Care homes: the big debate

It wanted to close 35 homes - including 19 in East Lancashire. But now an additional three will remain open for at least four years. Sixteen will provide respite and day care facilities.

What's behind the new proposals and why are opponents still upset about what is due to be finalised on September 26?

We ask three key figures in the debate...

AGAINST: Coun Tom Sharratt, South East Ribble County Councillor

CHRIS Cheetham knows perfectly well what he should do to save Lancashire County Council's old folks' care homes. He should seek extra money from the government with the support of the Local Government Association (LGA).

I have told him that repeatedly over the past six months. I have told him in public, in private, and in print, yet in the report on public consultation presented to the county council's cabinet on August 1 he appears to have ignored it.

My case is this. Last winter the Government brought in new standards for old folks' residential care homes. Improvements cost money, but the Government provided no extra cash.

What was the county council supposed to do? It could have dug into reserves, but that would have been foolish. It could have set a huge increase in council tax, but no-one wanted that. Or it could have done what it did. No-one wanted that either, but there was little choice about it.

Now just hang on. How about my idea - seeking the support of other councils through the LGA? Isn't that worth a try?

Several other councils are in the same boat - Durham, Hertfordshire, and Leicestershire spring to mind. Chris Cheetham himself has named several more. Yet he claims that if Lancashire approached the LGA there would be little or no support because certain other authorities have got rid of their residential care homes already - Kent and Liverpool, for example. But that's only two.

Let's be clear about one thing: Chris Cheetham and Hazel Harding, leader of the county council, do not deserve the abuse that has been heaped upon them during this crisis.

They both care about elderly people in Lancashire, and everyone else, as much as anyone. But they have been forced into an impossible position. It is the Government that is to blame - the Government and their compliant MPs who supported the imposition of new standards without the money to pay for the work that needs to be done. Imposition? Everyone thought so until July 24. Just two days before County Hall unveiled its response to public consultation Alan Milbum, the Health Secretary, announced that the government never intended the new standards to be compulsory; they were merely for guidance.

With his po-faced announcement Milburn pulled the rug from under Lancashire's feet. Now they're having a rethink - and so they should.

There is, of course, another major strand to their thinking - that changing times and changing preferences demand a move away from residential care, to care at home with supporting services. Not everyone is convinced of that.

It is true that authorities could go to the government individually to demand extra money. Chris Cheetham and Hazel Harding have done that, with an ambiguous, uncertain result. The door, we were told, is left open.

They would have a stronger voice if they joined other authorities to put their case through the LGA.

Never mind what party bosses tell them: Lancashire County Council's cabinet are not puppets, prancing as their masters pull their strings. Their first duty is to the people of Lancashire. I hope and trust they will remember that.

AGAINST: Pendle MP Gordon Prentice

HAVE you met anyone who agreed with Lancashire County Council's proposal to close 35 of its 48 care homes for the elderly?

The plan generated shock waves throughout the county. The residents in the homes were fearful about their future; relatives were often confused and I believe the county council itself had no clear idea about where it was going. Its spokespeople merely chanted the mantra that "there is no alternative."

There is little doubt the original consultation was flawed. People were given no options to consider. It was take it or leave it. We were told the response was "mixed" although I suspect the overwhelming majority would have been totally against the proposals.

Even now, who can breathe a sigh of relief when so much is still up in the air? In my own Pendle constituency, an excellent, modern residential care home in the town where I live has been reprieved -- but only for four years.

You can imagine the trauma this continuing uncertainty will generate. Other homes are still destined for closure. Others turned into day care centres. But is this the way forward?

I want the county to talk with all the other players in this drama. I want the district councils, the NHS locally, the housing associations and others to be signed up and willing to work with Lancashire to deliver its vision.

I have never argued for the status quo, but I certainly need to be convinced that the alternative models of care have been worked out; that other organisations with a clear interest have been consulted and lined up and that the views of the elderly themselves are paramount.

The county says that no resident, under the revised proposals, would be expected to move more than twice. But any move for a very elderly person will be distressing.

The county also needs to look at the implications of the government's commons statement on July 24 which, I believe, could have profound implications for what the county is proposing.

Between 1992 and 1997 real term funding for social services nationally rose by just 0.1 per cent per year. Now it is rising by three per cent per year and next April six per cent -- over and above inflation.

The government also pledged increased support for those who need care in residential and nursing homes. It will also be reviewing the Care Standards Act to ensure good homes are not forced to close if they fall just short of the best standards to which we should aspire. After all, this was the original justification for the closure programme.

We were also told elderly people requiring care would, in future, be able to receive a cash payment giving them a real choice over the services they receive.

The government's far reaching reforms and additional resources will mean more support for those who choose to live at home and there will be more sheltered housing too.

In this context, it seems perverse that the county should press ahead, with a final decision being pencilled in for the end of September, without considering the implications for its services of this new policy framework. There is an alternative.

FOR: Coun Chris Cheetham, head of social services for Lancashire County Council

OVER the two weeks there has been much discussion of the revised proposals for the prospects for services for older people in Lancashire.

Our aim has always been to develop a range of services that will meet the needs of our elderly residents now and in the years to come.

I can assure you that the county council will never stop caring for its elderly residents.

It has never been our intention to cut spending on services for the elderly or unnecessarily avoid investing money in our homes. The new proposals would actually mean that spending on services for the elderly will increase, along with the range of options open to people in need of care.

The main question I have been asked all along is why we need to change at all? Lancashire has traditionally placed a greater proportion of older people into residential care when compared to the average council. This does not mean we take better care of them but that our response to their needs was very much centred on residential care.

Some 85 per cent of this care is currently purchased from the private sector with the rest being provided 'in house' by the council.

In the future people are going to be demanding more from the county council and I aim to ensure we can meet their demands rather than offering the 'one size fits all' option.

Clearly the most important people who need to be safeguarded in any change are our current residents. Many of them and their relatives have been frightened by stories that they were to be sent back out to live on their own or that they were about to be left to fend for themselves. I have always stated that this will never happen.

I have given an assurance that all residents in county council care will be able to stay in county council homes if they wish. Our residents will also remain in the district where they live if they want to and would move at most twice during the refurbishment programme - some residents may not need to move at all.

Groups of friends and family groups can also move together. We have also made it clear that we will adopt the best practice of making the moves slowly and over time and keeping residents and their relatives fully involved.

Many people who have been in hospital have been able to retain their independence thanks to our rehabilitation programmes. These schemes have a 70 per cent success rate. Our spending on domiciliary care has also increased by £9million over two years to provide more support to people living in the community. We have been developing a range of proposals with housing associations for 'very sheltered housing' schemes to provide support to people in their own homes and these are starting to roll out across the county.

Most people and partner organisations have welcomed these developments in the way we will care for people as the way forward. Our proposals offer a clear commitment to continuing with Lancashire's proud tradition of caring for our older people while recognising that the individual and their needs are more important than continuing with options that are easiest for the council.

To make sure that we have at our disposal the resources to deliver this change we have proposed a reduction in the number of homes we currently operate.

The revised proposals mean:

The number of beds in county council care homes has been increased by 206 places.

Three of the homes earmarked for closure have been kept open and a new home proposed for Preston.

Extra specialist day care.

All residents currently in county council care will be allowed to remain in county council care in the district where they currently reside and will not be expected to move more than twice.

There will be a cost of between £8million and £13million over the transition, which is greater than originally envisaged.

The changes will take place over a number of years - estimated to be at least three years, compared to the original 18 months.

Lancashire has a proud record for caring for its elderly residents and we do not intend to change that record, simply improve and develop the way we deliver services for the future.