Debate contribution: Social Care Reform

Debate contribution by Mrs Diane Dodds on 8 October 2024.

MLA

Mrs Diane Dodds

Party at the time

Democratic Unionist Party

Date

8 October 2024

Type

Debate contribution

Business

Private Members' Business

Heading

Social Care Reform

Assembly identifier

Official Report component 4581689

Read the official Assembly record

Text

Thank you, Principal Deputy Speaker. I propose the amendment not to take anything away from the motion but merely to add to it an issue that has come to my constituency office and that Members may have experienced in their personal lives. I thank the proposer of the motion for supporting the amendment, because it is important. I want to highlight a number of things, but, mainly, I want to focus on delayed discharges from hospitals. The amendment addresses the need to ensure that we have appropriate costs for care and VAT in care homes. Nothing highlights the link between health and social care better than the difficulties with delayed discharges from our hospitals: the obscenity of hundreds of beds being out of use for operations in acute care because people who are medically fit remain in hospital awaiting care packages. Back in the spring, the Minister provided me with figures demonstrating that, on 15 March, 628 patients across Northern Ireland had a needless stay in hospital. The real figure might have been higher, as some trusts had only included in the calculation the beds on their largest acute sites, and that was well into the spring, when the annual winter surge of respiratory cases may well have subsided. Having more than 600 hospital beds unavailable is the equivalent of keeping the doors locked at one of our large acute hospitals and at another small one. It is the equivalent of locking the doors at the Royal Victoria Hospital and saying, "We can do no more admissions today." It is an issue that really must be tackled. Hospital staff are forced to go to work each morning with one arm tied behind their back. It ought to be a key objective to free up more capacity and allow the system to operate. The loss of beds impacts on all parts of the system, including waiting times, emergency departments and hospital admissions. It is poor care, too, for those patients who are kept in hospital unnecessarily. Many argue that we do not have enough hospital beds in Northern Ireland in the first place, but we certainly cannot afford to lose 600 beds within the system at any one time. I recognise that there can be difficulties finding replacements for individuals, but the issue needs to be gripped from the centre. It is a straightforward opportunity to transform hospital provision. For anyone looking in from the outside, or from any other walk of life, it is a simple means of making a fundamental impact on the efficiency of the overall system. The second issue that I want to highlight is regulation in the care sector. Too often, we hear that social care is not sufficiently valued. It is not helped by how it is funded. Down the years, providers of social care have had little confidence and, at times, uncertainty around that funding. The impression has always been that, when the financial envelope is squeezed, social care is one of the very last areas of the budget that will be considered. Whatever is left at the end of the budget process is what will be available to social care. Rather than being able to plan medium- and long-term care homes in domiciliary care, for example, the sector has had to put up with whatever the Department and the trust gives it. None of that assists in making the care sector an attractive one in which to work or seek to build a career. If the Government and the powers that be do not value social care, why should anyone else? The idea of regulating care costs was raised as far back as the Transforming Your Care review led by John Compton. That was when Edwin Poots was the Health Minister, so it is a long time ago. On social care, 'Transforming Your Care' stated:

"the Review ... recognises that the relationship with government, particularly over pricing can be difficult. Consequently, the Review recommends the" —

Department —

"undertakes a policy review to consider: • the benefits or otherwise of independent price regulation within the sector".

Proposal 20 of the review specifically recommended:

"An overhauled financial model for procuring independent and statutory care, including exploring the potential for a price regulator".

I mention that aspect and included it in the amendment because I know, as the Chair of the Committee said in her intervention, that many of us will have heard from families who are desperate because of the top-ups that are required from part of the independent sector. It is not a choice for families. Often, families just do not have the means to make those top-ups, and we really need to have some means of regulating them, particularly when they can reach extreme amounts very quickly. That is why we tabled the amendment.

Financial stability in the sector would be of immense benefit and would place a value on caring and the other work that those in the social care sector do. There also needs to be action to strengthen our domiciliary and social care workforce, such as making it more attractive by improving working conditions, establishing career pathways and providing support for staff. Mandatory training and professional development should be introduced with pay progression linked to skills, experience and qualifications. Finally, is the Minister able to provide an update on VAT for care home operators? I tabled a number of questions for written answer, to which I received responses in June, on Northern Ireland care home operators not being able to reclaim VAT to the same extent as their counterparts in other parts of the United Kingdom. Health and social care trusts are permitted to reclaim VAT on non-business activities, under the provisions of the Value Added Tax Act 1994. The regional residential and nursing home specification and contract, however, which was issued to trusts in 2015, does not permit independent homes to do so. The Minister answered:

"Independent Sector registered care homes in Northern Ireland are VAT exempt but related expenditure is not recoverable."

A further answer stated:

"Workstream 8 of the Social Care Collaborative Forum has been established to ... review ... the current Regional Residential and Nursing Home Specification and Contract."

The Minister advised me in June that the VAT issue was being prioritised for early consideration by the commissioning and contracting work stream. Can the Minister provide the Assembly with an update on that and on whether the issues have been resolved? In mentioning that, it is clear to me that, if there is additional money that can stabilise it, we should help the care home sector avail itself of that additional money, because we would like to see it being ploughed back into additional provision and care for those who require it. I am glad that the proposer of the motion is agreeable to our amendment, and I commend it to the House.

1,148 words. Text as published by the Northern Ireland Assembly.

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