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Long Term Care of the Elderly - Ministerial Response - 20 April 2009

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STATES OF JERSEY

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LONG TERM CARE OF THE ELDERLY (S.R.12/2008): RESPONSE OF THE MINISTER FOR HOUSING

Presented to the States on 20th April 2009 by the Minister for Housing

STATES GREFFE

2008   Price code: B  S.R.12 Res.(2)

LONG TERM CARE OF THE ELDERLY (S.R.12/2008): RESPONSE OF THE MINISTER FOR HOUSING

Overall reaction to the Panel's Report

I welcome the Health, Social Security and Housing Scrutiny Panel's review of Long Term Care of the Elderly and fully support Recommendations 1 and 18, which relate to the work of my Department.

Any policies relating to the provision of long-term care for the elderly need to be founded on good, accurate and up-to-date information on likely need. In the Housing context this has historically been difficult to achieve. One of the key reasons for this difficulty is the lack of a single registration point for access to social rented homes or other forms of affordable housing.

Under existing arrangements those needing housing can register with any number of providers,  the  Housing  Department,  any  of  the  Housing  Trusts  and  a  number  of Parishes. All maintain separate lists, some of which are means-tested, although many are not. It is not clear whether the same people are registered on more than one or all lists, and therefore it is difficult to quantify the overall long-term housing requirement of  the  population –  not  least  our  ageing  population.  It  also  creates  the  risk  that individuals fall between 2 stools and that their housing needs are not properly met because we do not know that they are in need. This is wholly unacceptable and is something that I am trying to address through the setting-up of a single means-tested Gateway to Affordable Housing', which was introduced as a concept in the debate on Jersey Homebuy. This concept would require anyone wishing to access any form of affordable housing to register and be assessed through the Gateway where a master list would be maintained. Applicants would then be assessed for the most appropriate form of housing for them, which could include Parish Housing, States Rental, Housing Trusts and schemes such as Jersey Homebuy. Crucially, because there would be one point  of  access  for  all  possible  housing  types,  applicants  could  not  fall  between 2 stools and we would always have access to reliable information of the true need for affordable  housing.  The  Housing  Department  is  also  committed  to  providing appropriate  "life-long  home"  type  accommodation  through  acquisition  and refurbishment.

Senator T.J. Le Main Minister for Housing March 2009

KEY RECOMMENDATIONS FROM THE HEALTH, SOCIAL SECURITY AND HOUSING SCRUTINY PANEL REPORT

RESPONSE FROM HOUSING

1

It is recommended that a working group be established to look at the organisation of long term care, headed by the Minister for Health and Social Services, joined by the Ministers for  Social  Security,  Housing  and  Planning and  Environment,  to  consult  with  relevant bodies and produce a report for the States by 30th  June  2009  responding  to  the recommendations  in  this  report. Consideration should also be given to setting aside law drafting time for related work in 2010.

The Minister for Housing would welcome the opportunity to work alongside the Ministers for Health and Social Services, Social Security and Planning and Environment in order to play an appropriate part in this piece of work.

2

The  working  group  should  be  tasked  with agreeing a strategic plan for a more unified system  for  long  term  care  and  prioritising options  for  development  of  future  public provision. It is recommended that this should include  setting  up  a  single  commissioning body  bringing  together  the  funding  and procurement  of  all  States-funded  nursing home, residential and home care, to operate at arms-length  from  both  public  and  private sector providers.

The Minister for Housing subscribes to this aspiration.

3

The  Panel  believes  that  this  plan  should specifically  include  an  evaluation  of  the potential  for  redeveloping  the  existing Overdale site as a centre for public long term care  provision,  training  and  all  associated facilities including day-care, respite, sheltered and extra-care housing.

The Minister for Housing subscribes to this aspiration.

4

A priority of the working group should be to investigate  possibilities  for  establishing  a contributory insurance-based scheme for the future funding of long term care, to cover the costs  of  both  residential  and  community- based care from within a single hypothecated fund.

The Minister for Housing subscribes to this aspiration.

 

5

Consideration  to  be  given  to  employing  a partnership  insurance  approach  whereby  a proportion of the costs could be the subject of a separate co-payment or private insurance; it should  also  be  considered  whether  such  a scheme should be designed to cover all long term care needs for individuals of any age, rather than limiting benefits solely to care of the elderly.

The Minister for Housing subscribes to this aspiration.

6

A  unified  assessment  and  funding  system should  include  specific  proposals  to  enable funding  to  follow  the  client'  in  future  to improve choice, flexibility and independence for those with long term care needs.

The Minister for Housing subscribes to this aspiration.

7

Service  level  agreements  should  be established with all providers of services to the public sector, backed up by contracts for individual  care  packages  between  providers and  clients  which  should  become  a requirement under the new regulatory system.

The Minister for Housing subscribes to this aspiration. He would, however, be concerned whether this could be delivered within existing resources.

8

Health  and  Social  Services  and  Social Security should work together to produce an accessible  guidance  and  education  package about  entitlements  to  care  and  funding support  for  the  elderly  to  enable  people  to plan for their own and their family's future.

The Minister for Housing subscribes to this aspiration.

OTHER  RECOMMENDATIONS  FROM  THE HEALTH, SOCIAL SECURITY AND HOUSING SCRUTINY PANEL, REPORT

 

9

The  funding  of  elderly  care  should  be approached as a discrete issue and considered as a matter of urgency rather than being tied to agreement on the entire New Directions' package.

"New Directions" presents a holistic approach to healthcare, for an entire life, the fragmenting of which may reduce the effectiveness of the strategy.

10

The  ability  to  carry  out  effective  police checks  on  all  care  staff  should  be investigated.

The Minister for Housing subscribes to this aspiration.

11

The  working  group  should  consider  a requirement  for  registration  of  all  those working in social care.

The Minister for Housing subscribes to this aspiration, although is mindful of whether this could be delivered within existing resources.

 

12

Changes to the funding of regulation should bring  in  an  appropriate  user  pays' contribution from the industry.

The Minister for Housing subscribes to this aspiration, although concerned that this could lead to higher costs to the public as the industry strives to recoup the increased costs.

13

All care providers with clients who receive benefits under Income Support or other public funding should be required to comply with an open  book'  policy  to  enable  appropriate levels  of  support  to  be  established  and maintained by means of an annual review.

The Minister for Housing is concerned with how this would work in practice.

14

Respite care services should be reviewed in consultation  with  care  providers  and  carers (believed to be in hand as part of the Carers' Strategy consultation).

This is indeed in hand as part of the Carers' Strategy; the Housing Department has already played a part in the development of this strategy.

15

Possibilities  for  delivering  a  continuing programme of training opportunities for care workers  supported  by  (refundable)  States grants should be investigated as a priority by the working group.

The Minister for Housing subscribes to this aspiration.

16

The Comptroller and Auditor General and the Public  Accounts  Committee  should  be requested to look into the financing of elderly care,  to  identify  overall  costs  and  possible efficiency  savings  of  moving  to  a  more unified system and including an analysis of the  financial  benefits  (or  otherwise)  of outsourcing  care  beds  and  services  in  the medium to longer term.

The Minister for Housing subscribes to this aspiration.

17

Accommodation for public long-stay patients should  be  addressed  to  ensure  that  single rooms become the norm for all long term care provision  (except  in  the  case  of  couples where both partners are in need of care or wish  to  stay  together).  Plans  should  be brought  forward  for  the  replacement  or redevelopment  of  any  outdated  facilities  as part  of  the  strategic  planning  process recommended in 12) above.

The Minister for Housing subscribes to this aspiration.

 

18

The Planning and Environment and Housing Departments  should  produce  an  analysis  of requirements  and  definitions  for  new sheltered  and  extra-care  housing  as  part  of their respective ongoing reviews of the Island Plan and Social Housing.

The Review of Social Housing will make various comments and recommendations in respect of the demand for social housing – however, it is unlikely that this will include any detail in respect of extra-care housing as this was not included in the terms of reference. The Minister intends to create a "Gateway to Affordable Housing" which will allow for a single point of access to affordable housing and could certainly be developed to include sheltered and extra-care types of accommodation – though this would clearly require an increase in resources.