Local people have been living in nursing homes for over 400 days, while they wait for a domiciliary care package to be put in place to allow them to return to their home.

This fact was revealed to local Councillors by the Western Trust’s Director of Nursing, Primary Care and Older People’s Services, Bob Brown, during a meeting of the Fermanagh and Omagh Health and Social Care Services Group in October.

Mr. Brown faced questions from Councillors about the waiting lists and costs associated with domiciliary care, which is the range of services, including home helps, put in place to support an individual in their own home.

Domiciliary care is carried out by a mixture of home helps employed directly by the Western Trust and home helps employed by the independent sector i.e. private companies which secure contracts through the Trust’s procurement process.

Last year in the Western Trust, 77 per cent of domiciliary care contact hours were provided by the independent sector and 28 per cent by the Trust. 

This pattern was the same across all five Trust areas and a Department of Health report has suggested that the difference may be due to more intensive domiciliary care packages being contracted out to independent providers by the Trusts.

The Western Trust is currently spending £23.35 per hour for in-house domiciliary care services and is overspent in this area, Mr. Brown said. These costs included carer time, travel, some capital costs, overheads and supervisory costs. 

Meanwhile, the hourly rate paid to the independent sector for domiciliary care is between £11.48 and £12.20 per hour, he revealed.

Mr. Brown said there is “minimal difference” in the take home pay of domiciliary workers employed by the Trust and independent sector staff. He added that the Trust was currently working through a tendering process to ensure value for money in these costs. 

A report from the meeting shows that Mr. Brown also told Councillors that the Trust spent £2.9 million in 2015-16 and £3.3 million in 2016-17 on domiciliary care commissioned from the independent sectors in Fermanagh. While Fermanagh accounts for 27 per cent of the Western Trust’s population, domiciliary care spend was higher here than in comparison to other parts of the Western Trust.

He said that in the past 18 months, 36 people in Fermanagh had been discharged to a nursing home at a total cost of £280,000. 

Mr. Brown told the meeting that one person had spent a total of 457 days in a nursing home waiting to get home. He said the second longest stay in a nursing home while waiting to get home was 406 days. 

He told the meeting that both in-house and independently commissioned domiciliary services were all subject to the same regulatory standards.
Mr. Brown stated that carers were placed according to individual needs including demand and location. He advised that gaps in provision delay were individually assessed and were reviewed on a constant basis. 
He confirmed that the cost of domiciliary care per person in Fermanagh for 2016-2017 was £3,600 which was slightly more than the cost in Omagh, Strabane and Derry/Londonderry. 

He told Councillors that provision of domiciliary care was dependent on the individual case scenario and that a pre-discharge assessment was carried out for each individual patient before they were discharged. 
Meanwhile, Councillors also received an update on the Western Trust’s International Recruitment Campaign, which aims have more doctors employed by the Trust and less money being spent on expensive locum staff.

Following six recruitment campaigns in Europe and three in non-European countries, 465 applicants are undergoing pre-employment checks on a regional basis but only eight applicants had commenced employment to date.  

Initially, 1,400 jobs had been offered but 100 applicants withdrew after failing either the Language test or the Clinical Skills test. Mr. Brown told Councillors that international differences in the standard of education was a factor in the exam failures. He added that Brexit implications may have an effect on international recruitment in the future.

He said a number of additional training places had been offered, but it would be 2019 before any of the trainees would be ready to take up their pre-reg places.

Mr. Brown told Councillors that the Trust is currently targeting locally trained nurses working in England, Scotland and Wales in an attempt to encourage them to return to work in the Western Trust.