Poots’ residential care home fiasco shows risk aversion brings its own troubles

So last week it was the Health Minister’s turn to get burned. Yet at the end of the week, it is not at all clear as to how the Health Trusts came to interpret ‘at least 50%’ of all Trust residential care homes as 100%, in the case of the Northern Trust, over the longer term.

On one level the Minister is getting it in the neck because of his own aggressive and highly populist positioning when Michael McGimpsey was Health Minister. BUt, as Jude Collins rightly notes, the one thing that did not feature in last week’s reporting to any great extent was the quality of care available there.

Jude’s own experience very much accords with my own. I had one elderly relative who only went in for two week’s care after a knee injury, and ended up taking to her own room since the level of social interaction in such a large institution was almost zero.

Having been wheelchair bound for a week and a half, she leap out of the wheel chair and almost ran into her own house on the day I brought her back home. In Jude’s case, it was…

…[an] old man who lived into his early 90s and whom I visited from time to time in his care home… he read, he watched TV and he was a vigorous conversationalist. He never left his room, and when I asked him if he didn’t want to mix with the other people in the home, he was very definite the answer was No. He didn’t say “I’d be fearful I’d catch their mood of hopelessness’ but it was clear that was what he felt.

Now it is not hard to see how a trust would want to get rid of the burden and the risk of some of these places. And in the case of the Northern Trust, there has been some pretty vexed relationships between to the Trust’s management structure and the Minister…

Two things strike me.

One, this jointed management style, with Trusts making recommendations which are at significant odds with the Minister’s intentions if not express instructions is a recipe for disaster. It’s not the only department playing this game. The focus on area plans in Education has the same potential for unravelling.

Two, parties in a mandatory coalition have no time out from management of the coalition (never mind managing their own departments) to give knotty problems like this sufficient investment in time and/or ideas to make such reforms work. Avoiding risk by pressing responsibility further down food the chain is no guarantee you won’t get caught short.

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  • Lionel Hutz

    What really struck me about this episode is that our Minister’s are content to not even pretend that we live in a democracy. In the post-democratic age decisions about little things like our healthcare are not taken by ministers but the chairmen and chief execs of this or that board. John Compton runs the health service here, not Edwin Poots. If this were across the water or the border, Mr Hunt or Dr Reilly would atleast pretend that they make the decisions. Edwin felt it was ok that such decisions could be made without him even knowing. Which is honest atleast.

  • sherdy

    Minister Poots says he does not want any more elderly people to suffer the distress caused to those highlighted last week.
    He says the ‘transforming your care’ will proceed at a slower pace. But this would indicate that 50 per cent of the homes in question will take a little longer to close.
    Does this not mean that at least half of the residents will be distressed when given notice of their removal from their present residences (I don’t like to use the term eviction)?
    Or what personal guarantees have been given to some of those Edwin spoke to, or will anyone who has a face-to-face with him receive similar promises?
    But then we may have a new health minister soon, and the new incumbent may not feel obligated to honour the previous minister’s secret promises.

  • Mick Fealty

    Its not clear, since the minister is at one remove from these reforms how the homes will close. Its possible to imagine the process could be managed over a sufficiently long period that would obviate any need for as you put it, evictions…

  • Lionel Hutz

    Evictions are inevitable. I was dealing with a similar scenario about 18 months ago and the problem is that if you stop taking in new admissions for permanent reisdence (which has been going on for a long time), then eventually the numbers dwindle to the extent that the home becomes unviable. You have to remove the remaining people and they will be distressed by it.

  • iluvni

    Personally speaking, my experience of a relative in one of these homes ‘under threat’, left me horrified.
    What sort of system allows unqualified care staff to dispense medicines to elderly residents at night?
    I couldn’t see that home closed soon enough for the safety of those who live there.

  • Mick Fealty

    Agreed Lionel, though we could for the sake of proportion also use the term transfer. In fact, providing the promised resources follow them, some will be transferring back home or into more independent living arrangements.

    Though having worked in some institutions affected in England when that infamous ‘care in the community’ came in never mind the distance between department and trusts, I’d not be assuming there’s going to be a smooth transition…

  • ayeYerMa

    The problem with promoting “independent living arrangements” is that not all elderly people are capable of living independently. Having had an elderly grandmother in her 90s with dementia recently move in to my family’s home recently, she has lost all desire to do almost anything independently (despite encouragement) and we have been told that she needs 24 hour supervision. This has put an absolutely massive strain on the family, and have asked for the help of external carers whose endless coming and going severely disrupts family life (and while they do an excellent job, they also seem extremely inefficient given the number of carers involved, the amount of bureaucracy involved, and amount of petrol used by them traversing up and down the country).

    It really isn’t the optimum arrangement, but in our local area they are refusing new admissions to the local NHS home, a home which the Northern trust has earmarked for closure (as they have all). There are also no private homes convenient to the local area for visiting, so another relative has completely changed his career and retirement plans just to be able to cope and keep our grandmother close to home.

    This situation is only going to get worse as more people start “living” into their 90s, so it seems madness to close homes entirely. I really don’t think Poot’s obsession with en suite bathrooms is the up-most of concern when compared to not having a home at all!

  • Mick Fealty

    Thanks for that AYM… I think that speaks to a general drift in the area of housing over a long thirty period in terms of attending to real needs.. But we are not talking about a huge involvement here.

    Marie Louise Connolly:

    “The Southern trust’s decision will affect 80 residents, in the Northern trust the number is 154, and in the South Eastern trust area 128.

    “In the Western trust there are 128 places available. A spokesperson said 73 of these beds are currently occupied.

    “Belfast, the largest trust area, began the process in 1990 and has since closed 10 homes.”

  • BarneyT

    AYM – you have identified the ticking timebomb….mental health combined with increased longevity. Dimentia in particular (having many forms), whilst associated with the elderly, increasingly is affecting folks that we would not consider to be old.

    We need a shared policy and philosophy with regard to residential homes and day care….however much of this will be politically informed so consensus regrettably is not possible.

    Its all very well saying that the elderly are better served in their home, which I can appreciate it, however this is not always possible and in the case where round the clock attention is required, the expertise and resilience within the family will in most cases not be there.

  • Stewart Finn

    @Mick

    “Its not clear, since the minister is at one remove from these reforms how the homes will close. Its possible to imagine the process could be managed over a sufficiently long period that would obviate any need for as you put it, evictions…”

    I think this has been tried before? and I would guess probably worsened the mood and morale which you mentioned in your original post…can you imagine running down the services and number of residents over a long period of time and in some cases literally waiting for people to die so the lights can be switched off and the shutter pulled down would improve the mood looking around a care home listed for long term closure? That sounds worse to me – which probably pushes Trusts towards a ‘lesser of two evils’ decision.

    The other question that hasnt really been answered is how many of those listed for closure are because the living conditions are not good enough and exactly how much would it cost to get them back up to scratch and meet standards and indeed if that is even logistically possible given the architecture of each individual building. I think a journalist should be doing an analysis/audit of the facilities we have – see if they come up with a different answer than the Trusts (and now the Board) did/will…that would be interesting.

    I dont really have an opinion on the proposed closures, suffice to say I would rather we provided quality, safe and positive places for people to live..if we cant do that now-why not?, how much would it cost? and how do we get there?