Corporate report

Care homes

Published 25 November 2016

Care homes

CMA recommendations to government

Capacity recommendations

(1) In England, that the government sets up a new function, independent of government, with the objective of ensuring that planning is of sufficiently good quality to provide confidence that the capacity will be in place to meet needs over a period, specified by government:

• to review and report on the planning by local authorities (LAs) of all types of social care for the elderly, and whether plans are sufficient to meet the objectives of providing care to all those with eligible needs
• to provide guidance to LAs as to what is required for market planning statements to be effective and to provide information to support LAs in developing plans
• to report on where LAs are, based on evidence provided, not planning to a standard required by their duties, or are not taking appropriate actions to ensure that the plans are then met

(2) That a process is established to provide independent advice to government, to be updated periodically:

• to provide evidence to government on the expected cost of different forms of care over that period
• to provide evidence to government on the need for different types of care (including residential care, nursing care, domiciliary care and other options) over the foreseeable future (5 to 10 years)

(3) In Northern Ireland, the Executive identifies a suitable body along with the design of a targeted approach to delivering on the same objectives as in England, and reflecting the different circumstances of Northern Ireland.

Recommendations to government and sector regulators

Consumer protection recommendations

(4) Sector regulators should take a greater role in helping to embed a culture of consumer law compliance across the sector.

(5) The industry should take steps to develop model contracts that could be recommended for use by care home providers with self-funding residents.

(6) The existing sector-specific regulations are strengthened to require registered care homes to publish indicative fee information for self-funders on their websites (if they have one) as well as any directory website they might appear on, together with information on what is included in and excluded from the weekly fees and any additional upfront fees that are payable. Where a care homes does not have a website, this information should be provided in any information packs sent to enquirers and in marketing materials.

(7) That existing sector-specific regulations are strengthened to require registered care homes to provide a copy of their standard (self-funder) contract and a summary of the important terms and conditions on their websites. Where a care homes does not have a website, this information should be provided in any information packs sent to enquirers and in marketing materials.

(8) That sector regulators review and where necessary strengthen their existing guidance to make clear that a copy of the contract and a summary of the most important terms and conditions should be given to prospective residents and their representatives at an early stage of their decision-making process, and explained to them in a timely way.

(9) That existing sector-specific regulations are strengthened to require registered care home providers to use a model template in summarising their most important terms and conditions clearly and prominently.

(10) That existing sector-specific regulations are strengthened to require registered care homes to protect residents’ deposits in full against the risk of insolvency.

(11) That sector-specific regulations are strengthened to require care homes to notify the sector regulator if they ask a resident to leave a home or impose a visitor ban.

(12) That sector regulators develop specific guidance for registered care homes on high quality practice to be used when asking residents to leave and when imposing visitor bans or restrictions, to ensure such processes are fair and transparent.

(13) That existing statutory guidance is reviewed and clarified to provide stronger protection and clearer policy and guidance on the payment of third party top-up fees.

In England, that the Department of Health and Social Care (DHSC) consider updating the recommending Care Act statutory guidance so that it is clear that LAs must explain to prospective care home residents and their families and people arranging their care that:

• care home providers should not approach them or their representatives such as relatives directly to demand a top-up without the involvement of the LA
• that there are significant benefits in arranging a top-up through the LA

The DHSC should consider making it a requirement that when an LA arranges the preferred accommodation with a third-party top-up, the provider agrees with the LA that its payment and other conditions will be the same, irrespective of whether the third-party contribution is paid to the provider via the LA or directly by the third party.

(14) The DHSC provides clearer guidance on the relationship between NHS Funded Nursing Care (FNC) payments and self-funding resident’s own contribution to their fees.

(15) The DHSC revises the National Framework for NHS Continuing Healthcare (CHC) and NHS FNC and practice guidance to clarify how the FNC payment affects self-funding residents’ fees.

(16) The DHSC provides clearer guidance on permissibility of top-up payments for NHS CHC Funded residents.

(17) The DHSC revises the National Framework for NHS CHC and NHS FNC and practice guidance to further clarify, in the context of CHC residents:

• the types of additional, private services that may permissibly be ‘topped up’ via private payments to a care home under NHS rules
• how the DHSC and NHS rules on top-up payments are monitored, applied to, and enforced against Clinical Commissioning Groups (CCGs) and providers.

Complaints

(18) That sector regulators review and assess: the steps a provider has taken to help ensure that its residents are aware of and able to access local third-party support; and the effectiveness of feedback processes, including:

• whether a feedback champion is required to act as a conduit between management
• residents/relatives, so that a culture of listening to and acting on feedback prevails

(19) That central government in England, the Scottish Government and Northern Ireland Executive undertake, in consultation with relevant bodies, a review of the coverage of advocacy services for residents of care homes with a view to ensuring that all residents have access to adequate services which are sufficiently targeted at care home residents:

• in England, that central government introduces a statutory requirement for providers to sign-post to the Local Government and Social Care Ombudsman
• in Northern Ireland, that the remit of the Northern Ireland Public Services Ombudsman be extended to hear complaints from private funders

Consumer decision making recommendations

(20) That a working group is set up from all industry stakeholders across the 4 nations, to take forward our work and to develop our recommendations further so they can be implemented in practice. These measures to be implemented cover:

• improvements in the existing provision of supported decision making (which is likely to involve development of online tools, telephone advice services, dementia advisers, social workers, and care navigators) to give people access to the information, advice and support they need to make informed decisions
• agreement on common standards for the provision of online information to be published on care provider and other websites, with the aims of supporting the development of online search and comparison tools, and making it easier for people to compare providers
• guidelines for all LAs on providing people with better information on how the care system works, care homes in their areas, and on choosing a care home
• that central government works with an organisation (or organisations) with a recognisable brand name and presence in care of older people to undertake an ongoing programme of work to promote awareness and develop prompts to encourage and support people to consider their care options earlier

Response

All recommendations accepted, or accepted in principle:

• Government response to CMA care homes market study
• Welsh government response to CMA care homes market study