The level of fuel poverty in Northern Ireland has been revised downwards following a Department for Social Development-commissioned study. The University of Ulster study revised the 2009 figure of 44 per cent figure to 13 per cent (75,000 households), using a new method of calculation.

Previously, the threshold was set at twice the median amount of household income that families in England spent on heating their homes in 1991 (10 per cent of household income), to maintain an acceptable temperature in their home. The study says 23°C for living rooms and 20°C for all other occupied rooms is recommended, with higher temperatures advised for the elderly and vulnerable.

It concluded that with the median amount of money spent in Northern Ireland on heating at 9 per cent of household income, applying a local twice-median (18 per cent), meant that 13 per cent were in fuel poverty in 2009. It also found that 33,499 households need to spend at least 25 per cent of their income on light and heat.

A UK-wide threshold shows that Northern Ireland has an acute problem. In 2009, the House Condition Survey found that Northern Ireland’s 44 per cent proportion contrasted sharply with 16 per cent of English households. Fifty-three per cent of those between 60-74 years of age and 76 per cent of those 75 years or older were in fuel poverty. The Registrar General’s annual report for 2010 found that there has been an average of 910 excess winter deaths (difference in the number of deaths in winter and the four month periods before and after) over the past 33 years.

According to the DSD, households in Northern Ireland spend approximately

60 per cent more disposable income on energy than the UK average, due to lower household incomes, greater heat needs and dependence on oil. Northern Ireland’s annual average fuel bill is £2,114. The Executive has allocated approximately £23 million for a one-off fuel allowance payment in February, for cancer patients and benefit claimants.

In March the then Social Development Minister Alex Attwood launched a fuel poverty strategy, Warmer Healthier Homes, which identified four key areas for action:

• targeting of resources;

• improving energy efficiency;

• achieving affordable energy; and

• building “strong partnerships”.

It included a target of achieving at least a 15 per cent average energy efficiency gain in homes assisted by the Warm Homes scheme; more energy efficient standards in the Code for Sustainable Homes; and a smart meters pilot to conclude and be evaluated by 30 September 2012. A DSD spokesman told agendaNi that the 12 month pilot commenced in November. The University of Ulster is expected to complete a project evaluation within six months of it finishing.

The draft Programme for Government commits to introducing “a range of initiatives aimed at reducing fuel poverty”. It promises full double glazing in Housing Executive properties by 2014-2015.

Northern Ireland’s Fuel Poverty Coalition, which includes Age NI and Save the Children, said that “tackling fuel poverty presents clear benefits across a number of key priority areas included in the draft Programme for Government” and that there should be a “detailed and costed action plan to eradicate fuel poverty” in the final document. A spokesman admitted that eradication is not possible in the short term but that it can be eventually achieved with a co-ordinated response.

The Fuel Poverty Coalition proposes energy brokering schemes in which the purchasing power of the Executive’s estate would be used to negotiate lower fuel and electricity prices for fuel poor households. The DSD has said it will introduce a test scheme for social housing providers by the end of March 2012.

The Energy Saving Trust administers Northern Ireland’s Sustainable Energy Programme, which is funded by an energy efficiency levy. It has a range of schemes to improve energy efficiency, and targets 80 per cent of its funding at alleviating fuel poverty.

Northern Ireland’s population is set to age, with an 18.6 per cent increase in over 65s between 2011 and 2020 and a 42 per cent increase by 2025. The population of children (under 16) will increase by 4.3 per cent and every working age person will have the equivalent of three children or four pension age dependants from now until 2020.

These trends, from NISRA’s statistics, will have implications for all health policies, especially residential care planning and care for the elderly in hospitals. Provision of childcare in the face of an increasing elderly population will be an ongoing challenge.

Budget cuts have already resulted in nursing home closures and only those assessed with having the highest levels of need receiving a care package. With the working-age population, which generates the money for the health and pension systems, not growing as quickly as the elderly population, policy-makers are faced with decisions as to where to place money to anticipate future demand.

Meanwhile, the region’s health is getting worse, with more older people suffering from long-term illnesses and a rise in chronic conditions such as obesity and cancer, often resulting from smoking, alcohol and drug use and a sedentary lifestyle.

Thirty six per cent of 4,085 respondents to the 2010-2011 DHSSPS’ health survey were overweight, while 23 per cent were obese (8 per cent were children aged between two and 15.) A weight-loss specialist has warned that Northern Ireland is facing an obesity “tsunami” in the next five to ten years.

Northern Ireland is facing a shorter life expectancy and health inequalities mean that people from deprived areas will not live as long as those in more affluent areas. The Troubles had a lasting impact on the physical and mental health of the population and this has to be factored into future care planning.

The draft Programme for Government includes plans to enrol people who have a long-term condition in a dedicated chronic condition management programme and to spend £7.2 million on tackling obesity.

John Compton’s review will shape health and care services for the next generation. Health Minister Edwin Poots has said that there is a need to encourage “greater personal responsibility among members of the public for their own health and well-being.” This will require “a sustained and growing investment in public health, early diagnosis and early intervention services,” he insisted.

A 2009 EU policy brief (on how health systems can respond to ageing) recommends better co-ordination of care across health and social services and across different levels of health care, ensuring more treatments are done outside of hospitals (to reduce inappropriate hospital stays), reducing the risk of disease through health promotion and disease prevention programmes, and funding programmes that keep elderly people active and get them out and about.

A report commissioned from PwC by Independent Health and Care Providers, and supported by Age NI found that some older people face nursing home bills of up to £500 per week which they cannot afford.

Esmond Birnie, PwC’s Chief Economist, commented that while approximately 10 per cent of the DHSSPS £4.4 billion budget in 2009-2010 was spent on the social care system for older people, “demand is rising fast, [and] the provision of care, both in terms of funding and care homes, is falling behind.” He said that “this situation cannot continue and, in a period of severe financial constraint, a comprehensive reform of social care delivery and funding is now appropriate.”

This is an unprecedented time for Northern Ireland’s health and care sector. The McKinsey report warned the province’s Health Service will run out of money in four years unless fundamental reforms take place. Its recommendations (including intensive rehabilitation before assessing someone for social care, ending non-essential treatments like aesthetic ENT surgery and increasing the use of generic drugs) are to be treated as “an à-la-carte menu” by Poots. A UN report on ageing highlighted the gravity of the situation, saying: “We are in a situation without parallel in the history of humanity.”

Overall population: projected increase (thousands)	% Increase in population 2010-2020

Demographic groups (thousand people)

	2011	2012	2013	2014	2015	2016	2017	2018	2019	2020
Children	383	384	385	387	388	391	394	397	399	400
Pension age	308	310	312	314	316	318	320	322	324	327

]]> http://www.agendani.com/overview-2/feed 0 http://www.agendani.com/age-ni-fixing-social-care http://www.agendani.com/age-ni-fixing-social-care#comments Wed, 21 Dec 2011 15:18:54 +0000 Agenda NI http://www.agendani.com/age-ni-fixing-social-care Age NI believes Northern Ireland’s social care system is broken and a new revised system is long overdue.

The Compton Review has provided a much needed platform to debate social care provision in Northern Ireland because the situation for older people in receipt of social care is already at crisis point and a new revised system is long overdue.

Age NI believes social care is the linchpin for wider health care provision, if we get it right everything else will fall into place. A system promoting low level services that enables older people to remain in their homes for longer and reduces hospital admissions, will ultimately be cost-effective and result in better outcomes for those in later life.

However the debate on social care provision cannot solely be lead by decision makers, it must also involve the wider Northern Ireland public because ageing affects us all. It is imperative that society takes the time to consider what quality of social care it can expect as we all grow older and what outcomes social care services must achieve.

Debate

The scope of care services also needs to be debated from ‘that little bit of help’, through to nursing and end of life care. The cost of the system must be factored into discussion but this cannot happen until we decide on quality, outcomes and the scope of services. Funding is important but it cannot be the only driver.

This debate must be framed in the context of our ageing population as the number of older people, particularly those over 85 who are most likely to need social care, is also set to increase. By 2021, the number of persons aged 85 and over in Northern Ireland is projected to rise by 67 per cent to 47,900.

Figures from the Department of Health, Social Services and Public Safety estimate that the cost of treating older people is expected to increase by 30.6 per cent over the next ten years.  Despite these inflationary pressures, planned funding for the Elderly Programme of Care (POC 4) only grew by £6 million or 1.1% in 2009-10.  With a real cut in the DHSSPS budget of around 2.7 per cent by 2014, it is unlikely that the funding needed over the next ten years to treat older people will be available.

Prevention

Age NI believes that with effective treatment, fair and equal access to services, appropriate levels of funding and prevention strategies, older people can continue to experience good health. By staying well and feeling good, older people are more likely to play an active role in their communities, contribute to society and live independently. The idea that preventing ill-health is a way of controlling costs is not new to health and social care. However, there has been no indication of a change in thinking or a shift in resources to give a higher priority to prevention.

There is clear evidence, however, that projects which promote early intervention and independence can produce early outcomes and greater efficiency for health and social care. A recent evaluation of the Partnerships for Older People’s Projects (POPPS) in Great Britain demonstrated that these projects led to cost reductions in secondary, primary and social care as well as an increase in health related quality of life. In particular, the projects lead to a 47 per cent reduction in overnight hospital stays and the use of accident and emergency departments was reduced by 29 per cent.

Vision

Through our work with older people and key stakeholders we have developed a vision of quality integrated social care that recognises the rights, aspirations and diversity of us all, and is based on the right to live with dignity, independence, security and choice. At the heart of our vision is a system that enhances well-being and independence, so that older people can continue to engage socially and maintain self-esteem, dignity and purpose.

To secure this vision, a shift in the language of care is needed, from one of services to one of needs and outcomes. This means that assessments should be a consideration of a person’s social care needs and the outcomes that they wish to achieve. The focus should not be on the person’s suitability for a particular service. Incorporating human rights and equality principles into social care can reinforce the importance of these broader issues.

Age NI believes that the outworking of the Compton Review affords decision makers a once in a lifetime opportunity to reform social care. We are calling on politicians to give the commitment and leadership that is needed to enact radical reforms to deliver the transformational change urgently needed in the provision of social care.

Age NI believes Northern Ireland’s social care system is broken and a new revised system is long overdue.

The Compton Review has provided a much needed platform to debate social care provision in Northern Ireland because the situation for older people in receipt of social care is already at crisis point and a new revised system is long overdue.

Age NI believes social care is the linchpin for wider health care provision, if we get it right everything else will fall into place. A system promoting low level services that enables older people to remain in their homes for longer and reduces hospital admissions, will ultimately be cost-effective and result in better outcomes for those in later life.

However the debate on social care provision cannot solely be lead by decision makers, it must also involve the wider Northern Ireland public because ageing affects us all. It is imperative that society takes the time to consider what quality of social care it can expect as we all grow older and what outcomes social care services must achieve.

Anne O’Reilly is Chief Executive of Age NI. For further information on the work of Age NI contact 028 9024 5729 or visit www.ageni.org. You can also follow Age NI on Facebook www.facebook.com/agenicharity or on Twitter @Age_NI

An Adoption (and Children) Bill is expected to be brought to the Assembly in 2013 aiming to speed up the process of placing children in care with a permanent family. It currently takes approximately three years and six months for a child to be adopted from care in Northern Ireland, while in England children wait an average of two years and seven months.

The Adoption (Northern Ireland) Order was passed in 1987 and is to be updated to recognise that it is no longer illegitimate babies, but often children from difficult or neglected backgrounds who need a home. An attempt to update the legislation failed in the last Assembly term.

agendaNi asked the DHSSPS why the new Bill will not be introduced for another year and it cited the primary legislation process which includes instructing counsel, ministerial clearance and public consultation.

Under direct rule, the 2006 ‘Adopting the Future’ draft strategy made 21 recommendations to improve adoption, including that unmarried and same sex couples be allowed to adopt. Of the 1,066 consultation responses, 1,025 (96 per cent) opposed same sex or unmarried couples adopting. Former Health Minister Michael McGimpsey took a previous Adoption and Children Bill (which didn’t contain that proposal) off the legislative table in October 2010. When asked why that Bill was delayed, considering the last Assembly’s four-year term, the department reiterated that the Bill hadn’t made it through clearance in time.

Unnecessary delays in care planning and court proceedings, a lack of adoptive families and poor post-adoption support have been identified as problems.

Potential adopters are made aware from the outset that there are very few new born babies available for adoption. Only two babies under one were adopted from April 2010 to April 2011. The average age of the children waiting to be placed is four years and eight months. They have generally been in and out of care and have suffered neglect or trauma.

When challenged on the low average adoption rate (2 per cent) a DHSSPS spokeswoman said that adoption is not the only option for children in care. She added that the department is currently considering special guardianship which is used in England and Wales; this gives legal parental responsibility to a guardian until a child is 18 but does not totally remove parental responsibility from the birth parent.

Barriers

Belfast’s Family Care Society Chief Officer Rosemary Hurl says more adopters are needed and that legislation must be “child centred”.

“The current process of freeing children for adoption can be a long and protracted one,” Hurl tells agendaNi. An average wait of 3½ years from entering care to being freed for adoption “is a huge amount of time for a young child” who needs stability.

Placement orders should be included in the Bill, Hurl proposes. This involves the court authorising a trust to place the child for adoption with prospective adopters (with or without consent from the birth parent). They replaced freeing orders in England and Wales in 2002.

Adoption practices across the five trusts must be standardised and adoption agencies need balanced information on the child. In addition, the trusts should have to adhere to a statutory timeframe, she suggested.

Stephen McVey, the Northern Ireland Development Manager of Adoption UK, adds: “While adoption is the last link in a child’s care plan and every effort must be made to try to return them to their birth parent, once a decision has been taken that adoption is in their best interest, then that should be done as quickly as possible.”

Post-adoption support is essential because adoptive children are likely to have behavioural problems stemming from their instable childhood. “A dedicated adoption budget would help because post-adoption services are practically non-existent or are piecemeal and dependant on where you live,” McVey contends.

Same sex and unmarried adoption has been allowed in the rest of the UK since the 2007 Equality Act but the average adoption rates have remained around 13 per cent for England, 3 per cent for Scotland and 4 per cent for Wales. The adoption rate in the Republic is lower, at around 1 per cent, with most families adopting from abroad.

It is unclear whether the new Bill will provide for unmarried and same sex adoption. However, it is unlikely that the DUP would support it (given its opposition in its 2007 Assembly manifesto).

The department will be bound by the outcome of a judicial review brought to the High Court by the Human Rights Commission, which is backed by a lesbian woman who wants her partner to be allowed to adopt her biological son.

DUP Health Spokesman Jim Wells said that it is difficult enough for married couples to adopt without “throwing the net wider” to include unmarried and same sex couples. He said many couples are put off by the “bureaucracy” and cited examples from his church of couples who have adopted Russian and Ecuadorian children.

However, Hurl and McVey point out that inter-country adoption incurs a cost and adopters must adhere to local legislation as well as that country’s relevant law.

Sinn Féin, the SDLP and Alliance support same sex and unmarried adoption. The SDLP wants an Adoption Bill to provide more support for post-adoption contact and look at the financial entitlements for adoptive and birth parents.

The UUP’s Health Spokesman, John McCallister, said the needs of the child must be paramount but regretted that reform will be delayed until the ongoing judicial challenge is resolved.

Placing children is “an onerous task for an adoption agency because it’s a choice for life,” but it does produce positive results, Rosemary Hurl reflects. Stephen McVey agrees: “When you speak to an adoptive family, they will tell you it has enriched their lives.”

Source: DHSSPS Community Information Branch

Palliative care is provided by five voluntary organisations in Northern Ireland: the Northern Ireland Hospice, Marie Curie Cancer Care, Macmillan Cancer Care, Foyle House Palliative Care and St John’s House Southern Area Hospice. They offer inpatient beds, respite care and bereavement services free of charge to patients referred by their GP or hospital.

Children with life-limiting illnesses receive nursing care and therapy from the Northern Ireland Children’s Hospice which has one 10-bed facility (Horizon House in Newtownabbey) where families are allotted day and respite stays and care in the home. Horizon West, a facility that will provide respite for four children and two families at any one time has been built at Killadeas, County Fermanagh, but will not admit patients until it has raised a further £500,000 for operating costs

(£1.2 million has been raised to date). Other charities work throughout the province to raise money for the treatment and support of children suffering from illnesses such as cancer or heart disease.

The five bodies received £5.58 million from the DHSSPS in the last financial year. The rest of their operating costs must be raised through fundraising campaigns. The only specialist palliative care beds in Northern Ireland’s health and care system are the 12 in Antrim Area Hospital’s new palliative care unit. A joint project between the Northern Health and Social Care Trust, Macmillan Cancer Support and the department, it cost £5 million. Other hospitals have contracts with the voluntary bodies.

Palliative care is defined as “the active, holistic care of patients with advanced progressive illness.” It aims to ensure a good quality of life from diagnosis to death for adults and children who will never reach adulthood. While each trust has access to palliative care beds, it is accepted that this is not always the most appropriate setting and that most people would prefer to die in their own homes.

A five-year palliative care strategy was released by then Health Minister Michael McGimpsey in December 2009. It aimed to develop a better knowledge of palliative care, identify the patient’s holistic needs and plan care so that a patient can die at home if they wished.

Over 6,000 outpatients were helped by hospital palliative medicine teams in 2010: 4,086 in hospitals in the west, 1,101 in Belfast City hospital, 810 in the six northern hospitals, 386 in the southern area and 26 in the Ulster hospital. Changing demographics (see pages 90 and 91) mean that people are living longer and often with one or more chronic condition.

Heart disease accounted for 31 per cent of deaths in Northern Ireland last year, cancer for 29 per cent and respiratory disease for 13 per cent.

“It’s a real challenge to keep the services running safely for the families who need it,” commented Tina McCrossan, Director of Children’s Services for the Northern Ireland Children’s Hospice.

Day care sister at St John’s House, Newry, Marianne Barry, has explained that “many of the patients come simply to avail of the company of others who understand what they and their families are experiencing.”

When challenged as to why the DHSSPS cannot fund all palliative care, a spokeswoman said that the £4.3 billion health budget provides “a wide range of critical services, all of which are rightly important to the public”. She cited an expected £800 million shortfall by 2014-2015 caused by price inflation and more demand on services which will make it difficult to maintain the current level of services.

Health and social care was one of three key areas discussed at a recent debate at Parliament Buildings, which was attended by around seventy Members of the Pensioners Parliament (MPPs). The debate, which took place in the Senate Chamber, followed on from the highly successful Northern Ireland Pensioners Parliament held earlier this year which saw twenty four motions being passed by older people from across the province.

The debate at Stormont, which took place at the end of November, was hosted by the Speaker of the Northern Ireland Assembly, William Hay MLA, and allowed MPPs to put forward three motions – on fuel poverty, fear of crime and health and social care – to the relevant departments in the Northern Ireland Executive. Each department then provided an official response to the motions through Social Development Minister Nelson McCausland, Stephen Farry (on behalf of Justice Minister David Ford) and Jonathan Bell (on behalf of Health Minister Edwin Poots).

The motion on health and social care called on the Health Minister to “increase funding for preventative healthcare programmes to help maintain the quality of life and independence of older people living at home; to take action to reduce hospital waiting times for older people and provide better support services for older carers”.

The Northern Ireland Pensioners Parliament survey, earlier this year, asked over 1,200 older people to select their top five concerns from a list of 16 issues. Almost one in three (31per cent) older people chose ‘access to health and social care’ as a concern for them, which highlights the need for action in this area.

Patricia Donald, Chair of Age Sector Platform, said: “Issues relating to health and social care become even more important as we get older, and it is clear from our dialogue with older people during the Pensioners Parliament that there is a lot that can be improved in our health and social care system.”

“Many older people are concerned about the current level of social care provision and its ability to meet the needs of older people now and in the future. Unfortunately, we heard many stories from older people across the province who have experienced cuts in home help provision, a lack of support for them as older carers and poor communication with them and their families from social workers. These issues must be addressed.”

“During the Northern Ireland Pensioners Parliament, there was a real recognition of the value of preventative healthcare in helping to ensure older people remain independent – something which older people want more than anything. Our health and social care system must ensure that older people who want to remain at home are able to do so. In the long term, social care as a preventative measure could save the Government huge sums of money by reducing the number of hospital admissions. The value of older people’s groups and their ability to prevent ill-health must also be recognised. These groups must be supported so they can continue the essential role they play in keeping older people active.”

“Some regional health issues which were raised during the local parliaments held in each county included concerns regarding the closure and downgrading of regional hospitals, inadequate transport options for older people travelling to hospital and health appointments, and concerns regarding the provision of food in some hospitals. These regional issues were discussed fervently at the local parliaments and must be explored by the Health Minister.”

“Unfortunately, age discrimination in our health service appears to be relatively common, based on the experiences of older people who attended the Pensioners Parliament. Many older people spoke of being ‘patronised’ and some claim to have been refused treatment purely because of their age. We are delighted to see that the Northern Ireland Executive has committed to bring forward legislation to outlaw age discrimination in the provision of goods, facilities and services. This legislation will mean that it will be illegal to refuse healthcare to someone simply based on their age.”

For more information on Age Sector Platform visit www.agesectorplatform.org or phone 028 9031 2089.

A Safeguarding Board for Northern Ireland is to be established in April 2012 after the Safeguarding Board Bill was taken forward by former Health Minister Michael McGimpsey and received royal assent on 10 February 2011.

While voluntary and statutory organisations currently work together to safeguard children (for example on the Regional Child Protection Committee), this is now a statutory requirement. The Safeguarding Board will replace the committee. It will be sited within the Public Health Agency premises and £750,000 has been secured within the existing departmental budget to set it up and cover running costs.

The objective of the board will be to co-ordinate and ensure the effectiveness of what is done by each person or body represented on the board to safeguard and promote the welfare of children. Policy development and reviewing information on the deaths of children will also be within the board’s remit.

Board members will include the Health and Social Care Board, the Public Health Agency, the five trusts, the PSNI, the Probation Board, the Youth Justice Agency, the NSPCC and district councils.

The former Director of Social Services in the Eastern Health and Social Services Board, Hugh Connor, was appointed as Chairman-designate of the Safeguarding Board by Edwin Poots on 30 June for a four-year term, receiving an annual salary of £34,333. As well as the above organisations, the board will include between two and four lay members appointed by the department, a safeguarding director, a professional officer and an administration officer.

The Safeguarding Board will be supported by five safeguarding panels, one located in each of the trust areas. It will also have a child death overview panel and a case management review panel.

An annual report will be given to the Health Minister who must then present it to the Assembly. Edwin Poots has said this represents a clear line of accountability between the Safeguarding Board and the Executive, adding that the board will also be open to scrutiny by the Assembly Health Committee.

Relevant bodies must comply as quickly as possible with requests for information from the board, only if they are responsible for that information and if it will help the board in carrying out its functions.

“Today many agencies are working with families who very often are overwhelmed by difficulties such as financial problems, domestic or sexual violence, physical or mental health problems, or because of dependence on alcohol or other substances,” the Minister has said.

Over 21,000 children are referred to social services in Northern Ireland every year. As of March 2010, there were 2,357 children on the child protection register, 2,606 children were being looked after by authorities and 1,653 were in care.

“It is important that we invest in the future fabric of our society so that fewer families reach crisis point and fewer children suffer harm. This Bill supports the wider safeguarding agenda which includes prevention and early intervention,” Poots stated.

England and Wales already have local safeguarding children’s boards which were set up in 2006.

In Scotland there is a children’s hearing system, which looks after children and young people who need welfare support as well as looking after those that appear before the courts. The Child Welfare and Protection Policy Unit carries out a similar role in the Republic.

Sinn Féin’s Assembly manifesto said it would “closely monitor” the implementation of safeguarding legislation for children. The SDLP’s manifesto welcomed the Bill and said it would encourage trusts to continue developing family support services for children in need. During the Bill’s final stage on 25 January 2011, Alliance’s Health Spokesman Kieran McCarthy commented: “Every family should welcome the Bill. This is what devolution is about, and it is a good news story.”

Nigel Dodds’ private members’ Bill aimed at highlighting and preventing abuse of older people and vulnerable adults will have its second reading in the House of Commons on 20 January. The Support and Protection for Elderly People and Adults at Risk of Abuse Bill, which enjoyed cross-party support at first reading, seeks to ensure training on how to recognise and respond to such abuse, promote local strategies for preventing abuse and provide assistance to victims.

At the first reading on 10 November 2010, Dodds said different forms of abuse affect hundreds of thousands of people across the UK every year and that abuse often goes unreported due to stigma, shame, dependence on the abusers as well as guilt or isolation. Stating that the benchmark of child protection should be used, Dodds said that his legislation would require abuse to be investigated, a more consistent and effective response by statutory providers, ensure better training and education, and offer enhanced guidance to the criminal justice system.

Speaking to agendaNi, Dodds said: “Part of the issue that I just wanted to focus [on] and highlight was that this needs to be taken much more seriously and in a more co-ordinated way across government.” He said his aim in producing the Bill is “promoting the need for a requirement on [social services] agencies to be aware of and to make this a priority.” The aspirational provisions of the Bill would apply across the UK, with the devolved administrations responsible for implementing the policies.

Support, at present, can be unco-ordinated and fragmented, with little formal contact between the relevant agencies and services, he claimed.

The DHSSPS says it has improved inter-agency working over the last two years, including financial support for establishing local and regional ‘safeguarding partnerships’.

Dodds told the Commons that there would be “immense benefit in bringing existing provisions together, including principles, definitions, a duty to investigate, clarification of powers of entry, powers to remove a perpetrator or perpetrators of abuse, and a duty of co-operation.”

In a UK-wide study of abuse and neglect of older people conducted by King’s College London and the National Centre for Social Research, published in 2007, 2.6 per cent of people aged 66 and over living in private households reported mistreatment involving a family member, friend or care worker during the past year. The predominant types of mistreatment were neglect (42.3 per cent of abuse), financial abuse (31.8 per cent), psychological and physical (18.2 per cent each) and sexual (9.1 per cent). Fifty-one per cent of mistreatment involved a partner, and 49 per cent another family member, with only 13 per cent of abuse reported to have been from a care worker.

The prevalence of abuse rises from 2.6 per cent to 4 per cent when incidents involving neighbours or acquaintances were included. The study stated that its findings were likely to represent an under-estimate of mistreatment.

Two per cent of people aged 66 and over in Northern Ireland suffered from mistreatment, according to the study, with neglect constituting half of this.

In his Commons speech, the DUP deputy leader added that a “major shift towards understanding the circumstances and situations that contribute towards abuse or render people vulnerable to it” was needed.

Earlier this year a cross-border qualitative study of older people’s understanding of elder abuse reported that some participants would be reluctant to tell anyone about mistreatment for fear of having to go into a nursing home, which was their biggest dread.

In Northern Ireland, the DHSSPS and the Department of Justice are currently developing policy on the safeguarding of vulnerable adults, with a framework to be issued for public consultation in 2012.

The details of Dodds’ Bill are expected to be published at committee stage if it advances past second reading.

It is not a member of TUC or ICTU and is not affiliated to any political party.

At the end of 2010 its membership stood at 409,801, including 13,418 members in Northern Ireland. Members include registered nurses, student nurses and healthcare assistants.

The union covers four regions: Northern Ireland, Scotland, Wales and the English regions. The six RCN branches across Northern Ireland hold regular meetings and organise events to promote nursing and the RCN at a local level.

Its governance structure consists of an RCN Council, responsible for policy making, and the executive team of legal services, communications, publishing, nursing and regional directors, headed by Chief Executive and General Secretary Peter Carter. Northern Ireland’s Regional Director is Janice Smyth.

Established in 1916 with 34 members, the RCN evolved from a professional organisation for trained nurses and a charity to a professional union. Its status as a charity ceased in 2010 when the independent RCN Foundation was established. A royal charter was granted in 1928 which stated that the RCN would promote “the science and art” of nursing at home and abroad. Men were admitted in 1960 and in 1977 it was registered as a trade union.

Frontline First is its main campaign which outlines the cuts required in each region and calls for members to reveal where those cuts are affecting patient care, examples of waste and inefficiency and of innovation on the front line.

On pensions, the RCN has welcomed the Government’s proposal that no one within 10 years of retirement will have to work longer or have a decreased pension. However, it was critical of the fact that the contributions from other healthcare staff are still planned to rise by up to 50 per cent from 2015. The RCN believes that nurses have not been properly engaged in the review of healthcare in Northern Ireland. In its submission, it said that a move from acute to primary care needs an appropriate workforce development plan. The RCN urged its members to join the TUC’s day of action on 30 November as a show of support and to oppose pension reform.

A book on nursing in the Troubles is due to be published in 2013. Northern Ireland gained a reputation for its expertise in microsurgery and prosthetics from treating patients injured by bombs and bullets, and the RCN is currently recording the real life stories of those nurses involved.

Internationally, the RCN works with partners such as the International Council of Nurses, the European Public Health Alliance and the International Confederation of Midwives to monitor and lobby on European policy and proposed legislation. It also works with other UK NGOs such as Action for Global Health, Marie Stopes International and the stop aids campaign to develop better health in developing countries.

The RCN received £1.1 million in subscriptions from Northern Ireland in 2010. Its total income for the year ended March 2011 was £71 million and its costs were £63 million. Its assets at March 2011 were £37 million and its liabilities were £7 million.

“We have firm views on how Homecare’s services can positively impact on our local communities,” according to Mairead Mackle who founded Homecare Independent Living along with her husband Gerald in 1995. Gerald is Executive Director and heads up the company’s housing division.

Mairead points out that “our business is all about enablng people to stay in their own home and using our skills to contribute to a better community. That is the ethos Homecare has held onto for the past 16 years and despite the company growth we have never lost sight of the family values it was built upon.”

She continues: “Working in the community care industry is not without its obstacles. With government budgetary constraints and a health and social care services review underway, the current challenge of delivering ‘more for less’ requires a fresh approach on how future services will be delivered. It needs new and innovative systems and solutions with a greater emphasis on prevention and delaying hospital admission and a focus on outcome measures and well-being.”

Planning

An ageing population will be one of Northern Ireland’s major challenges over the next 20 years. According to official projections, the number of people at pensionable age is to reach 432,000 in 2025 (up from 308,000 in 2010). This 40 per cent increase compares to an 8 per cent rise in the working age population. For the first time, our society will have more older people than children.

General Manager Bryan Meldrum explains: “Northern Ireland is already well advanced in its thinking on how technology can assist in the delivery of community care so we can build on that knowledge and create further workable solutions. Homecare is committed to connected health and is actively engaged with a number of partners and academic institutions to explore how care will be delivered in the future to meet the population’s needs. We are moving towards an electronic healthcare record and it is important to include all provider companies to ensure the record is as complete as possible. Homecare’s MIS [management information system] has the capacity to connect and share information with other systems.”

Mairead adds: “We are working with partners to create a ‘complete’ solution to give people choices about staying at home where possible for their care. Given that technology will play a huge part in the delivery of healthcare in the future we believe it’s the working together of both the professional and the practical side that will offer the real solution for people, especially for it to be done at scale.”

Gerald Mackle points out that it can be difficult for companies such as Homecare to budget, plan ahead and direct their resources in the right path. He says: “We invest a substantial amount of money each year to improve our services and with closer and earlier engagement, our investment decisions could be aligned better to the department’s planning. Therefore from our perspective, we would like to see providers like ourselves becoming closer to the Government’s strategic planning stage of care provision.” He believes that consultation and greater transparency are the key elements in co-operation between the public and private sectors.

Homecare provide services in each of the health and social care trusts in Northern Ireland. They have also expanded services to the Health Service Executive (HSE) in Southern Ireland which accounts for 40 per cent of its turnover. Over 1,000,000 hours of care were provided this year to more than 2,500 clients.

The company has invested over £2 million in technology, training and motor vehicles to enhance its services. Its head office is at Callan House, a restored listed building, in the village of Milford, County Armagh along with offices in Belfast, Magherafelt and Dundalk. It employs over 900 staff, a figure due to rise to over 1,000 by April 2012. In this financial year, its projected turnover will be an increase of 24 per cent on the previous year.

Financial viability is a necessity for any community provider organisation,” says Mairead. “It allows us not only to offer secure employment and stability within the service but also to continue to invest in new ways of delivering services to support people’s independence. It’s especially important now that commissioning keeps a fixed focus on quality and a long-term view of clients’ needs, as people will look to the department as a role model for good practice. Private providers like Homecare run an efficient and cost effective service but we also create inventive solutions through our research and creativity.”

Homecare services

The Homecare team provides services which positively impact on the major social issues including domiciliary care, housing, support services and nursing services.

Homecare’s Housing with Care model is unique due to the flexible and swift response of staff, offering a professional team with years of experience. Houses can be adapted if necessary to suit the needs of tenants and located in areas of need within walking distance of all amenities.

Gerald Mackle comments: "Homecare Housing offer ‘a home of your own’ supplying accommodation backed up by a team of floating support staff who can help our clients regain their independence in a variety of ways from budgeting, getting access to education and other services or just helping them to sustain their tenancies. These services are so vital particularly in today’s economic climate.

Our in-house building and maintenance teams can adapt a property to suit a client’s needs within a relatively short period of time, which can be a major benefit to people with disabilities.

Homecare’s ‘peripatetic service’ offers care, housing and support to people from a range of backgrounds, including those with complex mental health needs. A specialist social work led team in Belfast run this service.”

Bryan Meldrum points out that this is integrated care in practice, with assisted technology becoming the next arm of the service. “Our development of our nursing services further demonstrates the integrated care model and not only does Homecare support intensive domiciliary care but enables more continuing healthcare to be undertaken in the home,” he explains.

Quality of support

Mairead reflects: “Quality has always been our focus and as people are our most valuable asset, we achieved ‘Investors in People’ and ‘Excellence through people’ awards, as well as accreditation through RQIA [the Regulation and Quality Improvement Authority]. We constantly measure and benchmark our services through our partnerships with other companies across Ireland and in the UK.”

“Everything we do is process driven to improve both customer satisfaction and efficiency of our response. We set up a seven-day week ‘customer service centre’ based at our HQ in Milford,” she adds.

“Our strength is that we can complement the professional services in the Health Service in that, at any given time, where necessary we have the infrastructure on the ground enabling us to respond within a very short space of time.”

All staff go through training in NVQ L2 to L4 and fetac L5. The team also provides training to a number of outside companies. With the right environment, care can become a career for people.

Homecare’s offering is much more than a financial one. With its strong involvement in community and voluntary work, its approaches are non conventional.

Its charity committee, ICARE, draws its name from the company’s five values:

• Integrity;

• Commitment;

• Accountability;

• Respect; and

• Enthusiasm.

ICARE aims to “improve and help” the communities in which Homecare operates.

The 40-acre Manor House listed estate in Milford opens its 130 year old gate lodge as a Santa’s gate lodge for 16 days in December, and is manned by volunteers from Homecare and their families, students from local schools, members of local groups and residents. Altogether, over 200 volunteers welcome about 5,000 visitors from across Ireland.

Mairead comments: “This is a really special event that pulls so many people together from different backgrounds and all proceeds this year will go to the NSPCC in Craigavon and to the RVH via The Sophia Fund.

“Our proposed retirement village on this site is based on a model already used in the UK and will include a care home facility. A choice of care options will be available, from complete independence to daily assistance in housekeeping along with the provision of modern technology and an energy efficient housing design.”

Society’s responsibility

In the light of the growing need for care, I asked Mairead whether society can face up to that task and what her company can contribute?

She points to the befriending service which Homecare plans to launch in the Armagh area next January. Volunteers will visit isolated older people and help them take up interests they have enjoyed in the past e.g. walks in the area, visits to parks or libraries, gardening and baking. To this end the ICARE committee has managed to secure funding from a cross-border health project, CAWT (Co-operation and Working Together).

Mairead believes that many years ago, such a service would not have been needed as people knew their neighbours and had “a house to visit every night of the week”. Her mother, growing up in rural Fermanagh, would have visited and chatted with older neighbours round the fire at night time but that way of life sadly is now gone. “My mother talks about how much she valued older people then and I’m hopeful that our new befriending service will recapture some of the goodwill and community spirit that was a thing of the past.”

As the population has aged, the public’s expectations from care have increased and Mairead agrees that the service should meet those expectations: “Obviously, we are working with a restricted budget but a restricted budget should not mean poor delivery of services. In a lot of cases the key is letting people know what’s possible and what’s not from the outset. Good relationships make all the difference and I believe it is how people are dealt with that’s vital; respect, understanding and good communication still go a long way. Also people need to have realistic choices and then they or their families can supplement those services if they so choose. Choice, access and quality of services should be there for people.

“Technology also has a part to play. Social networking sites such as Facebook can keep older people in touch with friends and relatives. On the medical side, for example, blood pressure readings or other monitoring devices in the home can help people take some responsibility for their own health.’

The future

Homecare is set to continue to grow and develop its range of services into the community.

Even with this continued growth, Homecare aims to combine the efficiencies of good business practice with the social needs of the community.

Mairead states: “Being both socially focused and commercially astute is something that Homecare has mastered and will continue to do so in the future.

“We are focused on caring for people and building a strong ethical business that is at the heart of the community it serves.”

Overview

Homecare’s main areas of work are domiciliary care, temporary and long-term housing, nursing and support services which help prepare people for independent living. Its wide range of clients include older people, families, patients recovering from surgery, people with addictions, single and young parents, and young people leaving care.

www.homecareindependentliving.com