Mr Gallagher (Deputy Chairperson)
Ms Armitage
Mr Berry
Mrs Courtney
Mr J Kelly
Ms McWilliams
Ms Ramsey

Mr R Devlin ) Belfast Carers Centre

I welcome Mr Ricky Devlin from the Belfast Carers Centre.

Thank you for your invitation. I will try to keep my presentation as short as possible, because I run the risk of sounding like a cracked record. I am about to repeat much of what has already been said.

Generally speaking, the Belfast Carers Centre welcomes the introduction of the legislation. However, there are several short points that I would like to make. My chief concern is the definition of what constitutes nursing care. I see little distinction between personal care and nursing care. That could be an invitation for endless arguments and discord in relation to the legislation. I see it is deemed as being nursing care by a registered nurse, or nursing care carried out under the direction of a registered nurse. There is much ambiguity in that definition. Other staff routinely carry out many duties that were once the preserve of a qualified nurse. The boundaries in the legislation are somewhat hazy. Therefore, I would be fearful of potential disruptive debates as parties seek to challenge or present existing or potential interpretations of the Bill's wording.

Would I be presumptive in saying that if a cost has been formulated for this, should some thought not have been given to what actually constitutes nursing and personal care? I have possibly more questions than answers. Would it not be appropriate to include some such detail in the Bill?

There is also a question of infrastructure in relation to free nursing care. This issue has already been touched upon, especially in an appeals process. Whom do I appeal to if I am the carer of my wife or my father in a nursing home, and I am unhappy with what has been presented to me? Do I appeal to the nursing manager, the officer in charge or to this Committee? Whom do I appeal to? Such a question is one reason that the issue should be considered carefully.

A patient may be in a nursing home but may still be cared for by a wife, husband, daughter or son. I would be fearful of endless distress and argument over what constitutes what. If there is a review, the argument may arise that one person may feel that the case requires nursing care, whereas in someone else's opinion it is not nursing care. That would create much difficulty and distress. There is too much room for interpretation. Those who are the strongest advocates will win the argument; therefore, it is the most vulnerable and the least able to represent their views who will suffer the most. There is a danger that residents in one home may have different levies charged. The situation is a hornet's nest. There are too many grey areas and not enough black-and-white areas. The nettle should be grasped. There is a false distinction between personal care and nursing care: I cannot unpick that problem and have yet to see any other interpretation that would not leave room for argument.

You may not be in a position to answer this query, but given that you are from the Belfast Carers Centre, there is some evidence to suggest that with the transfer of reserved rights from the social security budget to the health budget that the problem is not only current funding. One of the trusts makes the point that in future these people may not be found places in homes, but may have to find places elsewhere because that funding runs over the years and those places start to decrease. Do you anticipate that carers in homes will take on that responsibility, because the Bill will have implications for those who are being nursed in their own homes?

Yes, that would be the case. The situation with regard to nursing or residential home care and support for the cared-for in their own homes is a time bomb. There is concern that more pressure will be put on carers to continue to care within the marital or family home, because provision will not be available, or the quality of that provision will be questionable. I do not know if it is anecdotal evidence, but the quality of the care currently provided in nursing and residential homes is a regular concern of carers coming to the centre. Unless that situation is addressed fully, the concerns I have heard expressed, and from my own experience with my family, are that carers will be taking on a greater burden. That could be the case for carers even if the cared-for person is in a nursing home. That could add to, rather than alleviate, their distress. Some of the carers' financial concerns and burdens may be addressed, but frequently it is the families and the carers of the cared-for - as we would arbitrarily describe them - who pick up the tab.

Ms Armitage and John Kelly raised the point that there seems to be variation in the rates. The situation where people are transferred out was also raised. John Kelly mentioned the case where someone had not been readmitted to a home.

We may all be aware of cases where people have not been accepted. That seems to make an even stronger case that rates should be agreed regionally, and that variation is avoided.

That is very important.

Does the group that you represent see that? Are you getting phone calls about people being shifted here, there and everywhere?

Less so. However, I am aware of the variations. The problem of readmittance is quite common. One has to ask why that is happening, and sometimes the answer is that a person's care or nursing needs change. We may not be qualified or equipped to maintain that person safely within the unit. Personal development is another matter. What sort of provision of care is there for that individual? Those variations do exist.

We could probably understand that, based on assessment of need, but our concern, if the Bill is passed, is that there might be assessment based on bands.

That could happen, but I would not be -

We would increase the disorientation of many older people by shifting them around the system.

That is a valid point, which applies to both patients and their carers. There is evidence of that happening already between one nursing home and another. I take people round nursing homes to show them the type of provision available, tell them what each home is charging and what they will be expected to pay. That causes much confusion and upset at a time when people are looking for suitable nursing care for their loved ones. All that does is pour fuel on the fire, causing more confusion, upset and disorientation. A false distinction is being made between personal care and nursing care.

The centre has highlighted that an infrastructure needs to be in place. Is the infrastructure there? If not, what changes must be made?

The basic problem is the argument about what constitutes nursing care. I do not think that the infrastructure is there at the moment, because nobody has a ready answer. People ask me to define nursing care and personal care, and I cannot give an answer. I reply that it is in the legislation, and I am told that it is not. Is it anywhere else? I cannot see it. I am simply an outside agent and an advocate for carers. If I have a statutory responsibility, whom do I go to? That is not clear. If I go to body A and it does not know, that indicates a lack of infrastructure and a lack of clarity. That will create more difficulties than it will resolve.

Are you saying that the provision of that infrastructure will reconcile the differences?

The way to reconcile the difference is to acknowledge that there is no difference. If a difference were to be made, then make it, because I cannot see it. We need a structure that allows a quick and clean method of reviewing the matter. Private day nursing care needs to change.

Thank you, Mr Devlin.