The Expert Advisory Panel Report, ‘Power to People: proposals to reboot adult care and support in Northern Ireland’

A quick review of this extensive report, authored by Forum Trustees Des Kelly and John Kennedy, to see what it has to say about residential care:


Only a small proportion of older people, for example, currently receive a domiciliary care package or are living in a care home. Indeed, less than 7% of our over 65 population receive domiciliary care, while less than 4% are in a residential or nursing home.This does not mean however that those without
current care needs will never have a need for care and support at some point in the future

Then on the impact of the make up of the sector on pay:

It appears that a rather strange situation of parallel worlds has
been created for social care. Social care in Northern Ireland is largely
commissioned by the HSC Trusts from for-profit and voluntary sector
providers. The independent sector now provides 100% of nursing home
care, 83% of residential care and 62% of domiciliary care. But there is
still a significant proportion of care that is provided by HSC Trusts.
In the public sector, wages (and conditions) for care work are fairer,
whilst in the private and voluntary sector, pay is often at minimum wage
rates and service conditions have been eroded. Given that the majority
of paid care work is now provided in the private and voluntary sector,
there is clearly an imbalance.

Obviously pay is important. Care workers need to be paid a decent wage, at the least the Living Wage, for the essential work they do. But, across the whole of the UK, only 91 care organisations are, as yet, accredited Living Wage employers. To put that in context, Northern Ireland alone has almost 1,000 registered providers of day, domiciliary, residential and nursing home care.

Crucially, the care sector should be raised above the bottom of the pay market to enhance its ability to attract the best people across a much wider pool than it currently does. The care sector shouldn’t have to be in direct competition with supermarkets, pubs and such like for its workforce. It needs to be seen as of higher national strategic importance.

On Intermediate care it says:

However, we don’t believe you can just commission intermediate care, you have to co-create it. Research carried out in Kent County Council showed that, of older people placed in standard residential care beds on a short term basis, around 80% remained there for the rest of their lives. When people with similar needs were placed in an intermediate care bed where there was a focus on helping people’s recovery, over 80% returned home. “It was not the assessed needs that made the difference but the offer that was available to the patients at the point of discharge”.

About housing:
In one evaluation, researchers found that tenants particularly valued that they were able to have their own personal space (many had previously lived in residential care) and that the housing model had given them much greater choice and control over their lives, which in turn had enhanced their personal

Measures to address perceived unfairness of charging for residential care:

Role of care homes in facilitating timely discharge should be more fully explored. Thinktanks like Respublica have suggested the creation of a Fast Track Discharge Fund with funds redirected from hospitals to residential care.

Residential care supported by in-reach nursing could support some clients currently in more expensive nursing homes.

A report worth a thorough read across the UK can be accessed here


Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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