At Stormont last week, Health Minister Edwin Poots announced plans for better care for the elderly.
He promised “better, targeted care… which will enable them to stay at home and remain independent where possible.”
Home-care packages, he said, would be designed to suit individual needs. “This will provide better services that people want and will reduce demand for residential care.”
Thus, his plan for closing half of all the residential homes in the North - 28 out of 56 - would not mean a deterioration in the service but an improvement. “The planned reduction in the number of residential homes signal(s) our commitment to thinking outside of an institution led approach to health and social care provision.”
According to Mr. Poots, then, the choice is between warehousing old folk in decrepit institutions - or making them content in their own homes. There’s no question which option an overwhelming majority would go for. If those were the options.
Almost everyone would accept the closures if services for those living at home were adequate. But they are not. They are woeful. And Mr. Poots said nothing to encourage us to believe that they are about to get better.
The elderly in the North already fare worse than their counterparts in England, Scotland and Wales. This was shown in a major survey published last year by the UK Homecare Association (UKHCA). The findings are directly relevant to the issues Edwin Poots was talking about last week.
More than 640,000 people in the UK are entitled to publicly-funded homecare: the 23,500 of these who live in the North are not as well-looked after as their counterparts across the water.
The UKHCA isn’t a radical campaigning group out to embarrass the authorities. It is the professional association of homecare providers from a range of sectors - private companies, voluntary groups, not-for-profit organisations and statutory agencies.
Their report concludes: “The commissioning of services (for the elderly) is becoming increasingly commoditised and poses considerable risks. Lowest price has overtaken quality of service in commissioning decisions.”
Lowest price means slashing the amount of time carers are able to spend on each visit. Somebody who has had an hour’s help a day might find their entitlement cut to 30 minutes. Or from 30 minutes to 15. This is happening all around us.
Agencies can measure the number of minutes being sliced off each visit and the amount of money “saved” as a result. But there’s no way of measuring the consequent reduction in human exchange.
Stopping for a chat before rushing out the door becomes a practical impossibility. Making a cup of tea is out of the question. This is more than a matter of comfort and convenience.
A bit of time over and above changing a dressing or helping in the bathroom isn’t just an add-on, an extraneous extra. Loneliness can make well people ill and ill people worse.
When extolling care in the home as opposed to care in a residential setting, Mr. Poots made no mention whatever of the shortening of home visits which is already underway. He didn’t promise that this tendency would be reversed.
Here are some of the statistics which, it seems to me, every MLA should study before deciding whether to back the Poots proposals.
In England, 73 percent of homecare visits are of 30 minutes or less duration. Scotland and Wales do significantly better - partly because of intervention by the devolved administrations - with 42 percent of visits lasting 30 minutes or less. Northern Ireland does significantly worse - 87 percent of visits being of 30 minutes or less.
When we turn to visits of 15 minutes or less, the North is again worst-off. More than one in four visits - 28 percent - fall into this category – again, the highest percentage of any region.
Overall, 34 percent of the bodies providing home care expressed concern that such short visits “put the dignity of service users ... at risk’’. The figure for Northern Ireland was a “particularly striking” 87 percent.
Not only are visits here shorter; care levels are further compromised by the fact that Trusts in the North - in company with councils in Wales, the West Midlands and the North West – offer providers significantly less per hour (£9.55 to £10.04) than the UK average of £12.87 - itself a shockingly low figure.
Moreover, a quarter of providers say that most payments from Trusts or other statutory bodes are late, “with particularly poor payment rates reported in Northern Ireland’’.
Of all the regions around us, Northern Ireland is no place to be old.
That’s at the moment. The notion that this situation will improve at the same time as residential accommodation is halved and the demand for care in the home increases makes no sense - particularly when overall spending in real terms is declining.
Mr. Poots and his proposals should be sent packing.