More appropriate use of available resources

Single Assessment Process (SAP)

care pathways

Intermediate Care

avoidance of bed blocking

More prescriptive standards and audits

More user choice

Where is the Government going?
quality and consistence in assessment
National Service Framework for Older People, 2001

basis on which care decisions are reached

Single Assessment Process (SAP)

person centred

professionals working together

rounded picture of care needs

taking account of user preferences


through an agreed evidence base

sharing information across disciplines

builds and supports good practice

produces standardised assessment information

outcome centred

appropriate and effective care plan

promoting healthy independence and quality of life

Quality and Consistence in Assessment
single assessment process april 2002
Single Assessment Process - April 2002
  • Nature of the problem?
  • NHS
  • GP/PCT
  • Social Services
  • Condition measured against set headings eg
  • clinical background
  • mental health
  • personal care and wellbeing
  • environment and resources
  • Focus on specific issues using relevant specialist resources
  • eg geriatric depression
  • Complex, multiple needs assessed

Contact Assessment

Overview Assessment

In-depth Assessment

Comprehensive Old-age Assessment

NB: No determination of Registered Nursing Care Contribution can be made until SAP is completed.

single assessment and care pathways
Single Assessment and Care Pathways

Assessment Completed

Care at home or in a residential home



NHS Continuing Care

Intermediate Care

Care in a Nursing Home

Referral to designated NHS Nurse. Checks all options have been considered.

Evaluation of care needs in CARE PLAN

Allocation to RNCC Banding

registered nursing care contribution
Low Band - Minimal Nursing Requirement £35 pw

- Care needs can be met in other settings

Medium Band - Multiple care needs £70 pw

- Daily access to nursing

- Physical/mental state STABLE AND


High Band - Complex needs £110 pw

- Frequent nursing interventions over

24 hours

- Physical/mental state UNSTABLE AND


Registered Nursing Care Contribution
intermediate care
NHS and Social Services MUST

“provide high quality pre-admission and rehabilitation care to older people to help them live as independently as possible by reducing preventable hospitalisation and ensuring year-on-year reductions in delays in moving people over 75 on from hospital.

NHS Plan


Care to last no more than 6 weeks

pneumonia 1-2 weeks

hip fracture 2-3 weeks

stroke 6 weeks

Intermediate Care
intermediate care models
Models include 2003/4 Targets

Rapid Resource

24 hour access to A&E, GPs NHS Direct 70,000

Hospital at Home people pa

intensive support at home beyond that

normally provided in primary care

Residential Rehabilitation 5,000 new

to regain function and confidence to return beds


Supported Discharge

home care and equipment to support earlier

return home 1,700 places

Day Rehabilitation

short term therapeutic support in a Day Centre

Intermediate Care Models
intermediate care residential rehabilitation
Multi-disciplinary team

Occupational Therapy


Social Workers

138 admissions, mostly over 75 with mobility problems

88% returned home

7% still under treatment

4% hospitalised

1% nursing or residential home

Follow-up on those returned home

76% still at home after 3 months

54% still at home after 6 months

Source : Broom Hayes, Rotherham Health Authority 2001-2002

Intermediate Care - Residential Rehabilitation
early intervention and prevention
“We believe the Government’s aims to be principled, but it remains to be seen whether the money is spread too thinly across these key areas. In particular, more funding is needed to provide preventative support for older people early on, rather than waiting until they need intensive community or nursing care.”

Source : Help The Aged

(Response to the Secretary of State’s

proposals for older people’s services)

July 2002

Early Intervention and Prevention
early intervention can work
Home adaptations ‘transform lives’

reduce the need for hospital and residential care

Minor adaptations

62% of survey felt ‘safer’

77% felt that their health had improved

Major adaptations

before: ‘prisoners’, ‘degraded’, ‘afraid’

after: ‘independent’, ‘confident’

Psychological aspects as important as physiological

Source : Joseph Rowntree Foundation 2001

Early Intervention Can Work
equipment and assistive devices
Secretary of State’s announcement 23rd July 2002 included:

Faster assessment by end 2004

Social Services contact within 48 hours

assessment within 1 month

equipment in place within 1 week

Removal of all charges for equipment from April 2003 (subject to legislation)

500,000 extra pieces of equipment

hand rails, ramps, hoists etc

Extension of direct payments to older people

choice of receiving a service OR cash payments

Carers’ grants doubled to £185m by 2006

Equipment and Assistive Devices
early signs and premature conclusions
Views from the coal face

Nursing home co-ordinator

Nursing home group


Premature conclusions

A personal view

As at February 2002

Low £35 - 19%

Medium £70 - 58%

High £110 - 22%

Source : HANSARD

Early Signs and Premature Conclusions
an nhs view
Bedding in OK after initial disorganisation

Each Authority establishing its own models for elder-care and intermediate care

within framework and guidance

highly dependent on existing resources

Most determinations falling into middle RNCC band

Workload issues

reassessments at 3 and 12 months

April 2003 DSS case load

GPs and Consultants need to ‘buy in’ to changes

SSDs defensive

especially on budgetary issues

Source : RED ARC Interviews, August 2002

An NHS View
a nursing home view
‘Free nursing care’ allowances inadequate

most assessments fall into £70 band

average difference between nursing home and residential home costs £113*

Payments made to care homes

direct payments would offer more choice


costly use of scare NHS nursing resources

single rate preferable (as in Wales)

variations in Local Authority interpretation


start date 1.10.2001

20% assessments outstanding 1.1.2002

Source : RED ARC Interviews, August 2002

*DSS Rates 2001/2002

A Nursing Home View
a charity view
Government should meet full cost of Long Term Care

no distinction between nursing and personal care

Allocation to bandings largely reflect pre 1.10.2001 ‘self-payers’

placed themselves in care

disposition will change over time

fewer in the lowest banding

Complaints about big increases in Nursing Home Fees

some homes not passing on the ‘savings’

shrinking supply of beds

reducing 5 to 6% per annum

Source : Age concern England

A Charity View
The approach in England is well-thought through, comprehensive and ‘joined up’

There is growing acceptance of the need to intervene earlier and apply the right level of care

There is an intent to give users more choice

Methodologies for standards monitoring, consistency of application and audit are in place


conclusions 2
It’s early days

DoH review only just starting

results not expected until early 2003

There must be concerns about

availability of trained resources to implement the changes

ability to manage a large multi-disciplinary, multi-agency programme




Conclusions (2)
discussion and questions
Some issues for Insurers

Will free nursing care improve LTCI sales?

care homes passing on the savings

general trends in nursing home costs

anticipating actual costs

Other opportunities. Where are they?

product development

affordable options

early intervention and prevention

controlling access to the customer

Observations and questions

Discussion and Questions