Interview with Stephen Ladyman

Derren Hayes, deputy news editor at Community Care, asks Stephen Ladyman, the new community care minister at the Department of Health, about his plans for the sector.

Care homes

Derren Hayes: You’ve said that the prime minister has made it clear that one of your biggest tasks is to address the crisis in the care home sector. How do you intend to go about that?

Stephen Ladyman: I do not accept that it is in crisis. There are 500,000 care home places in the country and 450,000 people in them. I do accept that in certain parts of the country there are more difficulties than others.

As a minister, I have to look at the charges made by all sides and whether people are being treated fairly and whether we can improve the guidance given to them, looking at the way care homes are commissioned and contracts managed. We have got officials looking at all these issues and we will form a view on how we can improve guidance.

It is clear that the money to resolve any problems has been given to councils. Already we have had a quarter increase in real terms, and a further 6 per cent in real terms over the next two years as well.

DH: So why are there homes closing and a shortage of beds in some areas?

SL: The issue is whether local authorities are diligently exercising their duties. These are only issues that can be tackled locally and not resolved from Whitehall. If I was to suggest a standard increase in care home fees, that may not be enough in some areas.

DH: So what can be done?

SL: We are looking at a range of options: whether we should have a model of how to work out what care home costs should be, which locally authorities could feed information into. It would be an agreed solution which everyone should have input into. But whether it is possible to come up with that kind of solution and whether it is desirable we are still looking at. It is just one of the options.

DH:  What are the other options?

SL: Is best practice being followed with commissioning practices? Having agreed a price for care home places, is best practice being followed by the care home provider and council? Does the contract give security for the person being looked after?

DH:  How will the delayed discharge reimbursement system help to address this issue?

SL: We have given the money [£50m in the first 6 months] up front so that councils can make sensible judgements about capacity. We’ve calculated the money to ensure that any local authority that does a reasonable job will make a profit on the transaction - in that they will pay less in fines than they receive in grant.

DH: Some local authorities would be surprised to hear you say that.

SL: We have worked very carefully on the figures and I am confident they are right. If local authorities and the NHS locally are doing partnership working in the way we want them to be doing then they will have no trouble avoiding any penalties.

If they decide to drag their heels and do no work at all then the money we are giving them will come back to health services to pay for doing the jobs that would normally be done by local authorities.

Care home owners need to understand that they are in a market. Why should councils pay more than they need to? They will pay the lowest rate - many local authorities are thinking of going into care home ownership again themselves.

DH: Can you see a situation where hospital trusts could commission care home beds directly with providers if bed blocking was occurring because councils were not prepared to pay the price for care beds?

SL: If the best way to deal with the problem was for a hospital to commission the services and the local authority to pay a share for them there is no reason why they couldn’t do that. But I would be surprised if the hospital trust got into commissioning directly.

If the local authority is letting them down, either they allow bed blocking to continue or deal with the problem themselves. I would regard that as a very last resort, and the system is designed for that not to happen.

Disabilities

DH: There have been concerns raised that the Access to Work scheme is not supporting disabled people get back into employment. Are you aware of that?

SL: That is news to me. I certainly want to be making it clear that that is not acceptable. Allowing people to work is a key message from Valuing People.

Recently I was in Wigan and visited a series of schemes. Seeing people with learning difficulties and seeing them making a contribution was uplifting. These are the sorts of schemes we have to be promoting.

Continuing Care

DH: The bill for paying for continuing care costs is rumoured to be more than the £300m set aside for this purpose. How will you make up the shortfall?

SL: I’m not aware of that figure. We’ve said we will compensate people and we will honour that. End of story. No problem.

Recruitment and retention

DH: The Department of Health has been running a social worker recruitment campaign for some time but isn’t it true that there will never be enough social workers?

SL: I would never take on a counsel of despair and say we’ll never have enough. Because of the important contribution they make, we will always want more.

We need to be even more innovative about the way we search for such people and support those that want to change their career and the way we reward people involved in social work and social care.

At the first meeting I went to, the director of social services for Wigan said that because of the agenda for change in the NHS - offering performance related incentives to people -there is going to be a temptation for social workers to move into the health service. He wanted a similar scheme for care workers and social workers. But that is easier in the NHS because staff are employed by the man down the corridor (health secretary, John Reid). It is not the same in social services: I can only lead the start of discussions that will lead to reform.

There is a demand that we have that debate. I don’t want to prescribe how that debate will go: I want views from all sides. What are the barriers to recruitment and what turns people off from entering the profession or feel positive and negative about it when they are in there? I’ve asked the Association of Directors of Social Services and the voluntary sector to start thinking about it.

Maybe we would have a different agenda if I opened the cheque book – we want to create a workforce that feels valued and create an environment that people understand how much they owe to social workers.

DH: How?

SL: Rather than focus on the one or two bad cases, we should focus on the millions of people that are helped by social workers. This is a good opportunity to do these things now and I don’t think we can bank on that kind of increase (6 per cent a year until 2005-6) in future years.

DH: Some people have criticised you for not having a strong social care background – what do you say to them?

SL: I will allow actions to be my judge rather than words. If you look into my background deep enough, you will see I have covered a lot of the ground I cover now.

Older people

DH: How is the extra care scheme developing?

SL: Across the NHS and social care we want to provide choice. Under Nye Bevan’s vision of the NHS there was never a one size fits all approach. We want choice across the board.

In terms of elderly care, the majority of older people are saying they want to stay in their own homes for as long as possible. I see a spectrum for provision that people can choose from, including their own home, sheltered housing and domiciliary care.

I can envisage a situation where a care package you are receiving changes as you change: you initially only need a few additional services, then as you get a bit frailer you may need a few more domiciliary services, and you change the package as you continue through your life.

I could see people buying a place in extra care homes and the equity released when they die. I could see extra care as being in the private sector, social care sector or their own homes.

Joint working

DH:  How do you see the future of joint working between the health and social care sector?

SL: I’ve just met with Bexley Care Trust. The Primary Care Trust and council are committed to working together. I wanted to find out what the magic ingredient was for them to work together. If we want to replicate that, we need to make sure there are cultures. In some places there are more serious obstacles than others, but I want to find out what makes it work and what doesn’t.