The case brought by IHCP surrounded the setting of the regional rate for payment by Health Trusts to private care providers; this tariff is used as the base for calculating any top-up fee for homes charging above this rate. Private care home providers are free to set what price for care they want, yet Trusts are required to contract for placements at the most competitive rate available.
The rate was increased by 2.5% for the year 2012/13, at rate contested by ICHP in a meeting with the Health & Social Care Board (HSCB) in March 2012, however Mr Cummings, Director of Finance HSCB said that he was seeking the Board’s approval to a 2.5% uplift in tariffs and that the 2.6% minimum efficiency targets was not passed on, thus providing an uplift equivalent to 5.1%. This was passed by the board during the same meeting.
Despite the raise of 2.5 % in tariffs and not being subject of efficiency saving the IHCP took a judicial review against the Board, The review was taken against the Health & Social Care Board and was brought on 3 grounds:
(a) Failure to comply with, justify departure from or properly take account of, the terms of Departmental Circular ECCU 1/2010 (the Guidance argument);
(b) Failure to take account of the potential effect of the decision on Article 8 rights (the Convention argument); and
(c) Failure to adequately consult the applicant (the consultation argument)
Following the decision IHCP have stated “IHCP members wish our older people and vulnerable adults to receive sustainable quality care and simply require the necessary resources to allow them to continue to do so.” (link)
From beginning to end of this review sustainability has been the most outstanding theme, could this now force Health Minister and CEO of the HSCB John Compton rethinking parts of Transforming Your Care and closing half of the statutory residential homes throughout Northern Ireland. If statutory homes are closed and there is a future crisis in private care homes there will be no safety net for elderly patients requiring care and they will end up as long stay patients in hospital beds.
Private Care homes are businesses and must have a viable amount of residents to maintain economic viability, while Trust are required to seek the most competitive rate for care, if they cannot find accommodation that is suitable at the regional tariff the Trust must top up these payments. Private care homes could be falling on their own sword of over inflated prices.
In the build up to needing to buy private health care beds the NHSCT shut down 2 inpatient wards at the Mid Ulster Hospital, known as wards 2 & 3. These were shut down under Modernization & recovery plans that had a one of saving of £875,000.
After shutting these 2 wards down the trust then commissioned Brooklands for 15 intermediate Care beds and Dalriada Urgent for out of hours services. Brooklands Private Health Centre was been awarded £430,155 to provide 15 intermediate health care beds for 6 months, not unlike the type of beds that have recently been removed from the Mid Ulster Hospital. In addition to this Dalriada Urgent Care was awarded £86,418 to provide backup services. This is 6 month contract which has already been renewed leaving the NHSCT paying out near £1 million per year, out stripping in one year the amount it saved on closing the 2 wards in Mid Ulster Hospital. Had the Mid Ulster wards remained opened it would have had a greater capacity and the pressures that Antrim Hospital are currently facing could of been greatly reduced.
If there are future problems in private health care providers and they are forced to close this will cause severe capacity problems in the public health care system, the Health Minister must consider any future reliance on private care on the basis that if it closes that there is sufficient capacity within the public health care system to cope with the extra demand.