PP No 2021/0012

PP 2021/0012

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS

First Report for the Session 2020-2021 Salisbury Street Nursing Home

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS FIRST REPORT FOR THE SESSION 2020-2021 SALISBURY STREET NURSING HOME

3.1 There shall be a Standing Committee of the Court on Public Accounts.

3.2 Subject to paragraph 3.6, the Committee shall have –

(a) a Chairman elected by Tynwald,

(b) a Vice-Chairman elected by Tynwald,

(c) four other Members, who shall be Chairman of each of the Policy Review Committees (ex officio) and the Chairman of the Committee on Constitutional and Legal Affairs and Justice;

and a quorum of three.

3.3 Members of Tynwald shall not be eligible for membership of the Committee, if, for the time being, they hold any of the following offices: President of Tynwald, member of the Council of Ministers, member of the Treasury Department referred to in section 1(2)(b) of the Government Departments Act 1987.

3.4 The Committee shall –

(a) (i) consider any papers on public expenditure and estimates presented to Tynwald as may seem fit to the Committee;

(ii) examine the form of any papers on public expenditure and estimates presented to Tynwald as may seem fit to the Committee;

(iii) consider any financial matter relating to a Government Department or statutory body as may seem fit to the Committee;

(iv) consider such matters as the Committee may think fit in order to scrutinise the efficiency and effectiveness of the implementation of Government policy; and

(v) lay an Annual Report before Tynwald at each October sitting and any other reports as the Committee may think fit.

(b) be authorised to require the attendance of Ministers for the purpose of assisting the Committee in the consideration of its terms of reference.

(c) be empowered to issue directions under Standing Order 5.6(3), provided that any direction so issued shall be reported to Tynwald within a year. (d) be the Accounts Committee referred to in section 3 of the Tynwald Auditor General Act 2011, with the relevant powers and responsibilities in relation to the Tynwald Auditor General; and

(e) be the Tynwald Public Accounts Committee referred to in section 3 of the Tynwald Commissioner for Administration Act 2011, with the relevant powers and responsibilities in relation to the Tynwald Commissioner for Administration.

3.5 The Chairman, Vice-Chairman and any member of the Committee shall not sit when the accounts of any body of which that person is a member are being considered.

3.6 Should the need arise in relation to a particular matter, such as a conflict of interest, Tynwald may elect an alternate member for the purpose and duration of the Committee’s consideration of that matter. Subject to paragraph 3.5, a conflicted member so replaced shall continue to serve as a member of the Committee for all other purposes.

The powers, privileges and immunities relating to the work of a committee of Tynwald include those conferred by the Tynwald Proceedings Act 1876, the Privileges of Tynwald (Publications) Act 1973, the Tynwald Proceedings Act 1984 and by the Standing Orders of Tynwald Court.

Committee Membership

The Hon J P Watterson SHK (Rushen) (Chairman)

Mr L L Hooper MHK (Ramsey)(Vice Chairman)

Mrs C L Barber MHK (Douglas East)

Ms J M Edge MHK (Onchan)

Mrs J Poole-Wilson MLC

Mr C R Robertshaw MHK (Douglas East)

Copies of this Report may be obtained from the Tynwald Library, Legislative Buildings, Finch Road, Douglas, IM1 3PW (Tel: 01624 685520) or may be consulted at www.tynwald.org.im

All correspondence with regard to this Report should be addressed to the Clerk of Tynwald, Legislative Buildings, Finch Road, Douglas, Isle of Man, IM1 3PW. Table of Contents

I. EXECUTIVE SUMMARY...... 1

II. INTRODUCTION...... 2

III. BACKGROUND...... 3

IV. BACKGROUND TO THE PROPOSAL TO PURCHASE SALISBURY STREET NURSING HOME...... 6

V. APPOINTMENT OF OPERATOR AND OPENING OF HOME ...... 7

VI. ALLEGATIONS MADE IN THE MEDIA BY DAVID MURRAY ...... 8

VII. CONSIDERATION OF ALLEGATIONS ...... 9

Bed Occupancy Levels ...... 10

Breakeven Calculation...... 12

Benefit Funded Percentages ...... 13

Paying Twice ...... 14

Personal Allowance Payments ...... 16

Cost of buying Salisbury Street...... 16

Coercion ...... 19

VIII. INSPECTIONS PROCESS ...... 20

IX. SUMMERHILL VIEW ...... 22

X. COMMENT FROM THE DEPARTMENT OF HEALTH AND SOCIAL CARE...... 23

XI. SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS ...... 23

WRITTEN EVIDENCE ...... 25

APPENDIX 1: 14TH JUNE 2016 - MTTV INTERVIEW WITH HOWARD QUAYLE MHK, MINISTER FOR HEALTH AND SOCIAL CARE 27

APPENDIX 2: 21ST JUNE 2016 - TYNWALD HANSARD ITEM 7 ‘SALISBURY STREET CARE HOME – PURCHASE BY DHSC – EXPENDITURE APPROVED’ 33

APPENDIX 3: 29TH JULY 2016 - ISLE OF MAN GOVERNMENT MEDIA RELEASE ‘PRIVATE OPERATOR SOUGHT FOR SALISBURY STREET CARE HOME’ 51

APPENDIX 4: 21ST MARCH 2017 - DEPARTMENT OF HEALTH AND SOCIAL CARE RESPONSE TO A REQUEST FOR INFORMATION UNDER THE FREEDOM OF INFORMATION ACT 2015 55

APPENDIX 5: 18TH MARCH 2018 - MTTV INTERVIEWS WITH DAVID MURRAY 91 APPENDIX 6: 19TH MARCH 2018 - DEPARTMENT OF HEALTH AND SOCIAL CARE STATEMENT TO ISLE OF MAN NEWSPAPERS 103

APPENDIX 7: 20TH TO 26TH MARCH 2018 - ISLE OF MAN EXAMINER NEWS ARTICLE ‘PUBLIC MONEY ‘SQUANDERED’ ON CARE HOME’ 107

APPENDIX 8: 22ND MARCH 2018 - ISLE OF MAN TODAY ONLINE ARTICLE ‘TAXPAYERS’ CASH SQUANDERED SAYS CARE HOME BOSS’ 111

APPENDIX 9: 2018 TO 2020 - TYNWALD AND HOUSE OF KEYS QUESTIONS REGARDING SALISBURY STREET 115

APPENDIX 10: SEPTEMBER TO OCTOBER 2018 - CORRESPONDENCE WITH DEPARTMENT OF HEALTH AND SOCIAL CARE 127

APPENDIX 11: MAY 2019 - CORRESPONDENCE WITH TREASURY 193

APPENDIX 12: 2016 TO 2017 - MEDIA COVERAGE REGARDING A DEATH AT BEACONSFIELD NURSING HOME 197

APPENDIX 13: OCTOBER TO DECEMBER 2020 - CORRESPONDENCE WITH DEPARTMENT OF HEALTH AND SOCIAL CARE 203

APPENDIX 14: 4TH SEPTEMBER 2020 - DEPARTMENT OF HEALTH AND SOCIAL CARE SALISBURY STREET DATA SNAPSHOT OF COMMISSIONED BEDS AND CLIENT’S BENEFITS PAYMENTS 213

APPENDIX 15: 6TH SEPTEMBER 2019 - MANX RADIO REPORT ‘PLANS FOR A 73-BED CARE HOME ON WOODBOURNE ROAD’ 217

APPENDIX 16: SEPTEMBER 2015 - BUSINESS CASE AND EXPLANATORY MEMORANDUM FOR THE CONSTRUCTION OF SUMMERHILL VIEW 221

APPENDIX 17: 1ST APRIL 2017 - SALISBURY CARE LIMITED ANNUAL RETURN 251

APPENDIX 18: 12TH MARCH 2021 - CORRESPONDENCE FROM KATHRYN MAGSON, INTERIM CHIEF EXECUTIVE, DEPARTMENT OF HEALTH AND SOCIAL CARE 257 To: The Hon Stephen C Rodan OBE MLC, President of Tynwald, and the Hon Council and Keys in Tynwald assembled

STANDING COMMITTEE OF TYNWALD ON PUBLIC ACCOUNTS FIRST REPORT FOR THE SESSION 2020-2021 SALISBURY STREET NURSING HOME

I. EXECUTIVE SUMMARY

1. The Isle of Man is not alone in seeing an increase in demand in the nursing care sector; and an upward trend is predicted. The purchase of Salisbury Street Care Home by Isle of Man Government, with the expectation of the facility being run by a private operator, provided an opportunity to respond to this demand. It was therefore a concern to note allegations made by David Murray, a former director of the firm selling the home and director of the private company contracted to run it.

2. We would like to thank Mr Murray for raising his concerns; we acknowledge that speaking out in this way is not an easy thing to do. We have considered each of the issues raised carefully and, while we do not agree with Mr Murray on all of the points raised, we have been pleased to have the opportunity to shine a light on what worked well and what did not.

3. We have found that there were some mistakes made, some elements of the deal were misunderstood, there was some unfortunate timing, and there was some inappropriate conduct by Department staff, but we were not able to draw all of the same conclusions as Mr Murray. Each of the points he raised in the media are addressed in detail in the body of the report.

4. We have concluded that buying Salisbury Street represented the right decision, both at the time and with hindsight. We have considered the cost of purchase and

1 the economics of block booking beds. The purchase price was eminently justifiable. The economics of block booking beds is not straightforward, but we have not identified any long-term risk to the public purse as a result. We note with concern that the Department in conjunction with Treasury acted outside of vires leading to a potential loss to the taxpayer in excess of £600,000, split almost evenly between paying for empty beds and paying twice through benefits. We conclude that Government needs to be careful in assessing its vires when entering into commercial negotiations.

5. In our quest for value for money, the Committee remain concerned that in the context of Salisbury Street being purchased for £7.9 million, and the new similarly sized care home planned for the Homefield site at an estimated £5 million,1 Government has commissioned the building of a similarly sized care home on the former Glenside site. This is Government owned land, and yet appears to be costing twice as much as it would for a private developer.2 We recommend that the Department justify its value for money in light of this report.

II. INTRODUCTION

6. In 2018 the Public Accounts Committee resolved to look into allegations aired in the media3 in relation to the purchase and operation of Salisbury Street Nursing Home.

7. The inquiry work was substantially concluded by the end of 2019; final publication of this report has been delayed due to the impact of the Covid-19 pandemic on normal parliamentary business.

8. During this period the membership of the Public Accounts Committee has changed; Mr Crookall, Mr Cretney and Mr Callister left the Committee and were replaced by Mr Hooper, Ms Edge and Mrs Barber. Mrs Barber is a Member of the Department of Health and Social Care so has not taken any part in this inquiry.

1 Appendix 15 2 Appendix 16 3 Appendix 7 - Isle of Man Examiner, 20-26 March 2018 p1-2; Appendix 5 – Transcripts of MTTV interview with David Murray, Adorn Domiciliary Care, https://www.manx.net/tv/mttv/watch/85223/operator-demands-enquiry-into-nursing-home-1-, https://www.manx.net/tv/mttv/watch/85224/operator-demands-enquiry-into-nursing-home-2-; and Appendix 8 – IOM Today, 22 March 2018, http://www.iomtoday.co.im/article.cfm?id=39372&headline=Taxpayers%27%20cash%20squandered %20says%20care%20home%20boss§ionIs=news&searchyear=2018; accessed 13 Aug 2020

2 III. BACKGROUND

9. When the Minister for Health and Social Care sought approval from Tynwald in 2016 to spend up to £8.1 million to enable the Isle of Man Government to purchase Salisbury Street Nursing Home, he said that nursing home care was ‘provided only by private sector operators on the Isle of Man … funded through a combination of Social Security benefits – in particular, Income Support for those who are eligible – and self-funding by those who have sufficient income and releasable assets to meet their fees without state support. Around half of nursing home residents are state funded and the other half pay for their own care.’4

10. He went on to say that there were no nursing home beds available at benefit-level rates5 – private nursing homes were able to charge whatever the market would bear and the average cost of nursing care was around £950 per week;6 an amount in excess of the maximum social security benefit rate,7 comprising of just under £820 per week;8 and that there was insufficient nursing care provision to meet demand which was creating difficulties for individuals needing that level of care, their families, Noble’s Hospital and for ‘the clinical and care staff stretched to provide suitable care for people of this Island.’9

11. The NHS describes residential care as providing accommodation and personal care, such as help with washing, dressing, taking medicine and going to the toilet.10 Nursing care homes provide services for people that may need more care and support so, in addition to personal care, there are always sufficient qualified nursing staff on shift who are responsible for ensuring that the nursing needs of people are met11. Because of the medical support, a nursing care place will usually cost significantly more than a residential care place.

12. In 2006 the Council of Ministers commissioned the Isle of Man Office of Fair Trading (OFT), under section 19 of the Fair Trading Act 1996, to investigate nursing

4 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3250-3254 5 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3275-3276 6 26 Jun 2018 Keys WA7 Fees of between £920-1005pw with 437 nursing beds available across 7 homes 7 This would usually comprise of one or more of the following benefits: attendance allowance, nursing care contribution, long term incapacity benefit, disability living allowance, state retirement pension and income support. 8 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3255-3259 9 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3276-3283 10 https://www.nhs.uk/conditions/social-care-and-support-guide/care-services-equipment-and-care- homes/care-homes/ accessed 14 Aug 2020 11 Adult Care Homes Minimum Standards 1 Apr 2017 (DHSC Registration & Inspection Unit) p24 https://www.gov.im/media/1356010/2017-adult-care-homes-standards-v2.pdf accessed 14 Aug 2020

3 home charges.12 In their first report, prepared with assistance from a UK specialist, Laing and Buisson,13 it was noted that ‘demand for nursing home places at current patterns of care is projected to grow by nine percent over the next five years and by 22 percent within ten years;’14 at that time 365 nursing care beds were available15 in seven nursing homes, all privately operated.16

13. In 2007, in a subsequent report, also commissioned by the Council of Ministers, OFT made the following recommendation:

that the DHSS urgently reviews its policy of funding nursing home care through the payment of benefits. Options identified in this report and the 2006 Report include the direct purchasing of beds from operators and the provision of a Department owned nursing home, with this latter option being recommended solely on the basis that the home is not operated by the Department itself but rather by a specialist operational contractor. Whatever policy direction is selected, the DHSS should determine and publish a method for calculating the amount that it is willing to pay for private sector nursing care that addresses the needs of the individual, the needs of the operators and the resources of the Department.17

14. A 2015 report from the Director of Adult Social Care to the Social Policy and Children’s Sub-Committee of the Council of Ministers on the Funding of Nursing and Residential Home Care stated that, ‘there are individuals in residential home beds, whose care needs cannot be met in the longer term, but who cannot afford to transfer to nursing home care.’18 It was noted that this would both reduce the residential care bed capacity in the Island and increase the demand for hospital care, through delayed discharges, for those who could not be looked after at home; ‘since the White Hoe and the Mannin Infirmary closed, there has been no

12 Report on Investigation into Nursing Home Charges by the Isle of Man Office of Fair Trading p2 https://www.gov.im/media/1359744/reportoninvestigationintonursing.pdf accessed 14 Aug 2020 13 https://www.laingbuisson.com/ accessed 14 Aug 2020 14 Report on Investigation into Nursing Home Charges by the Isle of Man Office of Fair Trading p4 https://www.gov.im/media/1359744/reportoninvestigationintonursing.pdf accessed 14 Aug 2020 15 Ibid p7 16 Ibid 17 Report on Investigation into Nursing Home Charges GR 0026/2007 para 7.7 https://www.gov.im/media/622949/finalreportintonursinghomeprice.pdf accessed 14 Aug 2020 18 Report of the Select Committee on the Funding of Nursing and Residential Care PP 2016/0120a Appendix 2 p75

4 state provision of long-term Nursing Care and there has been a rising differential between charges for residential and nursing home care on the Island.’19

15. In 2016 there were 448 nursing care beds, available across eight homes, with approximately 94% occupancy.20 In April 2016, the DHSC published its ‘Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021’21 alongside a public consultation22 in which it stated an intention to explore ‘a contractual relationship with providers for an, as yet, unspecified number of beds.’23

16. The report of the Select Committee on the Funding of Nursing and Residential Care24 published in June 2016, concluded:

that it did not favour a return to nursing homes operated by the public sector… where supply is inadequate, it is legitimate for Government to intervene in generating supply in the market. The best use of public funds might be in building and owning new residential and nursing homes and commissioning social enterprise to operate them.

17. This was the political landscape at the time when the proposal to purchase Salisbury Street Care Home was brought to Tynwald in June 2016.25

19 Report of the Select Committee on the Funding of Nursing and Residential Care PP 2016/0120a Appendix 2 p74 20 Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021 Appendix iii https://www.gov.im/media/1357424/mps-and-ci-current- supply.pdf accessed 14 Aug 2020 21Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021 11.2 p 19 https://www.gov.im/media/1357421/consultation-document.pdf accessed 14 Aug 2020 22 https://www.gov.im/media/1357426/the-future-of-services-for-older-people.pdf 23 Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021 11.2 p 19 https://www.gov.im/media/1357421/consultation-document.pdf accessed 14 Aug 2020 24 Report of the Select Committee on the Funding of Nursing and Residential Care PP 2016/0120a 25 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7

5 IV. BACKGROUND TO THE PROPOSAL TO PURCHASE SALISBURY STREET NURSING HOME

18. The Minister for Health and Social Care, Hon. Howard Quayle MHK, spoke to MTTV26 on 14th June 2016 about plans to purchase a new £8 million nursing home from a private contractor. On 21st June 2016, he advised Tynwald that the demand for nursing care ‘is quite clearly outstripping capacity at this time and we need to do something that will provide a viable solution urgently.’27

19. He said that at that time there were on average 30 people in Noble’s Hospital waiting for a nursing home bed; and that the cost of these beds for a year was £3,120,000.28

20. He went on to say that:

Over the next 20 years, the number of people on the Island aged 65 and over is projected to grow from 17,000 to 26,500 – an increase of 55%. With our current model of care, up to 411 additional care beds will be required by 2036, the equivalent of one new care home every 18 months to two years for the next 20 years. An average sized care home will provide between 55 and 60 beds, and that does not take into account, Hon. Members, the fact that if you analyse the current stock, probably 10 or 11 of the current stock will need major investment or replacement.29

21. The Minister explained that DHSC, in conjunction with the Treasury, had considered the most cost-effective way to resolve the situation; consideration had been given to increasing the social security benefit level by around £100 per week, to assist in meeting the cost of a private nursing home fees, but that this ‘would not put additional capacity in the market and it would also serve to increase the overall cost of care paid for by Government by an additional £1.2 million a year;’30 plans and costings for a new 60-bed unit31 on the former Glenside nursing home site on Victoria Road, Douglas had been drawn up but a new build would take a minimum of three years and would cost an estimated

26 Appendix 1 -https://www.manx.net/tv/mt-tv/watch/79433/new-8m-govt-nursing-home, accessed 13 Aug 2020 27 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3286-3287 28 Ibid ll3329-3334 29 Ibid ll3267-3273 30 Ibid ll3261-3263 31 Report of the Select Committee on the Funding of Nursing and Residential Care PP 2016/0120a App 4 p94

6 £10.4 million.32 Another option would be to purchase a purpose-built 68-bed nursing home for between £7.9 million and £8.1 million, being constructed by Salisbury Care Ltd, and due for completion by the end of September 2016.33

22. The Minister expressed the view that it would make economic sense to purchase a nursing home at a lower cost than they had been quoted for building one, which may take up to three years to complete. He explained that DHSC had initially approached Salisbury Care Ltd to see if it would consider making an agreement for a block booking of ‘benefit-level’ beds, but this proposal was declined.34

23. So, the Minister explained, DHSC were proposing to purchase the facility and, if approved by Tynwald, would ‘immediately start an open procurement process to identify an operator for the facility on the basis that two-thirds of the 68 beds are available at a cost accessible to those reliant on support from Social Security’.35

24. The Motion made –

That Tynwald authorises the Treasury to provide a sum not exceeding £8,100,000 as a Capital vote to fund the purchase by the Department of Health and Social Care of Salisbury Street Care Home;

was carried.36

V. APPOINTMENT OF OPERATOR AND OPENING OF HOME

25. On 29th July 2016 the DHSC issued a media release37 ‘Private operator sought for Salisbury Street care home’ inviting experienced and qualified nursing care providers to submit expressions of interest by 12 noon on 15th August 2016. The Expression of Interest document was also sent directly to 166 parties identified by the Department.38 Expressions of interest were received from ten parties; eight parties progressed to the Invitation to Tender stage and this resulted in two tenders being submitted to the DHSC.39

32 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3326-3328 33 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3289-3307 34 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3888-3893 35 Appendix 2 - Tynwald Hansard 21 Jun 2016 Item 7 ll3308-3310 36 Appendix 2 - Tynwald Votes & Proceedings 21 Jun 2016 Item 7 37 Appendix 3 - IOMG Media Release – Private operator sought for Salisbury Street care home 29 Jul 2016 38 Appendix 4 - DHSC Freedom of Information request response 21st March 2017 (Ref IM80-362i) 39 Appendix 4 - DHSC Freedom of Information request response 21st March 2017 (Ref IM80-362i)

7 26. Salisbury Street Nursing Home opened in May 2017 being operated by Adorn Domiciliary Care Limited (‘Adorn’).

27. As part of the contract with Adorn, the provider would rent the premises from IOMG under a five-year lease agreement which, through negotiation, could be extended for a further five years.40 With regard to the block purchase of beds:

The provider must ensure that 40 of the 68 bedrooms are used for referrals from social workers for people at critical or substantial need. These rooms will be purchased at a rate that does not exceed the maximum amount of income available through eligible Social Security benefit.41

VI. ALLEGATIONS MADE IN THE MEDIA BY DAVID MURRAY

28. The Isle of Man Examiner published an article ‘Public Money Squandered on Care Home – Operator calls for public inquiry into £7.9 million facility,’42 following an MTTV interview given by David Murray, Director of Adorn Domiciliary Care Limited on 18th March 2018.43 The article reported that Mr Murray’s concerns, in summary, were:

i. that DHSC over-estimated the demand for beds needed to accommodate residents solely reliant on state benefits to fund their nursing care and is paying £812.10 per week for beds whether they are occupied or not; ii. that some beds are now occupied by residents who fund part of their care costs privately; and for these beds Government is paying benefits to residents, but also the £812.10, effectively paying twice; iii. that the nursing home service users are not receiving their personal allowance from the Treasury. iv. that Government did not need to buy the facility for £7.9 million; that it cost £5.3 million to £5.6 million to build;

40 Appendix 4 - DHSC Freedom of Information request response 21st March 2017 (Ref IM80-362i) - Care Home With Nursing Specification July 2016 Part A para 1.1 41 Appendix 4 - DHSC Freedom of Information request response 21st March 2017 (Ref IM80-362i) - Care Home With Nursing Specification July 2016 Part B para 1.1 42 Appendix 7 - Isle of Man Examiner, 20-26 March 2018 p1-2 43 Appendix 5 - https://www.manx.net/tv/mt-tv/watch/85223/operator-demands-enquiry-into- nursing-home-1-; https://www.manx.net/tv/mt-tv/watch/85224/operator-demands-enquiry-into- nursing-home-2-;

8 v. that he was ‘coerced’ into selling his stake in the consortium that built the home; and the consortium were ‘coerced’ into selling the home to Government. 29. DHSC provided a statement to IOM Newspapers on 19th March 2018 which included the following information:

The Salisbury Street home was independently valued and a model put in place to ensure that anyone solely reliant on benefits would be able to access nursing care facilities. Since the beginning of the contract, three-quarters of the beds have been in constant use, as we modelled. We also receive rent from the care home operator.

Subsequent to Government’s purchase of Salisbury Street, the Department received offers from private investors/operators, including the current operator, to buy the facility at the price paid (by Government).

For Government to break even, 75% of the beds need to be filled over the course of the five year contract with the Provider: since the beginning of September, there has not been a period when less than 75% of the Department’s commissioned beds were not occupied and there is no reason to suppose that percentage occupancy will not be reached.

The provider is correct in saying that there are very few people who rely solely on benefits to fund their beds - for this reason the threshold has been set at 95%.

The Provider’s allegation he was ‘coerced’ by two civil servants into selling his stake in Salisbury Care has been made in a complaint to the Department. An independent investigator is reviewing this complaint.44

30. At its meeting on 11th July 2018 the Committee considered the DHSC press statement and House of Keys written answer45 regarding Salisbury Street Nursing Home.

31. On 21st September 2018 the Committee wrote to the DHSC requesting further information and received replies dated 1st and 2nd October 2018.46 We would like to thank the Department for its open responses to the Committee’s requests for information.

44 Appendix 6 45 Appendix 9 46 Appendix 10

9 VII. CONSIDERATION OF ALLEGATIONS

32. All of the allegations Mr Murray made to the media in March 2018 had been included in a formal complaint received by the Department of Health and Social Care on 23rd January 2018. As confirmed to the media on 19th March 201847 the Department had already commissioned a formal investigation on 29th January 2018 and this was completed on 6th April 2018.

33. We have read the independent external investigation report and the associated papers in full, including the contract and associated agreements between DHSC and Adorn Domiciliary Care relating to the provision of nursing care in the Salisbury Street facility. Parts of the report concern matters about which no public allegations have been made and, as many of the witnesses had spoken in confidence to the investigator, we have taken the decision not to publish the report. We have included references to the conclusions the investigator reached, in relation to the allegations subsequently made to the media, where necessary.

34. We also spoke privately to Mr Murray, to ensure we understood his concerns and to two officers from the Department of Health and Social Care; given the time elapsed only one of the officers who had been in post in 2015-16 was still in the Department’s employment.

35. We considered the allegations made by Mr Murray:

ii. that some beds arenow occupied byresidentswho fund partof their care costs privately; and for these beds Government is paying benefits to residents, but also the £812.10, effectively paying twice;

Bed Occupancy Levels

36. In an oral evidence session with the Economic Policy Review Committee on 26th March 2018, the Chief Minister told the Chairman:

The Chief Minister: […] we booked our beds and we paid for those beds. I think we costed in that after 75% of bed occupancy we were in profit on the deal. If you look at a bed in Noble’s Hospital I am sure, Mr Chair, it is about £2,000 a week if you have got someone in a bed waiting to go into a nursing home. […]

47 Appendix 6

10 Now, if there are empty beds for the remainder that does not come under our control, that is for the person running it and they can charge what they want to stay in those beds. All we were interested in was ensuring there was a block of 40 beds available, so that if we needed to get people from hospital into a nursing home then there would be availability at the Government rate.

Mr Moorhouse: […] At the end of last week, 35 of the 40 beds that we had contracted for were being used by our patients. […] at the moment we are over 30 that we require to break even.

The Chief Minister: Yes.

[…]

Mr Moorhouse: And we have been above 30 since last September?

The Chief Minister: We have indeed, yes.48

37. We asked DHSC how they had calculated the requirement for 40 beds. They replied:

the number of rooms required was estimated based on a number of factors (a decrease in the number of beds available on the Island, increasing demand and the lack of availability of rooms where the fees were covered by maximum social security benefit levels);

and also advised that:

the department commissions the rooms and the residents are all people who have been assessed as needing nursing care and where their social security benefit entitlement exceeds 95% of the weekly charge of £852.61.49

38. From answers to questions in Tynwald and the House of Keys50 we noted that this breakeven point for bed occupancy, of over 75% of commissioned beds,51 was achieved in the week commencing 11th September 2017, four months after the home began accepting residents, and it has not fallen below that level since. Average occupancy in 2018 was 95%, 2019 was 98% and to Jun 2020 was 100%.

48 Economic Policy Review Committee Oral Evidence 26 March 2018 QQ65-70 49 Appendix 10; note that by 2018 the maximum social security benefit amount per room had increased. 50 Appendix 9 51 Appendix 6

11 39. TheMinisterconfirmed thetotal cost of empty beds fromMaytoSeptember 2017 had been £360,573; from October 2017 to May 2018 it was £161,238; and from June 2018 to June 2020 was £66,141.52

40. In Tynwald in April 2018 the Minister explained that:

In any new Care Home it is expected that the beds become used gradually. This is not least because the Minimum Standards for Adult Care Homes require admissions to be carefully planned and managed;53

41. This explains why the available DHSC commissioned beds were not fully occupied immediately, and why the cost of empty beds was higher in the early months.

We conclude that, while the DHSC commissioned beds at Salisbury Street may not have been occupied as quickly as Mr Murray initially expected, there has been sustained demand for the 40 beds in the intervening three-year period which indicates that they were necessary; and are satisfying demand identified in the Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021.54

Breakeven Calculation

42. We asked how the 75% breakeven figure55 had been calculated and in 2018 the Department confirmed it ‘is calculated from comparing the room charges receivable with the amount payable to commission the rooms’.56

43. DHSC explained in 2020 that the figure is now 78% and that this amount had been arrived at as a result of the relationship between the amount paid to the private operator by DHSC for 40 beds each year and the annual rental income being paid by the operator to DHSC. They asked that the actual figures not be published as they are commercially confidential.57

44. While it is somewhat academic, as occupancy levels have remained high, it is our view that the premise on which this calculation is based is flawed. The rental income figure is in the region of the cost of 25% of the commissioned beds, but we would submit that the suggested offset is inappropriate. If rental income were

52 Appendix 9 53 ibid 54Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021 11.2 p 19 https://www.gov.im/media/1357421/consultation-document.pdf accessed 14 Aug 2020 55 Appendix 6 56 Appendix 10 57 Appendix 13

12 to be used to offset, it would be more appropriate for this to be set against any loan charges resulting from the purchase of the facility.

45. We are not aware of circumstances where the Department supports clients at a level greater than the maximum benefit rate, as such the only true breakeven position is when the beds are 100% occupied by 100% benefit-funded residents.

We conclude that securing availability at a known price has its advantages, but we do not believe that the Department’s current approach of calculating value for money is justifiable.

Benefit Funded Percentages

46. We then considered Mr Murray’s assertion that the DHSC commissioned beds were intended for clients whose nursing care fees were 100% funded by social security benefits; that part benefit funded clients would be in the 28 private beds, charged at a higher rate.58

47. He alleged, in an MTTV interview, that the number of clients who are 100% benefit-funded was much lower than estimated and that, as a result, part-funded clients were being placed in the DHSC commissioned beds.59

48. At the time of his interview with MTTV, Mr Murray stated that he had only 15 fully privately funded clients in the 28 private bed allocation, and that this client type was as rare as the fully benefit funded service user. He stated that, in the contract, the funding model had been based on the 28 private and partially-funded beds filling up quickly, making it a secure, financially viable model.60

49. We note that, in a media statement issued on 19th March 2018 following Mr Murray’s MTTV interview, DHSC stated that the threshold for the DHSC commissioned beds was that clients would be 95% benefit funded.61

50. We have reviewed the commercially confidential contract between DHSC and Adorn Domiciliary Care and confirm that it requires that 40 eligible beds should be provided at the maximum benefit rate; there is no reference to a percentage threshold; this was confirmed by DHSC in a letter to the Committee in December 2020.62

58 Appendix 5 p6-7 ll243-259 59 Appendix 5 p7-8 ll273-313 60 Appendix 5 p12-13 ll535-555 61 Appendix 6 62 Appendix 13

13 51. We requested a snapshot of the benefit breakdown for occupancy for a week in September 2020, the anonymised summary can be found in Appendix 14. There were 38 beds occupied that week and of these five clients were under the 95% benefit funded threshold.

52. We asked how, in general terms, this situation would arise and the DHSC advised that:

the Adult Social Care Team work with colleagues in Social Security and the Individual (or their Representative) to establish their benefit entitlement. It is noted, the process can be lengthy and an individual can be placed in a bed, based on their needs prior to the commencement of benefit payments.63

We conclude that, while the 95% threshold appears to have been informally acknowledged as the threshold, there was no contractual agreement regarding the minimum percentage of benefit funding required in order for a client to qualify for a DHSC commissioned bed; in theory therefore anyone in receipt of any social security benefit, including only a state pension, could legally occupy a DHSC bed.

Paying Twice

53. In his MTTV interview Mr Murray also alleged that Isle of Man Government are, in some cases, paying benefits to a partially funded client whilst also paying Adorn the fully funded benefit-rate bed, meaning that in effect some beds are being paid for twice; he said that some residents are not paying the difference between their benefit and the care home fee to Government and no reconciliation is taking place.64

54. Salisbury Street opened on 8th May 2017 and in August 2017 issues were identified with the ability of DHSC to charge for nursing care provided via a third party; and with benefit payments being made directly to a Department to cover fees.65 DHSC estimate the financial loss to Government as a result of these issues as £223,441 between May and Dec 2017 and £92,898 between December 2017 and April 2018.66

63 Appendix 13 64 Appendix 5 p12 ll521-535 65 Appendix 13 66 Appendix 13

14 55. We note that these amounts represent 32%67 of the possible income, based on occupied beds,68 for the period in question.

56. These issues were resolved by the following legislative changes:69

 Section 5(2) of the Adult Social Care Services (Charges) Regulations 2018, effective 9th April 2018, introduced a provision allowing the Department to recoup a fixed sum with respect to residency in a nursing home:

(2) A liable person residing in an adult care home which is a nursing home must pay to the Department a weekly charge of £852.61 for the social care service provided;70

 Social Security Administration Act 1992 (Application) (Amendment) Order 2018,71 effective 22nd February 2018, provided the vires for social security benefit payments to be made directly to a Department to cover costs, which would include nursing home fees.

57. Since these legislative changes in 2018, clients in a DHSC commissioned bed are invoiced for their nursing care fees and can arrange for these to be settled in full, or part, directly by social security from their benefits. Where the benefits do not cover the full amount, the client is expected to fund the difference. If any payments are not received, these are recovered through the usual Government debt management process.

58. Where a resident is in a private bed, they are responsible for paying the care provider directly. They may also be in receipt of benefits e.g. state pension, and will receive this directly from Social Security.

We conclude that the loss of income, due to the issues regarding charging and the benefit payment offsetting process, was avoidable; however, once identified, the required amendments to legislation were made with reasonable expediency.

67 Based on no. of occupied beds from weekending 8 May 2017 – 2 April 2018 @ £812.10 per occupied bed per week 68 Appendix 9 69 Appendix 13 70 SD 2018/0079; https://www.tynwald.org.im/links/tls/SD/2018/2018-SD-0079.pdf accessed 21 Aug 2020; Note the equivalent sum for 2020 is £882.63 71 SD 2018/0036; https://www.tynwald.org.im/links/tls/SD/2018/2018-SD-0036.pdf accessed 17 Oct 2020

15 Personal Allowance Payments

iii. that the nursing home service users are not receiving their personal allowance from the Treasury.

59. Mr Murray said that residents were not receiving their personal allowances. A personal allowance is part of Income Support; it is a set amount for ‘personal expenses - intended to be spent on toiletries, newspapers, etc.’72 Residents had been written to suggesting Adorn had the money, which was not correct. He said that, although Treasury had admitted this was a mistake and written to residents apologising, Adorn had not received an apology and residents had not received monies owed.73

60. We wrote to Treasury to ask about this. The Chief Financial Officer confirmed that there had been a question about the legality of payments being made to DHSC for residents; further that a misleading letter had been sent to Salisbury Street residents which implied that Adorn had been receiving the payments, which was not the case. They confirmed that the payment of personal allowances had been resolved, and any backdated monies owed had been paid. An apology letter had latterly been sent to Mr Murray.74

We note that the independent investigation report stated that this complaint was proved and an apology due; we note this was sent.75

Cost of buying Salisbury Street

iv. that Government did not need to buy the facility for £7.9 million; that it cost £5.3 to £5.6 million to build;

61. The long-term projection of requirements for nursing care were highlighted in evidence given to the Select Committee on the Funding of Nursing and Residential Care, who reported in June 2016 that:

Currently the Isle of Man has 916 care (residential and nursing home) beds with an over 65 population of 16,999 in 2015 (rising to 17,430 in 2016). In 2036 the over 65 population is predicted to be 26,544. The need for beds has been

72 Income Support for people entering Nursing or Residential Homes https://www.gov.im/media/1351194/a1-rnh-april-2020.pdf, accessed 04 Sep 2020 73 Appendix 5 p13 ll560-596 74 Appendix 11 75 ibid

16 calculated on the ratio of current care beds to over 65 population only, and indicates that by 2036 we will require an additional 411 beds.

Based on an average of 55 rooms/home, this equates to approximately 8 homes in the next 20 years. There is an average lead time for major builds of 2 years, with the final home required to be open by 2036, and assuming that planning for the first commences in 2016, a new home will need to be developed every 2.5 years.76

62. Mr Murray stated that, in his experience of building nursing homes, purchasing Salisbury Street Nursing Home should not be a lower cost option than building a new home on the former Glenside site, particularly as the IOMG already owned the land.77

63. During the Tynwald debate, some Members commented that the valuation of Salisbury Street appeared to be high; with regard to the property value the Minister said:

Significant work has been undertaken to establish the value of the property as a fully equipped and operational care home, including valuation by an off-island specialist, who has valued it at more than we are paying for it. I know there has been much debate, both formally and through social media, on whether the cost of the facility represents value for money. Let me reassure the Hon. Court that, as part of the overall valuation process, comparisons were made with appropriate sale prices of facilities across the United Kingdom and we have been advised that the purchase does represent good value for money and provides the Government with an asset that will retain its value over time.78

The Minister went on to say:

You all know I am keen to see evidence to support business cases, and the reality of this one is that it will take us a minimum of three years to build a new facility at Glenside – that is getting planning permission, probably a year, and then two years to build it – and if we build it ourselves the cost estimate is in the region of £10.4 million.79

76 Report of the Select Committee on the Funding of Nursing and Residential Care PP 2016/0120a Appendix 6 p127 77 Appendix 5 p10 ll420-441 78 Appendix 2 79 Appendix 2

17 64. Mr Murray stated the new nursing facility was constructed by Salisbury Care Limited at a cost of between £5.3 million and £5.6 million.80

65. On 2nd October 2018, the DHSC told us that ‘the government holds no information in respect of the costs of the construction of the Salisbury Street nursing home,’81 but:

The valuation was managed on behalf of the DHSC by the government valuation and asset management unit, and an external party was engaged following a procurement process.82

66. We have read the independent valuation report prepared for DHSC and have taken the decision not to publish it in full due to commercial confidentiality, however the valuation was prepared on the basis of Market Value as defined in the Professional Standards of the Royal Institution of Chartered Surveyors. As at the valuation date, the Report gives a market value of the freehold property, fully equipped as an operational entity and having regard to trading potential; this market value was within 2.5 % of the price paid by the DHSC. This was subject to two special assumptions: that the care home has been constructed in accordance with the plans and specifications provided and is offered as a turnkey opportunity; and that the care home is fully fitted with all items of loose furniture/furnishings as indicated within the quotation supplied.

67. We asked for a breakdown of all costs attributed to the purchase of Salisbury Street Nursing Home. DHSC confirmed the capital cost was £7,907,946.45 and additional sums paid were: pre start date, £34,914.02; and post start date £79,629.13.83

68. We also noted that in its 19th March 2018 press statement DHSC said:

We conclude that the DHSC paid the market value of a Turnkey property, fully equipped and ready to commence trading, and did not overpay for Salisbury Street Nursing Home, and overall this business model appears to have been a financial success.

80 Appendix 7 p2 81 Appendix 10 82 Appendix 10 83 Appendix 10 84 Appendix 6

18 Coercion

v. that he was ‘coerced’ into selling his stake in the consortium that built the home; and the consortium were ‘coerced’ into selling the home to Government; and

69. Mr Murray was a director of the private consortium, Salisbury Care Limited, who constructed Salisbury Street care home, until 30th September 2016,85 and is also managing director of Adorn Domiciliary Care Limited.86 In March 2018 he explained that ‘the original intention had been for Salisbury Care to build the facility and have Adorn run it.’87

70. In March 2018 Mr Murray stated that, at a time when the nursing home was under construction, in January 2016, he was called into a meeting with two DHSC officers who told him that Adorn would not be registered to run the home.88 Responding in the same newspaper article, DHSC confirmed that an independent investigation was taking place into the allegation made by Mr Murray that he was coerced into selling his interest in Salisbury Care Limited.89

71. We have reviewed the report of the independent investigation which notes that the timing of the meeting with DHSC officers was approximately a month after the death of a resident at Beaconsfield Nursing Home, a facility run by Adorn Domiciliary Care Ltd;90 The meeting was before the conclusion of the police investigation or the inquest.

72. The inquest confirmed the death was a result of natural causes but that some staff had been suspended as a precautionary measure while a police investigation took place. The Coroner commented that there had been an inappropriate use of restraint but that this treatment at Beaconsfield was not a contributory cause to the death.91

73. We note that the registration process for a provider of an independent care service requires a declaration of any previous connection to investigations by the police, Registration and Inspection Unit, Child Protection or Adult Protection services.

85 Appendix 17 86 https://www.linkedin.com/in/david-murray-46161a69/ accessed 26 Mar 2021 87 Appendix 7 88 Appendix 7 89 Appendix 7 90 Appendix 12 91 Appendix 12

19 74. The independent investigation report noted that it was difficult to be definite about what had actually been said at the meeting in January 2016, because the people present had different recollections, however it concluded that it was credible that a DHSC officer would have highlighted that, depending when any application to operate Salisbury Street was made, any unresolved issues at Beaconsfield would have to be taken into account. The report noted the considerable pressure Mr Murray was under at that time and suggested that his decision to withdraw from Salisbury Care Ltd occurred as a result; and that there was no merit in the complaint that he was coerced.

75. We do not know what was said at the meeting either, but we have seen an email, referenced in the independent investigation report, from a DHSC officer to Mr Murray a couple of days after the meeting, asking whether he has confirmed with his development colleagues that he will not be the care provider in the new development.

We concur with the finding of the internal investigation regarding the allegation of coercion, it is not proven. However, we consider an email from a Department Officer asking for confirmation of Mr Murray’s intentions about severing a private business connection was wholly inappropriate. We can understand how, given the stress Mr Murray was under during that period, this would have contributed to his decision to withdraw from Salisbury Care Ltd.

76. We also note that officers from both DHSC and the regulatory Registration and Inspection team were at the meeting in January 2016 and have serious concerns about whether this creates a potential conflict. We believe it is likely that this contributed to Mr Murray’s belief that officers were conspiring against him at this time.

77. We also wish to note, for completeness, that there was a further complaint covered in the internal investigation report concerning the behaviour of a third DHSC officer in dealings with Mr and Mrs Murray. The report concluded that the behaviour had been inappropriate; we agree with this conclusion. We note that officer is no longer employed in the Registration and Inspection Unit.

VIII. INSPECTIONS PROCESS

78. While reviewing evidence in this inquiry, we formed the view that the continued inclusion of the Registration and Inspection Unit in the DHSC is wholly unacceptable. The Registration and Inspection Unit inspect private and Government run facilities and, however professional officers are, the perception of a lack of independence is difficult to overcome. They are viewed as

20 Government officers in a way which, for example, the Information Commissioner or Manx Industrial Relations Service officers are not.

79. This issue was highlighted in the Independent Review of the Isle of Man Health and Social Care System92 which, commenting on regulation, noted that:

inspections report back to the DHSC and so, in the case of some inspections by the Registration and Inspection Unit, reports are to the provider of services. Therefore, in those cases, the DHSC is inspecting and regulating itself, which is neither aligned to international best practice nor considered an objective assessment.93

and recommended that:

Recommendation 3:

Services provided directly or indirectly by Manx Care should be inspected regularly by independent, external quality regulators, with a report to the Manx Care Board and to the DHSC.94

80. We note that, in the first Health and Care Transformation Programme Annual Report,95 work on Recommendation 3, external quality regulation, is scheduled to begin in phase 2.96

81. Forthcoming legislation97 setting out the respective roles of Manx Care and the Department places independent regulation firmly in their remit. In light of the experience of your committee in this investigation, we believe that:

 the Department is not the appropriate body to regulate both Manx Care and the Independent Care sector;

 that the Independent Regulator should be independent, and be seen to be independent of both the Department and providers in terms of

92 Independent Review of the Isle of Man Health and Social Care System, GD 2019/0021 https://www.gov.im/media/1365879/independent-health-and-social-care-review-final-report.pdf, accessed 22 Aug 2020 93 Ibid p24 94 Ibid p33 95Health and Care Transformation Programme Annual Report 2019-2020, GD 2020/0021 https://www.tynwald.org.im/business/opqp/sittings/20182021/2020-GD-0021.pdf, accessed 22 Aug 2020 96 Ibid p11 97 Manx Care Bill 2020, https://www.tynwald.org.im/business/bills/Bills/Manx_Care_Bill_2020.pdf, accesses 17 Oct 2020

21 not being co-located with the Department, or falling within its line management, and having autonomy over its work programme; and

 that the regulator should not be a party to contract negotiations, but should respond independently to either party with points of clarification where regulatory input is required.

IX. SUMMERHILL VIEW

82. With the Salisbury Street business model in mind, we looked at the Tynwald approval for a new care facility, Summerhill View, to be built on the former Glenside site. We note with concern that the circa £11.7 million estimated build cost for Summerhill View is significantly higher that the purchase cost of Salisbury Street; and twice as much as Mr Murray advised that Salisbury Street cost to build.

83. We note that, in contrast to Salisbury Street, Summerhill View is being built on a spacious site where the land is already owned by Government. We have reviewed the business case and found the following:

 Summerhill View is 60 beds, including 15 for dementia care residents and a 20-person day care unit; Salisbury Street has 68 beds.

 Summerhill View has the space for 20 extra care residential units but these are not included in the initial capital cost estimate of circa £10.3 million.

 Summerhill View will replace Reayrt ny Baie; which is expected to return approximately £1.3 million on disposal.

84. Since the production of the business case in 2015, the estimated cost has risen to £11.2 million and £575,000 has already been spent on design fees.

85. In September 2019 Manx Radio reported that Homefield Care had lodged plans to build a 73-bed care home on the Homefield site on Woodbourne Road, adjacent to Salisbury Street. It would provide primarily for nursing care but also provide for dementia and residential care. The company reported planning to spend no more than £5 million.98

We conclude that it is of concern that the build cost of Summerhill View has been estimated at approximately twice the build cost of Salisbury Street, as

98 Appendix 15

22 quoted by Mr Murray and the estimate reported in the media for the proposed new development on the Homefield Site.

Recommendation 1

DHSC should present evidence to satisfy Tynwald, or the Public Accounts Committee, if there are commercial confidentiality issues regarding the value for money of the Summerhill View Development.

X. COMMENT FROM THE DEPARTMENT OF HEALTH AND SOCIAL CARE

86. Recognising that a significant length of time has passed since the purchase of Salisbury Street Nursing Home and both political members and senior post holders of the Department of Health and Social Care have changed, we shared a final draft of this report with them prior to publication. Their response is included at Appendix 18.

XI. SUMMARY OF CONCLUSIONS AND RECOMMENDATIONS

We conclude that securing availability at a known price has its advantages, but we do not believe that the Department’s current approach of calculating value for money is justifiable.

99Adult Social Care Market Position Statement and Commissioning Intentions for Older People on the Isle of Man 2016-2021 11.2 p 19 https://www.gov.im/media/1357421/consultation-document.pdf accessed 14 Aug 2020

23 any social security benefit, including only a state pension, could legally occupy a DHSC bed.

We note that the independent investigation report stated that this complaint was proved and an apology due; we note this was sent.

We conclude that it is of concern that the build cost of Summerhill View has been estimated at approximately twice the build cost of Salisbury Street, as quoted by Mr Murray and the estimate reported in the media for the proposed new development on the Homefield Site.

Recommendation 1

DHSC should present evidence to satisfy Tynwald, or the Public Accounts Committee, if there are commercial confidentiality issues regarding the value for money of the Summerhill View Development.

J P Watterson (Chair) L Hooper (Vice Chairman) J M Edge J P Poole-Wilson C R Robertshaw

March 2021

WRITTEN EVIDENCE

25 26

Appendix 1: 14th June 2016 - MTTV Interview with Howard Quayle MHK, Minister for Health and Social Care

27 28 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

MTTV Interview, 14th June 2016: ‘New £8 million Government nursing home’

https://www.manx.net/tv/mt-tv/watch/79433/new-8m-govt-nursing-home

Mr Paul Moulton: I’m talking to Howard Quayle, Minister for Health and Social Care and the big announcement of this nearly £8 million being spent on buying a nursing home – buying this off the private sector, instead of building your own. And you’re going to either tell me it came up, it was a great opportunity not to be missed and that’s why you taken it. But it’s not in the 5 Pink Book. You’ve got no allocation for these funds. Where are you going to find the money?

The Minister for Health and Social Care (Mr Quayle): Yes. That’s why we’re going to Tynwald for a vote of up to £8.1 million. Yes, this is a curveball. It is not something Government normally do. We were looking to 10 replace Glenside and build a 60-bed unit there and we were getting the designs drawn up. We’d had the costings done and we became aware of an all-singing, all-dancing, purpose-built, 68-bed nursing home unit which had been built, which was going to be ready probably by the end of September, and it just made economic sense to see what would it cost for us to buy it, as opposed to building our own one. The price was substantially less than what it was going to cost 15 us to build our nursing home at Glenside and it was ready to go straight away. Now, at the moment we have peaked at 38 people in Noble’s Hospital in the winter, waiting for nursing home beds on the Island. The market isn’t there. The beds weren’t available at benefit rate. Government pays a few pence short of £820 a week on benefit rates and there are no beds available at that price. I think the prices go up to £950 a week. 20 So this gives us the opportunity of enabling the people who are at Noble’s Hospital to go into a nursing home this year and that will free up the beds at Noble’s Hospital for people who need acute nursing care … Sorry, I should say acute hospital care, not acute nursing care.

Mr Moulton: This is something the private sector seems to have passed on. I mean, the fact 25 is, this was a privately built nursing home and it now can’t be run for whatever reasons. They’ve come to you looking for it?

Mr Quayle: No, they haven’t come to us. They built it for themselves and they were putting it out to tender for them to run it – for a private company to run it on their behalf – and they were 30 going to charge a rent. We approached them to see if they would take benefit level beds that we could block book. That wasn’t a model that they were interested in and therefore we asked could we buy it. We negotiated a price. As I say, it’s cheaper for us than building one and it makes economic sense. I would give you an example: if you’re wanting to purchase a brand-new car and you’re about 35 to order it and you want various extras on it, and then you happen to go past a garage and there’s the very car you want, but with maybe a hundred miles on the clock, quite a few thousand cheaper, you’re going to nip in and buy that, aren’t you?

Mr Moulton: The Government got out of running nursing homes. You’re now getting back 40 into it this way, are you?

Mr Quayle: Well, we’re not wanting to run it. We’re going to provide the building and rent it out. Subject to Tynwald approval, we’re going to go out for expressions of interest for a private

______Interview Transcripts Page 1 29 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

provider to come in and run it, but with the proviso that of the 68 beds, 40 of those beds must 45 be at benefit level, £819 and so much pence a week.

Mr Moulton: But Government sold that land, did it not? I mean it wasn’t your Department, but now you’re basically going to buy all back again?

50 Mr Quayle: Well, that’s a red herring, Paul. A private company has built a nursing home that they were going to rent out to the private sector. We have a site at Glenside where we were going to build a new nursing home and it transpires that we can buy this purpose-built, key-turn nursing home cheaper than what it was going to cost us and three years earlier, and we need it now. It just makes total sense. 55 Mr Moulton: You’ve been a stickler for tendering for things – the children’s service and all sorts of things. You have been absolutely wanting to make sure that everything is tendered right here. Who has told you it’s worth that money?

60 Mr Quayle: I’ve had it valued by independent experts to make sure that the amount we’re paying for it is an acceptable figure.

Mr Moulton: If they can’t run it, if the private sector don’t want to run it … which seems incredible, because nursing home spaces, you just said yourself, they’re in demand. People need 65 those spaces. Why can’t they make it work in the private sector; the Government has to step in and you have to take over?

Mr Quayle: Because they won’t provide benefit level beds. That’s the key issue.

70 Mr Moulton: That’s costing you how much a week? About £500, is it?

Mr Quayle: No, just a few pence short of £820 a week and –

Mr Moulton: People in Noble’s Hospital said they were … £2,000, I think you said. 75 Mr Quayle: Yes, to provide a bed for a week at Noble’s Hospital is around £2,000. So there are no benefit-level beds available on the Isle of Man. So as a result, people who don’t have any money and can’t afford to pay the extra top-up which other families are doing at the moment, are, you could say, stranded at Noble’s Hospital. 80 Mr Moulton: But they won’t all be benefit beds, will they? I mean, you’re going to have some people paying as well, are you?

Mr Quayle: Yes, 28 of the beds will be private and 40 of the bed. 85 Mr Moulton: Don’t you need them all for benefit, though?

Mr Quayle: No, because the model isn’t sustainable with it all being benefit beds for a private company to come in and run. So we’ve booked 40. That will be the deal. The expressions of 90 interest will go out for a tender, subject to Tynwald approval: 40 beds for benefit level and then 28 beds will be for private people.

Mr Moulton: Okay, you’ve done a presentation to the MHKs and MLCs, but what was the mood music like? 95

______Interview Transcripts Page 2 30 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Quayle: They got it.

Mr Moulton: Your curveball, as you keep on calling it.

100 Mr Quayle: Well, it is a curveball. It’s not in the Pink Book. It’s not something Government normally does, but we have a problem – we have a problem that there are not enough nursing beds on the Isle of Man. So what do we do? We’ve got Noble’s full at certain times because they are facing, effectively, bed blockers, with people waiting to go into nursing home space. Do we put up with that for the next three years whilst we go out and build a more expensive nursing 105 home at Glenside; or do we seize the opportunity of buying something that’s ready to go now?

Mr Moulton: Were you passing a law to stop the bed blockers, to make sure that people have got – ?

110 Mr Quayle: No, we were passing a law to stop people who were refusing to leave.

Mr Moulton: Granny dumping.

Mr Quayle: There’s the difference. These are people who are happy to go into a nursing 115 home, there is just no nursing home bed available. The people that we passed a law for are people who were refusing point blank to leave Noble’s Hospital.

Mr Moulton: So you got rid of them and you have still got a whole ward full. 120 Mr Quayle: That legislation hasn’t got Royal Assent. (Mr Moulton: Sure.) But we hope to have it this year, July.

Mr Moulton: It’s just incredible. I mean the Isle of Man must know its own population and I 125 know you come up with figures, in another 20 years you need x more –

Mr Quayle: Yes, in the next 20 years there’ll be an increase of 10,000 people over the age of 65 on the Isle of Man and I’ve given five roadshows round the Island where we’ve pointed out that will require another circa 420 beds to look after the requirements of that 10,000 increase. 130 Mr Moulton: So this is just the beginning of it. I mean the Government’s going to start … Well, Glenside will be the next one, will it?

Mr Quayle: Yes, well, we would hope that the private sector will themselves go out and build 135 more –

Mr Moulton: But they don’t seem to be wanting to, for some reason.

Mr Quayle: And if they don’t, then we as a Government are going to have to step in. We 140 can’t just put our head in the sand and say, ‘There’s not enough beds; we’ll just let people get on with it.’ We’ve got to be responsible. We’ve seen that there’s a problem and we have reacted to it and by reacting to it we’ve managed to save the taxpayer numerous millions and solve a problem maybe three years quicker than it was going to be.

145 Mr Moulton: If the money can be found. Is there a pot of a spare £8 million sitting there for you?

______Interview Transcripts Page 3 31 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Quayle: This will have to come out of our reserves.

150 Mr Moulton: Are you worried about that?

Mr Quayle: This makes economic sense to do, Paul. The reasons I’ve given – we’ve got 30-odd people stranded at Noble’s Hospital who should be in a nursing home. It’s better for them – 155 Mr Moulton: Okay, do you think you’ll get it through?

Mr Quayle: I would hope to get it. I’ve never lost anything I’ve taken to Tynwald, but I always like to think we’ve got a good plan. We explain it clearly. We’ve had the full presentation to 160 Members. Whilst we’ve had very searching questions, the Members have left feeling that their questions have been answered. Whether I’ll get 100% support or not, I don’t know, but I am hopeful that I’ll get good support because it makes sense.

-- END --

______Interview Transcripts Page 4 32

Appendix 2: 21st June 2016 - Tynwald Hansard Item 7 ‘Salisbury Street Care Home – Purchase by DHSC – Expenditure Approved’

33 34 7. Salisbury Street Care Home – Purchase by DHSC – Expenditure approved

The Minister for Health and Social Care to move:

That Tynwald authorises the Treasury to provide a sum not exceeding £8,100,000 as a capital vote to fund the purchase by the Department of Health and Social Care of Salisbury Street Care Home.

The President: Item 7. I call on the Minister for Health and Social Care.

The Minister for Health and Social Care (Mr Quayle): Thank you, Madam President, and I thank Hon. Members of the Court for the previous vote. 3245 The funding of care for a growing elderly population and how best to divide costs between the public purse and private contributions is a problem across Western Europe. Whilst there are clearly a number of important policies related to the future funding model for care that need the consideration of this Hon. Court, the shortfall in financial support for nursing care accommodation is a current and critical issue. 3250 Nursing home care, which is provided only by private sector operators on the Isle of Man, is currently funded through a combination of Social Security benefits – in particular, Income Support for those who are eligible – and self-funding by those who have sufficient income and releasable assets to meet their fees without state support. Around half of nursing home residents are state funded and the other half pay for their own care. 3255 Private nursing homes are able to charge what the market will bear and it is a matter of highest concern that since May 2015 there has been no nursing home on the Isle of Man offering beds at a rate fully covered by the maximum Social Security benefit which a person can be awarded, an amount just under £820 per week. The average cost per week of nursing care provision in the sector is up to £950 per week, and often more. 3260 There has been a suggestion that by raising the benefit level by £100 per week this would be less expensive than the proposal before you now. It certainly would not put additional capacity in the market and it would also serve to increase the overall cost of care paid for by Government by an additional £1.2 million a year – because you would not just increase it for the 20 beds that someone had mentioned; you would have to increase it for just under 50% of the 490 people in 3265 nursing home care, so you are looking at about 240 people who will be receiving support towards their nursing home care. Over the next 20 years, the number of people on the Island aged 65 and over is projected to grow from 17,000 to 26,500 – an increase of 55%. With our current model of care, up to 411 additional care beds will be required by 2036, the equivalent of one new care home every 3270 18 months to two years for the next 20 years. An average-sized care home will provide between 55 and 60 beds, and that does not take into account, Hon. Members, the fact that if you analyse the current stock, probably 10 or 11 of the current stock will need major investment or replacement. My Department, in conjunction with Treasury, has considered the most effective way to 3275 begin to resolve this situation. Currently, there are no nursing home beds available at benefit rates in the system and not enough generally to provide for those in hospital and in residential accommodation requiring nursing home care. The existing provision for care on our Island is logjammed, and this has a number of knock-on effects for individuals and their families who desperately need to access care. This affects all of us, from those who need nursing care to 3280 those in residential care, for people who require respite care allowing them to continue to look after their loved ones at home and for those people currently located in Noble’s Hospital who need to be discharged to more suitable care accommodation. And let us not forget the clinical and care staff stretched to provide suitable care for people of this Island.

Tynwald 21/06/2016 35 As a Government, we have not provided nursing care directly through the provision of a 3285 nursing care facility since 2003, hoping that the private sector would grow to meet demand. But we need to be honest and recognise that need is quite clearly outstripping capacity at this time and we need to do something that will provide a viable solution urgently – and we can do this through the proposal before you now for consideration. There is a new privately funded care home which is due for completion next month. This is 3290 the home being built by Salisbury Care Ltd and is located at Salisbury Street in Douglas. Purchase of this home will provide the Island with a range of options to ensure that care is available to those who need it without damaging the existing nursing home care market and without expanding Government services. Significant work has been undertaken to establish the value of the property as a fully 3295 equipped and operational care home, including valuation by an off-island specialist, who has valued it at more than we are paying for it. I know there has been much debate, both formally and through social media, on whether the cost of the facility represents value for money. Let me reassure the Hon. Court that, as part of the overall valuation process, comparisons were made with appropriate sale prices of facilities across the United Kingdom and we have been advised 3300 that the purchase does represent good value for money and provides the Government with an asset that will retain its value over time. It is my Department’s intention, with the support of this Court, to purchase this home as a Government asset for a total not exceeding £8.1 million. However, I am cautiously optimistic, Hon. Members, that the real cost of this facility will be £7.9 million, which is the price that has 3305 been agreed with the caveat that Government completes the purchase within a timely manner. The additional £200,000 is there to ensure that there is incentive for us to do so – and that is something which I think is a reasonable business agreement. If you agree with the proposal today, the Department will immediately start an open procurement process to identify an operator for the facility on the basis that two-thirds of the 3310 68 beds are available at a cost accessible to those reliant on support from Social Security. Should this process fail to identify a suitable provider, my Department will seek to establish an arm’s- length provider, separate to but wholly owned by Government, to deliver the service as a last resort. This measure will help to meet the Government aim of protecting the vulnerable on the Isle 3315 of Man. It will also address some immediate issues of concern, including delayed discharges from Noble’s Hospital, reducing risk in the community for older people, and lack of move-on and respite facilities in the residential care sector, which leads to increased risk for individuals who need a higher level of care. I know this is not an easy option and it will be difficult and challenging on many levels to 3320 deliver the right outcomes, not only because of the sensitivity of cost but because we know there will be challenges in resourcing this facility when we have a care market that is stretched to cover what we do now. Hon. Members, life is not easy and we as an Island face considerable challenges going forward, but I stand before you today with a proposal that, in my view, makes sense and one we 3325 would be foolish to reject. You all know I am keen to see evidence to support business cases, and the reality of this one is that it will take us a minimum of three years to build a new facility at Glenside – that is getting planning permission, probably a year, and then two years to build it – and if we build it ourselves the cost estimate is in the region of £10.4 million. We have, on average, over 30 people alone waiting in Noble’s Hospital for suitable care 3330 accommodation at any one time, and this peaked this winter at 38 people, which is certainly not good for them or their families, or us as an organisation dedicated to providing quality care. This is currently costing us £2,000 per week. If we realistically do the maths on this we are paying £3,120,000 per year to maintain the status quo with 30 people in Noble’s, all year round, who need to be in a nursing home. Over the next three years we will have paid £9.36 million for the 3335 status quo, which is £1.5 million more than buying this facility. This is just not an option we can sustain or ignore.

Tynwald 21/06/2016 36 Madam President, I beg to move that the purchase of Salisbury Street Care Home at a cost not exceeding £8.1 million be approved.

3340 The President: The Hon. Member, Mr Quirk.

Mr Quirk: Thank you, Madam President. I beg to second and reserve my remarks.

3345 The President: The Hon. Member, Mr Cregeen.

Mr Cregeen: Thank you, Madam President. Firstly, can I ask the Minister to confirm that no commitment for any finances has been given already, so there has been no deposit put down on this property or any commitment to 3350 purchase? I know that he has mentioned that there is going to be an issue regarding the staffing of this premises. Has he got a ballpark figure of what he considers the annual salary scales will be – salary for the premises – and also if he has got Treasury approval for any funding, if there is a shortfall between the occupancy level and his staffing costs? 3355 Also, will he give a figure for what it is actually costing per night for each person to be kept in Noble’s Hospital instead of in a nursing home, and give a commitment that in the future – he is saying there are 30-odd beds that are being taken up at Noble’s Hospital by people who should be in nursing care – these are not going to be backfilled by another 30-odd people, because then I do not think he will be making the saving that he is hoping to make. 3360 I understand that they are looking for possibly another nursing home to be brought online every two to three years for the next decade or so. Is the private sector then, in the future, going to be in dialogue with the Department, or is he going to be in dialogue with the private sector, to ensure that need is met and we are not going to be put in a situation where the Department in the future is going to have to provide that provision because they have gone in and unbalanced 3365 the private sector? If he can give me some clarification on those points, please.

The President: The Hon. Member for Onchan, Mr Karran.

3370 Mr Karran: Eaghtyrane, I fully understand the problems that the Minister has on the subject of ageing population on this Island. It is a subject that has been dear to my heart for a long time. Yes, that is something that we totally agree with. This could be a way of dealing with the issue, but it just looks to me, again, as if we have got some sort of moonshine salesman who has got the CoMin put under a spell and the taxpayer will 3375 have to cough up for their stupidity and lack of strategic long-term policy directive on this most important issue. I can remember – I think it is relevant to this, because the reason we are here today is because of the mistakes they have made – in utter disgust, when we still had a policy, maybe not written, where we did not prosecute Departments, and again the taxpayer will pay for the 3380 stupidity of the strategic long-term policy directive. I can remember the Department not allowing the situation as far as the Reayrt ny Baie development. It was illegal before it even opened its door, but that did not matter because the Minister at the time said it was acceptable. If there had been any residential home that should have been knocked down, or closed down, it should have been it instead of the one that it ended up being with the likes of Glenside, 3385 particularly when you allow for the number of geriatric beds which were provided on the lower ground floors of Glenside that could have addressed the issue of the 40-bed blockers at the Hospital. I have written to the Public Accounts Committee about the whole Glenside affair, but there seems to be no interest; and anyway, I suppose at least with the debate the other week it has shown it is almost like being savaged by a dead sheep – maybe quoting famously the 3390 description of a former Chancellor.

Tynwald 21/06/2016 37 What I think Hon. Members need to realise is – like I said with the previous debate, where we ended up spending £1.1 million in 2005, and in 2010 I am still complaining about the fact that the facility had not been opened and operated – this is not an issue about you personally; this is an issue about bringing about proper long-term strategic planning. But if we refuse … 3395 I am fully aware of what the problems were with the Prison Service, as far as mental health was concerned. We were concerned in the 1990s about the issues of prisoners becoming addicted to prescribed drugs and we did bring in the issues about the first twilight nursing service, so I need no lectures from the Hon. Member. What I am raising on these issues, like this issue and the previous issue, are things that members of your own staff cannot say to the 3400 Department Members – and one day we will be able to do that. If we are going to learn from these mistakes we have got to stop repeating them, and attacking and misrepresenting what people are saying in this Court does nothing to stop that situation from continuing. Today, here we have the issue of £8.1 million being requested from the taxpayer for the 3405 purchase of Salisbury Street Care Home. The first question I have to ask is why aren’t we just trying to get the owners to lease the property to another operator in order to help solve the issue. Why is Government …? Maybe under the Government value system it sounds like good value for money, the £8.1 million, but in the real world I am led to believe that this is a couple of million heavy from what it should be. Not the Hon. Member for Onchan, Eaghtyrane. Like the 3410 previous … people talk to me and they trust me. This is people from the industry saying to me that this is a very expensive purchase as far as value for money for the taxpayer. What is even worse is not just the access to the money and how we are going to develop a strategic policy to try and create the environment to get people to invest in the long-term-care industry … We will never get that sorted out if we have a situation of an in-out approach, where 3415 we have different standards for accountancy, where we have different standards for inspection between the criteria if the homes are owned by us or owned by the private sector. And that is not the Hon. Member for Onchan speaking; that is actually people in the industry who bitterly complain about the inconsistency in approach. And remember, I brought the piece of legislation in for the 1988 Act. 3420 So the situation has to be that we have to start looking not from a panicked knee-jerk reaction. We will not sort out the problem of the bed blockers by trying to rewrite history … that we made a fundamental mistake in closing down Glenside and brushing it all under the carpet, as usual. What we have got to try and do is develop a strategy that will work so that we can get people to actually say how things work. I think today the reason we are here is because of the 3425 issue of Glenside, and this idea that we can allow the mud-to-the-blanket routine … that the absurdity of knocking down Glenside is the reason we are staring this issue in the face today. And we are not addressing where those corporate decisions, those ministerial decisions, were made, how they were made and how we are going to make sure we do not repeat that fiasco – like the drugs centre that never opened, that cost us £1.1 million in 2006 and was still not open 3430 in 2010, and, I am led to believe, never actually opened how it was designed because it was not to the convenience of the management at the time. I raise these issues because they need to be raised. We need to be working out, firstly, like we did many years ago … Maybe the answer has to be like a grant and loan system, like we did with the hotel industry. We have got a number of sites on the Island that are vacant and owned 3435 by Government, that could be part of that grant scheme. We are into a different fiscal environment. The idea of being able to buy things on the hoof and not have any good planning is not the way forward. If we are going to make a difference in the future, we have got to create the environment where people will see a long-term investment opportunity in nursing and residential homes 3440 provision and will break the cartel we have at the present time. We have the problems at the present time … and I understand the ignorance of not understanding these things by the new Members and the bushy-eyed and bushy-tailed ideas of having to defend the indefensible, but some of us have been here for 30 years. We have to allow for the fact, when we talk about developing strategy, of the crazy situation that where it is the

Tynwald 21/06/2016 38 3445 private sector all the capital costs are taken into account as far as the charging structures, but in the state system they did not have to worry about the capital costs. Admittedly, we have improved that in recent years, but it is still part of the Mickey Mouse economics that have been allowed to last for the last 20 years in this Chamber. You have got to come up with a strategic policy. You are going to have to start developing. If we are to protect the sacred vows of the 3450 welfare state of a care system, we are going to have to look at new ways forward. I do not want to attack the Minister, because I believe the Minister wants to do the best thing he can, but you do not help yourself outside this Chamber when you tell us it is going to cost us £3 million more and something like a 40% mark-up, and we own the land, if we were to build it, to boot, and it is still 40% more than the private sector. Either we have complete and utter 3455 incompetence in our capital way of us developing capital projects that most people now recognise, or there is something fundamentally corrupt in the systems of government that allow a situation where a piece of land that we own … and we still spend 40% more to provide the same building. So I think you need clarity on that point, Eaghtyrane. Questions need to be asked. You are 3460 going into difficult times and I believe that Government cannot afford the La-La economics that we have seen with the Brown and Bell administrations, and supporting this as it is at the present time is not the way to break the way things are going. I hope Hon. Members will have the good sense to reject this proposal. I understand all the cries of crisis, all the cries of we have got to do something now. Well, I am sick of being in this 3465 Court with this crony capitalism, where we end up with a situation where the taxpayer ends up being fiscally robbed. What the Department needs to do, in my opinion, is develop the environment to get the capital investment into the services in order that we have a level playing field, fair accessibility and fair value for money for the people, instead of what we seem to end up with time and time again: the ‘fiefdomism’ that seems to be allowed to flourish for the few at 3470 the expense of the many. Yes, I know we have a job, and actually trying to get control of this thing, as far as the Minister is concerned, is not going to help but we have to get away from the situation where we have, because of stupidity, because of lack of parliamentary process, we were allowed to knock down Glenside. My good friend in Council, Mr Henderson, who was worried about me having to 3475 dig out the Hansard, leaving the Chamber, to prove that I am actually talking fact and others are talking fiction in here about the … I have forgotten the name of the wing that was down there that I used to visit on a regular basis for geriatric hospital beds, (A Member: Victoria Lodge.) which was perfectly all right to be used for such a purpose for more high-dependency people. Hon. Members, the easy way forward is to vote this through. I am a leftie around here, but 3480 the fact is the easy way forward is to vote this through. We have ended up with another engineered crisis and the taxpayer is staring us in the face. I understand there are 40 beds that are being blocked in the Hospital. It broke my heart when I was down there having to see the staff tied up with one particularly demented individual who should not have been in that particular ward and how much time it takes. But I think you need to be looking at the issue of 3485 why are we buying this property. Why are we not saying to these people, with the shortage of finance we have got … The implications as far as revenue costs are put from capital costs. Why are we actually purchasing this building? Why didn’t we encourage the owners to go and find an operator to run this home and actually create that environment? As members of the legislature … and many members of this legislature do not realise, and 3490 most people outside do not realise there is a difference between Government and being a member of a legislature. The problem has been, for far too long, there is no money in doing what I do, and that has been the problem. But we create the environment, we put audit onto Government, and what I believe you have got to get away from is the toxicity you have got at the moment of the fact that by going down this road you will not help the situation to try and 3495 get the private sector to actually run these homes. We have a public sector deficit. We have recognised that there were other agendas, as far as Glenside was concerned, about the public sector pension liabilities, but we cannot have this sort of schizophrenic situation where we are supposed to be the champions of capitalism and then we fall back here.

Tynwald 21/06/2016 39 I think you need to ask the fundamental question: why didn’t they leave the operator to find 3500 an operator to run … [Inaudible] and why aren’t we trying to promote, in order to help the dependency to be lessened by the public purse on the construction industry at the moment, which soaks up our unemployment? Why aren’t we turning round and saying to developers that we need to address the idea of some of these vital sites? We have got the prison site, we have got the site at the old Park Road School – many of these sites could be addressed. 3505 I am tired, Eaghtyrane, of seeing us engineered into a crisis and the situation ends up where the taxpayer has to pick up the cost, and what happens is nothing is ever done about addressing why we are in that mess. I would like to know why the Minister is so silent, or is it the sacred rule: if you are part of the club, no matter what you do, whatever you mess up will be covered up? I hope the Minister … 3510 As in the previous debate, all I want is to help him to bring about the management changes that will need to be happening in more austere times. With this, I believe if we support this we will not actually be doing him or the people who come after him any service by supporting this programme, because unless he comes up with some rabbit out of the hat, economically this is not the right way forward. 3515 The President: The Hon. Member, Mrs Beecroft.

Mrs Beecroft: Thank you, Madam President. I do have a few queries on this. Unfortunately, I was not able to go to the presentation, and 3520 the Minister has issued further explanations just recently but I still have some queries left. Why didn’t Salisbury Care continue with the deal? There is obviously a gap in the market, or they would not have commissioned this building to be built in the first place. If they are coming out and leaving the developer in the lurch, then we should be getting it at a real knock-down price, not at something that does appear to be … I am not an expert in the construction industry 3525 at all, but it certainly appears to be well over what you would expect to pay. Even if the valuer has said that it is worth more than that, if a developer is left with a building because the company which has asked him to develop that property has pulled out, then he would be looking not to be making a profit on that, just to break even so that he did not suffer a loss. When buildings are being done, you usually have a quantity surveyor and you get staged 3530 payments, so I would like a bit more clarity on actually how this has come about. Were we actually relying on this building being built and opened to solve some of the problem of the lack of beds on the Island, because if there is such a shortage of beds there is a gap in the market. I do not know why somebody would pull out and nobody else would be able to take that place if there is this supposedly lucrative market and there is this huge demand for 3535 the service. If we were not relying on that then I am afraid it is down to lack of planning, because we keep getting told all the time about more people not wanting to be kept in hospital, they are living longer, blah, blah, blah, and yet there has been no provision made: Glenside closed, ward 20 closed. Where was the fall-back plan, knowing all this was going to happen? So it really does concern me, and particularly with the bed-blocking nights that the Minister 3540 gave us: 800-odd, 800-odd, and then up to 3,000 in the last year. Is that because of ward 20? I know he said that ward 20 is now used for the oncology department while new premises are being built for that, but it did not have to be; it could have been made into a nursing ward to free up the actual hospital beds until further accommodation could be found for those people. There just does not seem to be any strategic planning gone into this: Glenside closed, nothing in 3545 its place; ward 20 closed, nothing to take that capacity. The Minister has gone on today about how much of the extra money that he has asked for, for his Department, for his overspend, has come from having to use bank staff because we cannot get sufficient medically qualified people – nurses and consultants, but particularly nurses. I am delighted that he is training more on Island but there is a long way to go. Where 3550 does he think he is going to get the people to actually staff another care home of this order? You are going to need a lot of qualified people, and, if you are struggling to get enough for the Hospital, where are they going to come from?

Tynwald 21/06/2016 40 I have to say that the explanatory memorandum, on first reading it without the back-up information that we have, rang alarm bells with me because it says:

The Department intends to seek expressions of interest for providers to run the home. If this is unsuccessful, as a last resort the Department will seek to provide the services through an arm’s length operation.

3555 Why are we going to go into something when we are using terminology like ‘as a last resort’? We do not need to do that. The developer will find another purchaser and somebody else will do it, and those beds will get filled because there is the demand for it. I do not see that we have to be doing things and making provision plans and saying ‘as a last resort we are going to do this if this one fails’. It all seems a bit panicky to me. And I hate to say this, because I usually do try to 3560 support the Minister because I know he does his best and he has not got an easy job, but I do think he has got it wrong in this instance, and unless he can convince me otherwise in his summing up I am afraid I will have to reject this motion.

The President: The Hon. Member for Peel, Mr Harmer. 3565 Mr Harmer: Thank you, Madam President. Just a couple of points to support this motion – obviously, a Member of the Department. I wanted to address a couple of issues that have come up. One is mainly on the ‘why’ issue. In essence, the beds that we are talking about are 3570 essentially Social Security beds. In a sense, at the moment, the market does not provide those beds (Mr Cretney: Hear, hear.) and we are effectively bringing up supply. That is the essential point. So, if we do not do this, or if somebody else takes over, there will be 68 beds but they will not be Social Security beds. Without those Social Security beds freed, then what will happen is those beds will still be in there – we will have bed blocking within Noble’s. So this is about 3575 supply. It is about actually improving the market. The only other point I wanted to make was that there is a concept of saying this is knee-jerk. Actually, nothing could be further from the truth, because certainly as I have joined the Department, under excellent stewardship of Malcolm Couch and the Minister, what is clear to me is that a five-year plan has been developed. We are looking at lots and lots of different 3580 issues: early intervention in Children Services; in the Hospital we are looking at certain issues to do with efficiency – paperless and e-prescribing, all those kind of good things; in Mental Health Services the Hon. Member of Council is looking at a whole load of step-up facilities, step-down facilities, and all of the improvements that have been made there. We are working incredibly hard, and some of the issues that we have talked about in terms of social care of the elderly we 3585 are looking at, and, in terms of the Hospital, we are looking again at step-up, step-down facilities in Ramsey and the south. The key thing here is that the budget … What is clear with the supplementary vote is the fact that, in the past, the £9 million has been obscured by other savings and it has always come under or within budget, but actually that £9 million overspend has been there for a while in Noble’s and we have to address that. So, taking what the Member 3590 for Onchan was saying – ‘Well, okay, we pass the supplementary vote, but then we do nothing about it’ – does not solve the problem. So, what I am trying to say is that the Department and the Members in the Department are working hard on a strategy, but this issue has come up to actually solve a problem that has come up and we are dealing with it, and it is that kind of reactive and responsive approach that we need as a Government, and that is why I will be 3595 supporting this motion.

The President: The Hon. Member for Douglas West, Mr Thomas.

Mr Thomas: Thank you, Madam President. 3600 I come at this with an open mind and I will try and structure my remarks in terms of a series of questions. The first one is a bit stimulated by what the Hon. Member for Peel just said, which is that obviously the proposals in the south and the north that were mentioned have been around for a

Tynwald 21/06/2016 41 long time, but manuscripts do not burn and I took it upon myself to look into some of the 3605 manuscripts in the past. The Hon. Minister himself, back in March 2012, stated:

… a replacement facility should have been planned for the Douglas and Braddan area, as sadly, senile dementia and severe health problems mean that a Glenside-type facility will always be required?

That is a matter of public record, so I am looking to the Minister to explain why things changed so quickly between March 2012 and now, especially as in October 2014, when asked by the Hon. Member, colleague from Council, Mr Henderson, about Glenside in particular and about 3610 shortage of beds, the very clear answer the Minister gave to Mr Henderson – the man from Treasury perhaps has looked at this … When he was asked about what the implications were of Glenside, the Minister answered:

On 13th October there were 29 beds with private providers across the Island and the Department would need their permission to disclose where those beds were. The Department’s information clearly indicates that any delay in discharge from Noble’s Hospital is not as a result of a shortage of beds.

And so on. So things have changed very quickly and I look to the Minister to provide an explanation in the context of that information I have just provided. 3615 Another important aspect of the Minister’s case and the Treasury’s case and the case that is being made for this is about value. I approached this with a completely open mind, just looking for the evidence, and now I am going to present the evidence back to the Minister. I just ask him in his remarks, which will persuade me which way to vote on this, to explain the evidence that I am about to give him in terms of my questions. 3620 The first piece of evidence is that there has been – unusually perhaps in the Isle of Man, because when I look back at the Office of Fair Trading investigations into this type of market in 2006-07 there is not a great market in the Isle of Man in residential and nursing care homes, but there has actually been a transaction in Saddle Mews Nursing Home in 2014-15-16, depending on whether the registration or the publication, or whatever it is of the deeds that counts. And a 3625 home that once traded, apparently, for £3.5 million – Saddle Mews Nursing Home in 2005 – traded recently at £440,000. That is all a matter of public record in the Deeds Registry. That nursing home is not the most modern, it is 1988, but it does have 22 or 23 beds, some of which are double – they are large beds. I do not know, I have not looked at it, but it was marketed at much more than £440,000, so I wonder why the Department did not actually consider 3630 purchasing that facility and renovating it. Then I look across and I also look at some evidence that seems to be available from building costs in the public domain. I think the site that this facility is on traded for about £900,000, nearly £1 million. Across, in May 2016, there was a similar size facility available on the market for more like £5 million to £5½ million in Bedfordshire, where the market seems to be much 3635 more developed, and that seemed to be the value when the land is much more expensive. I found another example where the price in the market seems to be approach £7 million or £7.8 million, or something like that. And just to avoid any confusion, these are turnkey projects, fully completed. This is not just construction cost; this is a turnkey project that is actually being marketed in the public domain for us to take evidence from. 3640 Of course, we have already been told that an international, properly professional valuer has told us it is worth the money, but the crucial thing in Manx prices is always the premium that is added in for it being on the Isle of Man. That valuation that says this is a fair value could have said it would cost 30% less in the UK, but because it is the Isle of Man it is worth 30% more. The only evidence I have got is the evidence from the procurement review that the Tolson 3645 report did about housing and construction costs back in July 2013, their procurement view, and the conclusion of that is whilst making comparisons is not straightforward, the report concludes that the evidence collected suggests that there are significant opportunities for reducing costs without impacting on the quality of service, and then it goes into various suggestions about how that could be done.

Tynwald 21/06/2016 42 3650 Talking to a few quantity surveyors and chartered surveyors and the like, the £120,000 per bed turnkey price does seem rather high for some comparable schemes that are going on for comparable places. I have been sent so much information from Savills, public reports from all sorts of people, which seems to suggest that. So a question to the Minister, then, is: in summary, please explain why this is really value, given that evidence that has just been presented. 3655 The third area of questions is about what impact this transaction might have on a number of excellent processes that are going on in the Minister’s Department and in other parts of Government. So, for instance, we are actually in the process of looking at how we go about caring for older people in general and extra care facilities, and that is work in progress. We are actually going on, trying to drive down the costs of construction projects, addressing the point 3660 that the Hon. Member for Onchan made, which is that it is ridiculous to say just because Government does it, it is £3 million more, which is what the Minister said a couple of days ago. It got down to £2 million more in today’s presentation. I think we were told that if Government did it on Glenside, for land that we already own already, it would be £10 million. It was £11 million a few days ago. I have got £12 million here. As far as I can see, that is work in progress. 3665 Before you can cost something, you have got to know exactly what it is you are trying to do. If the private builders can build it in a year, why can’t we build it in a year? Why is it going to take us three years? I was there in the Planning Committee when the Salisbury Street building went through, and the Planning Committee worked very efficiently and passed it first time, as far as I remember. (A Member: Correct.) I cannot see why it is imagined that it would take so long. 3670 Therefore, what I am saying is … It is suggested to me that it would take so long, but the fire station that you are about to hear at the next Item went through in one Planning Committee, and it was a very quick process once it finally got the green light from Treasury after a couple of years of arguments in Treasury. We have to be realistic. It is no good saying Government is bad. We have got to make Government better and I think this could be detrimental to some of the 3675 processes that we have got going on in estates, in housing, in project management, in procurement and the like. That comes on to the point that the Hon. Member for South Douglas, Mrs Beecroft, mentioned. I understand from Royal College of Nursing sources that we are 50 nurses short. I am looking to the Minister to tell me how many staff are involved in running this type of facility, but 3680 it has been estimated to me 50 or 60. I do not know, but could the Minister tell us how many people we are talking about and how we are going to find those people to operate it; and, if we do not find those people, how much it is going to cost us to have a building – turnkey, beautiful, and everything like that – sitting empty because we have not … That difficult problem … The Minister can solve all sorts of problems – he is assisted by some excellent departmental 3685 Members; he will cope – but how much will it cost for every week, every month, every six months that we do not manage to get involved with the actual operation of this facility because we bit off more than we can chew and we have upset the providers who could have come in and done a deal to operate it on our behalf? Then, finally, as this significant capital transaction is not in the Pink Book, for some reason, 3690 and it is not even hinted at, I just wanted to make sure from the Minister that he is absolutely convinced that the financing can be obtained without using the bonds that we are going to debate later on. It is hard for me to keep up with: one minute we are short of money, the next minute we have got lots of money and we are going to put it into a fund to make more money – the next minute we are short of money and we do not need the £50 million but we are 3695 borrowing £50 million. It seems to me £8.1 million is a lot of money, even though it is now down to £7.9 million because of good trading, and if we deal quickly we can have it probably … I do not know, it all sounded … £7.9 million now, not really £8.1 million, but where does that money come from? Is it dependent on the issuance of a bond? And if so, how long is the bond going to take? 3700 In conclusion, I think it is worth going back to the Office of Trading Report on Nursing Care Homes 2007, because this is good news for the Minister. Back in 2007, the Office of Fair Trading really looked into the cost per bed for nursing and residential homes, really studied it and came up with pages of analysis about how to get good value and how to get the £60,000 that they

Tynwald 21/06/2016 43 estimated each residential care bed should cost in 2007, and their recommendation was actually 3705 more or less the way that we are doing it now, after some planning and after all the other work that is going at the minute. So we will be ready for what they recommended in 2007 by about 2018, it seems to me. At 7.7 the OFT recommends:

The OFT recommends that the DHSS urgently reviews its policy of funding nursing home care through the payment of benefits. Options identified in this report and the 2006 Report include the direct purchasing of beds from operators and the provision of a Department owned nursing home, with this latter option being recommended solely on the basis that the home is not operated by the Department … Whatever policy direction is selected, the DHSS should determine and publish a method for calculating the amount that it is willing to pay for private sector nursing care that addresses the needs of the individual, the needs of the operators and the resources of the Department.

So we have finally got there but we have not got the underpinning in place, and this seems to 3710 me to be an excessive price, unless the Minister comes back with very good answers.

The President: The Hon. Member for Douglas South, Mr Malarkey.

Mr Malarkey: Thank you, Madam President. 3715 I was not really going to talk to the debate today; I thought we had a very good presentation last week. What I will add to the debate is a constituent of mine, on the Thursday before the bank holiday weekend at the beginning of May, rang me quite distressed. This lady, in her 80s, a very independent lady living on her own in a bungalow, suddenly could not cope. Due to family situations, the family could not help her either because they had other health problems going on 3720 at the time. She contacted her doctor: her doctor said, ‘You need respite, you are not coping, you cannot be left on your own.’ So the family then immediately started ringing just about every home on the Island. Personally, I thought they were exaggerating when they contacted me on the Saturday morning. She contacted me in distress and said, ‘Bill, is there anything you can do, because I cannot cope anymore. I need respite. I am happy to pay for it.’ The lady has got the 3725 money, she wanted to pay for it – the issue was there was not a bed available for her in any private nursing home on the Island that the family contacted. So I busily that morning started ringing round all the nursing homes I know on the Island, saying I needed respite for this constituent of mine, a dear friend who would not be complaining unless it really was serious. I visited her. I spotted the fact that she was not capable of getting 3730 out of the chair, she had got so weak. She needed help. I ended up having to get in touch with Mr Quirk. Mr Quirk then got a Social Services social worker in touch with me. I managed, by late afternoon, to get a social worker out and this lady got the only emergency bed on the Island. It was a bank holiday weekend. On Tuesday, after the bank holiday, after having respite and a lot of hard work, they finally found somewhere for her to go, and to this day she is still in that home 3735 and she is paying privately. I do not think Members realise in here just what a critical state we are at in having nursing accommodation for our elderly. Madam President, I was in charge of Social Services in 2009-10 when we lost all of that financial money going forward, and at that time Social Care had to find big budget costs. I will stand here and say in 2010 Glenside was only half full. We had room in Peel, we had room down 3740 at Southlands, we had room in various places around the Island. When we added up how many people we had in Glenside and how many empty beds there were round the Island at the time, there was enough to fill the beds round the Island without using Glenside. Glenside was one of the oldest homes on the Island. Very few of them had en-suite facilities. It was in a very poor state of repair, the building was very old and needed replacing, so the decision was made at the 3745 time, because we were in great financial hardship because we had lost £170 million at the stroke of a pen, that Glenside had to go. But it was a prime site for redevelopment. The decision was made by Social Services that stay at home was the answer going forward, so more and more people were encouraged to stay at home. We had more private businesses coming out helping people to stay at home, and that was the way forward. But another seven 3750 years have elapsed since then, and some of these people who are staying at home now or have

Tynwald 21/06/2016 44 stayed at home for the last seven years have now got to the stage where they can no longer stay at home, (A Member: Hear, hear.) so we need now to look at facilities. I am quite amazed at how long it has taken for Glenside to be closed and pulled down – and why it has not been redeveloped, I must say, at this stage … (Mrs Beecroft: Hear, hear.) I was 3755 always in favour of it being pulled down because it was not really in very good condition. But now we find ourselves in a position where we have colossal bed blocking at the Hospital. We have not got any spare beds whatsoever on the Island for our elderly if they need it in a hurry – and I have proof of that – so I do not honestly think we have any option moving forward than to support this today, because we need this unit open. We need it open before Christmas, before 3760 we go into another winter of more bed blocking, more elderly people needing to go into care, and we responsible politicians here should be able to supply that by supplying this home moving forward. I do not think we have any options today. It is a need and it is an emergency. I would urge Members today to support this, because I can tell you first hand there are no spare beds available and there will be a lot less come this winter when the elderly living at home 3765 do not cope going forward. Thank you, Madam President.

The President: The Hon. Member, Mr Quirk.

3770 Mr Quirk: Thank you, Madam President. I just want to echo the sentiments that my friend and colleague, Mr Malarkey, has just said. I would ask any Member … and I was one of the ones who did not want Glenside knocked down at all. I was standing there with other individuals saying it should stand. There was a different Minister at the time, and I remember saying, ‘No, this is not going to happen.’ 3775 We do have the likes of Reayrt ny Baie and we also have Cummal Mooar in Ramsey, and I would encourage any Member who has not visited those facilities, the ones that are still in existence … and look at some of the homes we have got round the Island. If you want your loved ones to go to … Most of them are Victorian houses, most of them need a real upgrade, and I would not want to put some of my friends, colleagues or relations into those particular homes 3780 for the last four or five years of their lives. And that is where they go when they get to that point in time where people cannot cope, like Mr Malarkey said – it is a dramatic situation. I would say to Hon. Members here today that the Members and the Minister, and Treasury, we looked out of the box. There was an opportunity, and do not degrade that opportunity which we have taken. We want to take that opportunity. It definitely will fill a need, and when my good 3785 friend from West Douglas, Mr Thomas, says it is a large facility with a lot of beds, you can phase it in. There is recruitment happening now. There are individuals who want to train in adult services. We want to bring that generation forward. Instead of being nurses … They do not all want to be nurses; some of them want to be in social care, to go outside and go to people’s homes. We have got to do all these things for the future. 3790 Do not kick this out at all, Members. It is no ego trip for the Department. We need to satisfy a need, and, Hon. Members here today, we will still have Glenside. Glenside is still in our pocket. As the Minister has indicated, we will have to start looking at them but we cannot build them within a year or seven days. That need is going to be coming just before Christmas and we have got to have that need for the people we care about on this Island. 3795 Support the motion today, Members.

The President: The Hon. Member, Mr Speaker.

The Speaker: Madam President, just very briefly, I shall certainly be supporting the motion. I 3800 think actually the Department has moved very astutely in this matter. (A Member: Hear, hear.) The fact that there was nothing in the Pink Book at all demonstrates in fact that advantage has been taken of an opportunity that has arisen. Quite clearly this facility was not commissioned by the Department; circumstances have made it become available. It would have been very easy to let this slip through Government’s fingers by slowness of action or inertia. Certainly that has

Tynwald 21/06/2016 45 3805 happened in the past when opportunities have been missed. I think for legitimate questions to be asked about this, about the costing of alternative ways of doing it short of Government involvement … Those have been answered, and I think answered quite effectively, and I would just like to congratulate the Department on seizing this particular opportunity and giving us the opportunity to support it this afternoon. 3810 Mr Robertshaw: Hear, hear.

The President: The Minister to reply.

3815 The Minister: Thank you, Madam President. I thank all Hon. Members who have taken part in this debate because this is a very serious issue and I think it needed plenty of scrutiny. I will take it on first person first. The Hon. Member for Malew and Santon, Mr Cregeen, wanted some assurances that the deposit had not been paid. I can assure the Hon. Court the 3820 person we are looking to buy the property off was told nothing would happen without Tynwald approval. Having said that, we have already got Treasury approval and we have already got full Departmental support. We have taken it to Tynwald Court to get support. So nothing has been paid up front, nothing has been done earlier on it. I think this is one of his key issues. He wanted to know what the costs were of a bed at Noble’s Hospital and I think I gave in my 3825 speech on the overspend it was £2,000 per week, so on very fag-packet calculations it is £280- £290 a day for that. Will there be an imbalance on nursing homes on the Isle of Man? I think that was his last point. Mr Malarkey has already pointed out he has personally rung round: there is no spare nursing home capacity on the Isle of Man. Noble’s Hospital has become a nursing home, Hon. 3830 Members, and as a result of that all we are trying to do is to provide a facility for people who are living in an eight-bed ward for months and months on end because there is nowhere for them to go. This nursing home is not going to compete or suddenly put everyone out of business, because the demand is there. I have already give a speech saying there will be a 10,000 increase in people over the age of 65. Had some of the Hon. Members who have been critical of this 3835 proposal bothered to turn up to the Department’s five roadshows, two of which were held in Douglas, and listened to the presentation we gave the public, we explained then about the nursing home situation and the seriousness of the situation – and I am glad to say Mr Cregeen was one of those Members who turned up (Mr Corkish: Good lad!) and I am counting on his support because he understands the issue, along with all the Rushen Members etc. 3840 (Interjections) So I hope I have answered the Hon. Member, Mr Cregeen’s thoughts on this one. Mr Karran is complimentary about some things that we are doing as a Department, but is very critical about this. I am afraid I am going to upset my friend, Mr Karran, because he has upset me by the fact that we gave a presentation on this where all Members had the opportunity to come along. I know it is a curve ball – we have had to act fast because an 3845 opportunity has come along. Sadly, he stayed in his office, he did not come up and see the presentation. I could have personally answered any of the concerns that he had on this issue, but he chose not to come up. (Interjection by Mr Karran) He was the only one in the Chambers – I nipped down straight after. We have just had a discussion where Mr Karran was concerned about vulnerable people, 3850 during his Question to me this morning, in nursing homes. He wanted to know what was I doing to protect them and look after them. One minute he is playing the knight in shining armour for looking after vulnerable people who are not being looked after well enough, and the next minute he is happy for me to have eight elderly people in a nursing ward, having to share toilet facilities for months on end because there is no nursing home space for them. He must think 3855 that is acceptable. For me it is not. Having our elderly in our Hospital – it is a fantastic place if you are sick and you need looking after, but if you are needing nursing care, living in a ward of eight people with people coming in and emergency operations in the middle of the night, disturbing your sleep, you have not got your own en-suite facility … It is the last year or so of

Tynwald 21/06/2016 46 your life: you want a nice facility, you want en-suite, you want to be not disturbed by families of 3860 other people coming in and interrupting your sleep or thought process, your privacy. And yet here we are – he is happy for that situation to continue for a number of years until the situation is fixed. (Interjection by Mr Karran) He then says he has been advised by people in the nursing home fraternity who say that the property is too expensive, (Interjection by Mr Karran) and then in the same sentence he went on 3865 to describe that there is a cartel in the nursing homes who have just been advising him that this property is too expensive.

Mr Karran: I said a member in the building industry, I think you will find, on that subject.

3870 The Minister: Well, we will double check there, Hon. Member.

Mr Karran: Yes, do, and come back and apologise later … [Inaudible]

The Minister: Had the Hon. Member for Onchan bothered to attend the presentation, and 3875 had he read the fact sheet that was sent to him answering all the questions … We have had an off-Island nursing home valuer come over and look at our facility. They have compared the facility at Salisbury Street with other sales on Island and off Island. They are comparing apples with apples. They have given us examples of a 60-bed turnkey located in Hertfordshire, and that sold in mid-2015 for £120,000 per bed; a number of homes of between 60 and 66 beds located 3880 across England and Scotland that are currently on the market or have been sold in the last two years at prices broadly in the region of £90,000 to £100,000 per bed. These are second-hand nursing home beds. These transactions typically reflect markets within the average fee achievable in excess of £750 but no higher than £900 per week, and we are being charged a minimum of £950 on the Isle of Man for people of the Isle of Man. Turnkey values in excess of 3885 £135,000 per bed are achievable in the market across England and Scotland; however, these are predominantly within the southeast of England, where average fees rate in the region of £1,000 per week or more. And that, sadly, is where we are going on the Isle of Man. He raised a valid point about why didn’t we say to the providers of Salisbury Street, ‘Let’s block book at the payment level of £820,’ and again, had he been there he would have heard the 3890 answer: they would not accept it. They had done their business case on £1,000-£1,100 a week: that is the way the market is going; this is arguably the best nursing home on the Island – it is the most recent, the size of the rooms is 14.5 m2 to 16.5 m2, a fantastic facility for the people of the Isle of Man. Therefore they would not accept the benefit levels. Because there is not any spare capacity on the Isle of Man, why would you accept £820 a week when you can make £1,000- 3895 £1,100 per week? That is the reality of the situation we are living in. And Mr Malarkey has independently rung around – I do not know if the Hon. Member for Onchan has rung around to see what the nursing home capacity is on the Isle of Man. He has not, he just – (Interjection by Mr Karran) I thought I had the floor, sir.

3900 Mr Karran: Yes, well, you just asked a question.

The President: Hon. Members, come on, we are getting tetchy. Let’s settle down to proper debate, please.

3905 The Minister: This nursing home is going to have 40 beds for people who are unable to pay the full market price. It will enable us to get people out of Noble’s Hospital. We have already mentioned the fact that it is £2,000 a week in Noble’s Hospital. When you look at the cost of the facility, sadly, whilst it is a lot of money at £7.9 million, what we are faced with as a Department having to pay, as taxpayers, to keep people in Noble’s Hospital, it is a very cheap option and it 3910 puts people where they should be, not where they want to be. The Hon. Member is right about the design. Designing Government projects going forward, I hope that we will look at it, because at the moment, paying an architect a percentage to design

Tynwald 21/06/2016 47 a building and a percentage of the cost, I am not sure we do get good value for money and I think design and build is something that we are going to have to look at going forward. The 3915 Department has already done this with a home for adults with disabilities at Leece Lodge and it has turned out to be a very good facility. If we move on to my hon. colleague, Mrs Beecroft, who was sadly off sick and I fully accept she could not make the presentation, though she did not make any of my roadshows and she did not come to me to ask. I value her opinion and I would have happily given her the support. She 3920 asked the valid question: why did they not continue to run it? Well, if they had run it, it would have been at full market price. We were faced with the fact that we have got in the Pink Book going forward costs to replace Glenside. I put a year down for planning because it would have to go to an independent inspector. There are a lot of wealthy houses in the area and I think we might have had some objections to that, so I allowed a year for planning. It has taken 16 months, 3925 I think, and counting, to build Salisbury Street, so I do not think it has been done in 12 months, but I stand corrected if the Hon. Member … I think Mr Karran felt … or Mr Thomas, I think, said it could be built in a year. He would be doing well. If he can give me examples of a nursing home built from start to finish and kitted out in a year, then I would like to know the company that has done that so we can have a word with them. 3930 I think it was Mrs Beecroft … about could it be mothballed, the development, if they cannot find it. And I think Mr Thomas raised the issue of whether or not we, as a Department, are going to have problems getting staff to run it. I did specifically state in my speech that it is not going to be easy. However, we are not talking of 50 nurses to run this, which … whether I misheard … It is nurses plus care assistants. The Department has recently advertised for 14 care staff and we 3935 have received 26 applications, so I would hope that would give reassurance that whilst I know it is not going to be easy, first of all we hope that, should it be approved by Tynwald, we will go straight out for expressions of interest, and we have been working on that contract for some … The minute we thought we were going to go ahead with this we have been working already on all the paperwork to go out for expressions of interest so we can hit the ground running. It is 3940 only as a worst-case scenario, if no one contacts us to run the nursing home for us, that we will then set up an arm’s-length company, though I am led to believe we have already had interest and it is just by the publicity generated. If we move on to Mr Harmer, I thank him for his support. Obviously, he has been involved in the Department discussions. He will know all the details and has had a few weeks’ notice on this, 3945 because this has not been something we have been working on for a year. An opportunity came along, we were in negotiations to try and block book benefit beds, we could not find anyone who would accept it, so we took the decision that if we were going to have to design and build and get Tynwald approval for a nursing home … How long would that take? Two to three years – and then we have got a hospital with 38 people and peaked at the wintertime. Do we want to 3950 have another two to three years of winters of our elderly people having to go through that? Or would it be cheaper to buy this facility and ease the situation at Noble’s Hospital whilst we go out to conversations with nursing home providers to try and encourage them to build more nursing homes on the Island – because obviously with the figures I have given time and time again there is a demand for it. 3955 Now if I can move on to Mr Thomas, and again, had he attended any of the Department’s roadshows – there were two excellent ones in Douglas, one standing room only – then he would have heard the comments about the nursing home. He mentioned something I said in 2012 as Minister – I do not think I was Minister in 2012; it was 2014 before I had the honour to be made Health and Social Care Minister – but he did mention that in October 2014 I gave an Answer 3960 about numbers, and if he had listened to my previous answer on the overspend, I gave the number of bed blocking needing nursing homes for the last three years, and in that period I think I gave, off the top of my head, 828, 830 nights, and then, the following year, 2015-16, after we had had the conversation on the floor of Tynwald or Keys – I do not know when he was quoting me from – it shot up to three thousand one hundred and something, and that is where 3965 the sudden increase has happened.

Tynwald 21/06/2016 48 He then goes on to the comparisons on cost of nursing homes, and it has been a theme which I have had quite a lot, which is why we got off-Island experts in nursing home valuations to compare like with like, not a 30 or 40-year-old building with 20 beds that has come to the end of its life, not something in Wales or wherever at different prices. We do not know whether the 3970 size of the rooms is big enough, do they comply with the standards or not, and therefore … I do not have the technical expertise of comparing building costs for nursing homes on and off the Island; I am sure the Hon. Member, Mr Thomas – and Mr Cregeen, who also raised it with me – do not have these skills. And yes, people will come along and say, ‘Oh, you’re paying too much for that,’ which is why we went out and took expert, professional advice in the field from people 3975 who understand this valuation, just to make sure that we were not paying over the odds – because, trust me, Madam President, no, I do not want to be paying over the odds for a nursing home if I can get it cheaper. I am very keen on making sure that the taxpayer gets value for money. He was concerned about staffing it. I have been totally honest with Members, I addressed it 3980 in my opening speech: this is not going to be easy, but it must be done because those people living in Noble’s Hospital, in wards of eight, waiting to go in, those people who want respite care for their loved ones but the residential homes are full because they have got people waiting to go into nursing homes and there are no nursing home beds … We have to get the solution through and we have to make it work, and that is why we have been working flat out as a 3985 Department. When you see a problem you have got to try and fix it as quickly as possible, and there is no way I or any Members of our Department, and the Council of Ministers, want elderly vulnerable people having to live either in hospital in wards of eight beds, or having to stay at home because they cannot get anywhere else. This is a solution. It is an unusual solution, I know. It is not something you would want to do every day of the week, and trust me, it has taken an 3990 awful lot of officer time and departmental time with all my political colleagues working hard to try and come up with a solution to help those vulnerable people. Mr Thomas said also he was concerned about the fact that it was not in the Pink Book. If I could point out that the cost for a redesign of Glenside, a rebuild of Glenside, was in the Pink Book – there were architects’ fees of, I think, about circa £300,000 (Mr Thomas: Three hundred 3995 thousand, yes.) for the design, which showed the Department’s proposal to go head. Glenside was shut, we have had provisional plans drawn up to replace it, we had had provisional costings of a new care home on the Isle of Man. We were working through all that and we had a business case going to Treasury, when all of a sudden a situation presents itself where a nursing home that we can buy cheaper than we were going to build ourselves solves the problems three years 4000 in advance, or maybe two and a half years. Or maybe two years, if Mr Thomas can find a builder who can do the lot in 12 months and key-turn it – then it still solves the issue significantly quicker and saves … I have given the figures of over £3 million a year for 30 people living in Noble’s Hospital, who should be in a nursing home. That is millions, not tens of thousands, hundreds of thousands. It is a big cost. It has not been an easy decision, it is not something we 4005 have taken lightly; this is a serious situation. Mr Malarkey – I thank him very much for his support. He has rung round and seen for himself the concerns that his constituents in Douglas are experiencing – a little bit critical of why Glenside was not replaced earlier, but I would say we as a Department were working on a strategy to replace it. We were hopefully going to go to Tynwald next month to ask for the 4010 support to go ahead with it, but that would have taken a much longer period to do. This is a quicker solution and suits all. Mr Speaker – I would like to thank him very much for his support. I am sorry I have taken so long, Madam President, but it is an incredibly important issue and I wanted all the facts to get out to all Hon. Members. 4015 I beg to move.

The President: The motion before the Court is set out at Item 7. Those in favour, please say aye; against, no. The ayes have it.

Tynwald 21/06/2016 49 A division was called for and electronic voting resulted as follows:

In the Keys – Ayes 20, Noes 3

FOR AGAINST Mr Bell Mrs Beecroft Mr Boot Mr Karran Mr Cannan Mr Thomas Mr Cregeen Mr Gawne Mr Hall Mr Harmer Mr Joughin Mr Malarkey Mr Peake Mr Quayle Mr Quirk Mr Robertshaw Mr Ronan Mr Shimmin Mr Singer Mr Skelly Mr Teare The Speaker Mr Watterson

4020 The Speaker: Madam President, in the Keys, 20 votes for, 3 against.

In the Council – Ayes 9, Noes 0

FOR AGAINST Mr Anderson None Mr Coleman Mr Corkish Mr Cretney Mr Crookall Mr Henderson The Lord Bishop Mr Turner Mr Wild

The President: In the Council, 9 votes for, no votes against. The motion therefore carries, Hon. Members. At this point we will take a break, and the break will be until 5.25.

The Court adjourned at 4.59 p.m. and resumed its sitting at 5.27 p.m.

Tynwald 21/06/2016 50

Appendix 3: 29th July 2016 - Isle of Man Government Media Release ‘Private Operator Sought for Salisbury Street Care Home’

51 52 13/08/2020 Isle of Man Government - Private operator sought for Salisbury Street care home  Covid-19 Coronavirus

Private operator sought for Salisbury Street care home Friday, 29 July 2016

An experienced and qualified nursing care provider is being sought by the Department of Health and Social Care to operate a care home on Salisbury Street in Douglas.

Plans for the Department to purchase the newly built facility were put before Tynwald in June as a ‘bold move’ to ‘ease the gridlock’ within the Island’s health and social care system, largely caused by a lack of nursing home capacity within the private sector: a shortage which has led to a growing number of older people in Noble’s Hospital and in residential care being unable to secure a place in a nursing home.

Currently, all of the Island’s nursing homes are privately operated and set their own fees based on market forces. Nursing home care is privately funded, although those who are unable to pay can claim a number of benefits from Social Security to help with the cost.

The Department’s purchase of the Salisbury Street care home aims to address the shortage of nursing care places whilst potentially stimulating the local market to respond to the shortage of nursing home places.

Under the plans, the Department would own the care home but rent the premises to an external provider to operate it on the condition that 40 of the 68 beds are available for the Department to place people in need of nursing care and at a rate no higher than the maximum available through Social Security. Creating this immediate and guaranteed extra capacity means than older people awaiting discharge to nursing care from Noble’s Hospital will no longer find themselves effectively ‘stranded’ on a ward. Not only

53 https://www.gov.im/news/2016/jul/29/private-operator-sought-for-salisbury-street-care-home/ 1/2 13/08/2020 Isle of Man Government - Private operator sought for Salisbury Street care home does this not provide as homely an environment, it is also more expensive than nursing care provided in a care home, and is placing strain on the hospital with full occupancy a regular occurrence on many wards.

Interested parties must submit their expression of interest no later than 12 noon on Monday 15 August 2016. Further information is available here.

Issued By Health and Social Care

54 https://www.gov.im/news/2016/jul/29/private-operator-sought-for-salisbury-street-care-home/ 2/2

Appendix 4: 21st March 2017 - Department of Health and Social Care Response to a Request for Information under the Freedom of Information Act 2015

55 56 Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

Chief Executive: Malcolm Couch Freedom of Information Team Department of Health & Social Care Chief Executive’s Office Crookall House Demesne Road Douglas Isle of Man, IM1 3QA [Contact details redacted] Website: www.gov.im/dhsc Date: 21 March 2017 FOI Reference: IM80-362i Dear

REQUEST UNDER THE FREEDOM OF INFORMATION ACT 2015 (“the Act”)

Thank you for your request to the Department of Health and Social Care dated 7 March 2017

Your request

On 29 July 2016, a Department of Health and Social Care article on the Isle of Man Government website invited any experienced and qualified nursing care providers interested in the operation of a care home on Salisbury Street in Douglas, submit their interest no later than 12 noon on Monday 15 August 2016.

In relation to this, you asked:

Question 01: “Was this [the above] the complete tendering process?”

Question 02: “Overall, how many parties expressed an interest?”

Question 03: “I understand a contract has now been awarded. Was a notification of the successful party circulated and were the parties who expressed an interest informed of the Department’s decision and given reasons for their decision?”

Question 04: “What were the terms of the contract that was awarded?”

Response to your request

While our aim is to provide information whenever possible, in this instance we are unable to provide some of the information you have requested; the reasons and statutory exemption sections are shown as part of the corresponding answers below.

Question 01: Was this the complete tendering process?

In response to Question 01, the Department of Health and Social Care (“the Department”) can confirm that the Expression of Interest (EOI) was a publicly issued document and was only part of the process to secure an operator for Salisbury Street. The EOI was published from 27 July 2016 to 15 August 2016 and a direct EOI was sent to 166 parties identified by the Department. Page 1 of 3 FOIA/DHSC/01r02 57

Question 02: Overall, how many parties expressed an interest?

In response to Question 02, The Department can confirm that Procurement Services received Expressions of Interest from ten parties. Two parties failed to provide evidence of how they met the requirements of the ‘Declaration of Compliance’ that was issued with the EOI and as such only eight progressed to Stage 02 - the Invitation to Tender (ITT).

The ITT was issued on 20 October 2016 and ran to 01 December 2016 and resulted in responses being received from just two tenderers.

Question 03: Was a notification of the successful party circulated and were the parties who expressed an interest informed of the Department’s decision and given reasons for their decision?

In response to Question 03, following a period of evaluation and presentations the successful and unsuccessful notifications were sent to the two parties who submitted a response on 19 January 2017. The parties involved at the EOI stage were not informed of the outcome of the ITT stage of the process.

Question 04: What were the terms of the contract that was awarded?

While our aim is to provide information whenever possible, in this instance we are unable to provide the information you have requested in Question 04 because of an exemption under Section 30 (qualified exempt information having ”economy and commercial interests”) of the Act applies to that information. While the financial details are commercially sensitive, we have included the service requirements which form the terms of the contract as Appendix One.

Your right to request a review

If you are unhappy with this response to your Freedom of Information request, you may ask us to carry out an internal review of the response, by completing a complaint form and submitting it electronically or by delivery/post to the FOI Co-ordinator, Department of Health & Social Care, Chief Executive’s Officer, Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA.

An electronic version and paper version of our complaint form can be found by going to our website www.gov.im/about-the-government/freedom-of-information/how-to-make-a- freedom-of-information-request/ . Your review request should explain why you are dissatisfied with this response, and should be made as soon as practicable. We will respond as soon as the review has been concluded.

If you are not satisfied with the result of the review, you then have the right to appeal to the Information Commissioner for a decision on:

01. Whether we have responded to your request for information in accordance with Part 2 of the Freedom of Information Act; or 02. Whether we are justified in refusing to give you the information requested.

Page 2 of 3 FOIA/DHSC/01r02 58

In response to an application for review, the Information Commissioner may, at any time, attempt to resolve a matter by negotiation, conciliation, mediation or another form of alternative dispute resolution and will have regard to any outcome of this in making any subsequent decision.

Further information about Freedom of Information requests can be found on the Information Commissioner’s website at: www.inforights.im/information-centre/freedom-of-information. Should you have any queries concerning this letter, please do not hesitate to contact us.

Yours Sincerely

Freedom of Information Team Department of Health and Social Care

Page 3 of 3 FOIA/DHSC/01r02 59

Department of Health and Social Care

Rheynn Slaynt as Kiarail y Theay

CARE HOME WITH NURSING

SPECIFICATION

July 2016

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Contents Contents ...... 2 Introduction and Scope of this Specification ...... 4 PART A ...... 5 1. Lease of the Building ...... 5 PART B ...... 6 1. Block Purchase of 40 beds ...... 6 2 Review process...... 7 3 Service Description ...... 8 4 Quality Standards and Outcomes ...... 10 5 Transport ...... 12 6 The Regulatory Framework ...... 12 7 Medication administration ...... 14 8 Infection prevention and control ...... 14 9 Nutrition and hydration awareness ...... 14 10 Assessment and Support planning process ...... 15 11 Out of hours contact ...... 15 12 Risk Management and Risk Assessment ...... 15 13 Data Protection ...... 15 14 Service Staffing and availability ...... 16 15 Involvement of Service Users...... 16 16 Adult Protection ...... 17 17 Behaviour that challenges services ...... 17 18 Urgent notifications ...... 17 19 Dignity Standards ...... 20 20 Customer Care ...... 20 21 Continuity of Care ...... 21 22 Economic Wellbeing...... 21 23 Financial Protection ...... 21 24 Quality Assurance - Monitoring ...... 21 25 Provider Annual Quality and Performance Return ...... 22 26 Sharing of Quality Data ...... 23 27 Performance Monitoring ...... 25 28 Registration and Inspection Unit ...... 26 29 Complaints and Compliments ...... 27

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Introduction and Scope of this Specification

The care home at Salisbury Street(“ the Premises”) has 68 single en-suite bedrooms, 40 of which will be block purchased at Benefit rates by the Commissioner.

The aim of this Specification is to ensure the provision of high quality, safe services that meet the quality outcomes and safeguarding responsibilities of the Commissioner.

One of the main objectives of a care home with nursing is that it shall provide support to people to deliver outcomes which allow them to live as full and independent a life as possible. The Service should also encourage Service Users to be active participants in their community whenever they so choose.

The Service should be delivered in such a way that is consistent with the Service User’s status and rights as a citizen and which gives the individual Service User as much control as possible over their own life whilst protecting them and others from unnecessary harm

The Provider will ensure that the Service is offered in an individualised and personalised way. All the types of support that are discussed below should be delivered in such a way that they are in line with individual Service User’s needs, choices and preferences and are subject to appropriate risk assessment.

It is the expectation that the Provider will hold and adhere to the policies and procedures as prescribed in the Adult Care Home minimum standards (as amended) and the Provider is expected to provide the Commissioner with copies of these Policies and Procedures.

The Provider must be able to demonstrate experience of running a Care Home with Nursing. In addition, The Provider will be required to comply with the Isle of Man Regulation of Care Act 2013 (“RCA2013”) and all associated Regulations and Standards.

The Provider must not, in any jurisdiction, have failed to meet a compliance notice in the last 2 years, been prosecuted or had a service registration cancelled.

The Commissioner’s Adult Social Care Services Division holds a core set of values, commissioning vision, guiding principles and approach to social value. (See Appendix i). It is the expectation that the Provider will share these values.

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PART A

1. Lease of the Premises

1.1 The Provider will rent the Premises from which the service is delivered from Isle of Man Government under a 5 year lease agreement, which through negotiation could be extended for a further 5 year term. All leasing and associated costs will be the responsibility of the provider and therefore must be included in the charges.

1.2 Under the terms of this lease, the Provider will be responsible for the maintenance and the upkeep of the interior and the exterior of the Premises, of the gardens and grounds and all internal fixtures. The property will be maintained to appropriate standards which are mutually acceptable to the landlord, and meet the necessary requirements for registration under the Isle of Man Regulation of Care Act 2013 (“RCA2013”) and all associated Regulations and Standards.

1.3 The Commissioner will insure the Premises against loss or damage by fire, storm, flood, malicious damage, theft etc.(as defined in the policy) on the Isle of Man Government’s block insurance policies. Excluded from cover under these arrangements are fixtures and fittings and contents provided as part of the Turnkey arrangement by the Commissioner, the contents and personal effects belonging to Service Users, all contents and personal effects provided by the Provider, and accidental damage to glass, glazing and sanitary fittings, which will be the responsibility of the Provider to take out insurance. The Provider will also be required to insure against business interruption.

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PART B

1. Block Purchase of 40 beds

1.1 The Provider must ensure that 40 of the 68 bedrooms are used for referrals from social workers for people at critical or substantial need. These rooms will be purchased at a rate that does not exceed the maximum amount of income available through eligible Social Security benefit.

1.2 The Provider will have a Registration & Inspection registered location within the Isle of Man to offer a presence and base for operations at all times.

1.3 All placements within the service are allocated by the Commissioner. Taking account of eligibility criteria, levels of occupancy and priority, the Commissioner will make nominations for any vacant places up to a total of forty.

1.4 The Service will offer support over 24 hours, 7 days a week, including all Bank Holidays (365 days per year).

1.5 These Service Users shall be:

1.6 65 years or over.

o Assessed by Social Workers as having a care need which requires long term nursing care. o Meet the residency requirement of the Social Services Act 2011 to receive a Service from the Commissioner. o Assessed as meeting the Fair Access and service eligibility criteria at a ‘critical’ or ‘substantial’ banding.

1.7 Subject to the principles of confidentiality and the Service User or the Service User’s Representative’s consent, the Commissioner will provide access to the information the Provider requires to make the decision to proceed with providing a Service to the Service User

1.8 Providers will flexibly respond to any request for a Service and to work with the Commissioner to agree a mutually acceptable Service start date.

1.9 When a prospective new Service User is identified, the Commissioner will work with the Provider to:

 Identify all known risk factors  Assist in a smooth planned transition into the identified placement  Contribute to the development of an appropriate person centred plan  Contribute to ongoing review and person centred planning processes as necessary.

1.10 In circumstances were a new referral is received The Commissioner will provide an assessment and care plan under the Fair Access to Care Services Policy (which

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is prepared by the Commissioner’s Social Worker) for each referral. The assessment and care plan will include:  Key contacts.  General Practitioner details.  Risk factors.  Outcomes to be achieved.  Other relevant information.

1.11 Service Users requiring defined health related tasks will have been assessed by an appropriate Health Professional and the health related tasks communicated to the Provider.

1.12 When continued residence of a Service User is threatened by their changing needs, the Provider must enter into early discussion with the Social Work Team, who, with other professionals, family members and/or advocate will work with the Provider to overcome difficulties and/or consider enhanced or alternative provision. Under no circumstances should the provider withdraw the service/ commence eviction proceedings without first liaising with the Commissioner.

1.13 The Provider shall ensure that the Services provided to state funded Services Users are no less than the Services provided by the Provider to privately paying Service Users.

1.14 If the Commissioner decides to exercise the option in clause 2.2 of the Agreement, the Commissioner may review the nomination of state funded bedrooms and privately funded bedrooms at the Premises for any extension of the Term and Lease.

2. Review Process 2.1 The Commissioner will usually carry out a review when care/support has been in place for 6 weeks or sooner if in response to a Service User’s changing needs, and thereafter if requested due to a change in presenting needs of the service user.

2.1 The Provider must, if required, attend any Review meeting called to consider the current needs of the Service User.

2.2 Following a review, or at any other time when substantive changes to the service provided for a Service User are required, those changes must be discussed with the allocated Social Worker and reflected in a new or revised support plan.

2.3 The Provider shall ensure that staff have all the documentation required before implementing changes in service following a review.

2.4 Where sufficient documentation is not provided the Provider shall refer back to the Commissioner. If in doubt the Provider shall contact the Commissioner for written clarification.

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2.5 The Commissioner will require the Provider to attend reviews/reassessments/multi-agency forums as necessary.

3 Service Description 3.1 The service will provide an outcome based model of service delivery, which is designed to ensure that people receive a personalised service which meets their assessed needs.

3.2 The provider will ensure that mandatory training to comply with the 2013 Regulation of Care Act is in place, in addition specialist training must be provided for staff working with people who have additional needs (such as dementia support training, supporting people after stroke, Parkinson’s Disease training).

3.3 The Provider shall ensure that staff have an understanding of each Service User’s emotional and physical needs and be aware of warning signs and “trigger” points, which result in particular behaviour. Staff are required to have skills in anticipating, diverting or defusing challenging incidents. Staff shall have appropriate listening skills and be familiar with strategies which enable them to minimise behaviour that challenges the service.

3.4 The Provider shall maintain detailed records that evidence when any de- escalation techniques or interventions have been used.

3.5 Agreement to meeting any additional specialist assessment or support costs, outside the existing providers resources must be obtained in advance, in writing, from the commissioner, by the Provider’s nominated senior officers.

3.6 Placements must support the outcomes as defined by the person’s Care Plan, as identified by the commissioner and meet the requirements laid out in the monitoring and performance section of this specification.

3.7 The Service will include:

 Therapeutic activities.  Personal care.  Food and nutrition.  Practical support.  Social Support such as providing opportunities for communication, social integration and relationship building.  The development of new interests or the maintenance of meaningful social activity.  Specific health care tasks as identified, following appropriate training and under the direction of an appropriately qualified practitioner.

3.8 The Provider will prepare a Person Centred Support Plan for all residents demonstrating how they will positively support the person in their development.

3.9 The provider will be able to evidence how their support methods promote the persons physical health, psychological and social wellbeing and social inclusion.

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The provider will monitor improvements in these areas and evidence the impact these changes have made to the persons development, independence and inclusion.

3.10 The Person Centred Support Plan should seek to:

 Identify care and support needs.  Promote ownership by the Service User of how they wish to be supported and what aspirations they have.  Achieve a consistent approach across staff teams.  Realise supplementary outcomes for Service Users such as maintaining links with their community and undertaking meaningful activity (such as being assisted to undertake domestic tasks, gardening and crafts).

3.11 Individual care support for Service Users

3.11.1 The Provider should note that service users do not have routine access to Day Services. Therefore the care of each individual should be tailored to support that individual to enjoy meaningful, constructive activity in accordance with positive and person centred support planning processes.

3.11.2 The Provider will take particular account of the aptitudes, abilities and interests of individual service users. Goals and expectations should always be stretching and aspiring, seeking to add value to the person’s experiences and outcomes.

3.12 Health

3.12.1 Staff supporting adults will take an active approach to health care. Staff should be familiar with and use the latest advice provided through statutory agencies in respect of medical and health care support, diet, healthy eating and exercise.

3.12.2 Provider staff will ensure that they are aware of all medical and dental appointments and liaise with family (where appropriate) to make the necessary arrangements for preparation and attendance.

3.12.3 In line with the Adult Homes Minimum Care Standards from the Regulation of Care Act 2013 staff will be appropriately trained in the administration and proper storage of medication and comply with the medication arrangements for each Service User as prescribed.

3.12.4 The Provider will be responsible for arranging specialist services such as Occupational Therapy, Speech and Language Therapy, Physiotherapy, Older people’s Mental Health Services, Dietician, Dentist for the individual Service Users as required via Community Health Services. The Provider will highlight to the Commissioner any unmet needs they become aware of in this area.

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3.13 Activity

3.13.1 Meaningful daytime activity should be actively promoted and structured in a manner that focuses on the individual’s needs and wishes.

3.13.2 Resources and an appropriate range of activities must be provided and staff should promote inclusion and choice.

3.14 The Provider shall use the assessment and support planning process contained within the Adult Care Home Minimum standards. In addition the Provider will include as a minimum strategies and plans to meet needs in the following areas:

 Social inclusion.  Identifying Service User wishes and maximising choice, control and independence

3.15 The Provider must determine staffing levels based on the needs of service users in accordance with the Registration of Care Act 2013, associated regulations and standards. Although numbers are not specified, there must be appropriate numbers of Registered Nurses available to ensure the needs of service users are met. The Provider must make efforts to ensure the use of agency and relief staff is kept to a minimum to ensure continuity of care and support for service users

4 Quality Standards and Outcomes

4.1 Quality of service will relate to Service User experience and outcomes.

4.2 Quality of service will be measured against performance standards within this specification and any service specific standards and outcomes prescribed by the regulator.

4.3 Quality of service will be monitored by the commissioner.

4.4 The quality monitoring process will be robust and transparent.

4.5 The Commissioner and the Provider will work in partnership with internal and external partners to assure quality.

4.6 The Commissioner and the Provider will communicate with each other clearly and regularly.

4.7 The Provider will sign up to the Adult Social Care and Support charter.

4.8 The Commissioner aims to promote improved health, independence and inclusion through the provision of care and support services which enable vulnerable adults to achieve as full and independent a life as possible. The Commissioner has adopted the following change, maintenance or prevention, and service process outcomes:

Outcomes involving change

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 Improvements in physical symptoms and behaviour;  Improvements in physical functioning and mobility;  Improvements in morale.

Outcomes involving maintenance or prevention  Meeting basic physical needs.  Ensuring personal safety and security.  Having a clean and tidy home environment.  Keeping alert and active.  Having social contact and company, including opportunities to contribute as well as receive help.  Having control over daily routines.

Service process outcomes These refer to the ways that services are accessed and delivered and include:  Feeling valued and respected.  Being treated as an individual.  Having a say and control over services.  Value for money.  A good ‘fit’ with other sources of support.  Compatibility with, and respect for, cultural and religious preferences.

4.9 Older people are supported to make the transition into their new home, are seen and treated as individuals, have choice and control over their lives, enabling them to do the things that matter to them, and are treated at all times with dignity and respect.

4.10 Older people living in the care home, through access to health promotion, preventative care and reablement services, are supported to sustain their health, mobility and independence for as long as possible.

4.11 Older people in the care home receive the care and support they need to sustain their emotional and mental wellbeing and anti-psychotic drugs are not inappropriately used. Residents feel safe, valued, respected, cared for and cared about, and care is compassionate and kind, responding to the whole person.

4.12 Older people living in the care home clearly understand their entitlements to primary and specialist healthcare and their healthcare needs are fully met.

4.13 There are sufficient numbers of care staff with the right skills and competencies to meet the physical and emotional needs of older people living in care homes. This includes an appropriate number of Registered Nurses available on every shift, in accordance with the Regulation of Care Act 2013.

4.14 The service shall ensure that older people’s lives have value, meaning and purpose as they;

 Feel safe and are listened to, valued and respected;  Are able to do the things that matter to them;

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 Are able to get the help they need, when they need it, in the way they want it.

4.15 Live in a place which suits them and their lives

5 Transport

5.1 The Provider will supply and maintain appropriately adapted vehicles to enable Service Users to be transported to appointments and activities etc. as necessary.

5.2 In respect of the operation of the vehicles, the Provider must ensure that:

 The driver holds a valid driving licence;  The vehicle is operated in accordance with the Road Transport Act 2001 and any other statutory provision;  The vehicle has current insurance appropriate to the usage;  The number of passengers must never exceed the insured or licensed maximum;  The vehicle(s) (and any additional equipment on the vehicle) is/are maintained and serviced in accordance with the manufacturer’s instructions with full records being kept to verify this;  The vehicle(s) is/are suitable for the type and condition of passengers to be carried, including having seat belts or personal restraints which conform to the relevant Standard and which are used in all instances;  The vehicle(s) is/are always driven safely and with consideration to passengers’ needs. This includes conforming to road traffic legislation and never driving whilst under the influence of any amount of alcohol, drugs or medication which would impede driving performance;  The driver must always be properly trained in handling the type of vehicle and the nature of the passengers to be carried. Escorts should be used where risk assessment indicates this is necessary.  All vehicles will carry a first aid kit and fire extinguisher which are maintained in accordance with the manufacturer’s instructions;  The Provider will use their best endeavours to ensure staff treat the vehicle with care and in line with the purpose for which it is supplied i.e. for the transportation of the Service User.

6 The Regulatory Framework

6.1 The commissioned services must comply with the Regulation of Care Act 2013 (“RCA2013”), the purpose of which is to do the following for social care and non-NHS health care services:

6.2 Protect people who need them

6.3 Regulate how they are provided

6.4 Standardise how they are regulated

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6.5 Promote transparency

6.6 The Registration and Inspection Unit prescribe minimum standards for the Service The link to this documents is:

6.7 https://www.gov.im/media/815771/adult_care_homes_minimum_standards.pdf

6.8 The Commissioners expectation for the service is that the Provider will exceed these minimum standards through innovative care practices and demonstrate a commitment to continuous improvement through internal quality assurance procedures.

6.9 Service delivery will be consistent with each Home’s Statement of Purpose and Function as approved by the Registration & Inspection Unit.

6.10 The Provider must register as the ‘Registered Provider’ of the Service. A suitable person must be registered as the manager of the service.

6.11 Any change to the Provider’s registration status must be notified to the Commissioner immediately.

6.12 The Provider will at all times in its performance of the Services and its treatment of Adults have regards to, and abide by the principles of the Human Rights Act 2001 the European Convention on Human Rights and the provisions of the Act.

6.13 The Provider’s relationship with the Commissioner:

6.13.1 Throughout the Term, the Provider will work positively and proactively with the allocated Social Worker, other professionals and where applicable, family members, to achieve the outcomes of the Care Plan and outcomes as set out by the Commissioner.

6.13.2 The provider will work with the Commissioner to ensure that assessed needs are based upon all relevant and up to date information. Assessments being undertaken should be jointly planned and agreed between the Service User, Social Worker, health professional and Provider staff. The provider will have robust systems in place to monitor the Service Users needs and address any changes identified.

6.13.3 Support practices must challenge barriers to inclusion and promote equal access to opportunities for learning and social participation.

6.13.4 The Provider will ensure that Service Users are supported to have meaningful contact with relatives and peers as specified in their Care Plan.

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7 Medication administration

7.1 The Provider shall hold and enforce an appropriate medication policy, the contents of which comply with the RCA2013 and all associated Regulations and Standards.

7.2 The Provider’s policies and procedures on medication must protect Service Users and assist them to maintain responsibility for their own medication wherever possible. Anti-psychotic medication is only used as a last resort and in accordance with best practice and NICE guidelines.

7.3 The Provider shall ensure that staff have all the documentation required for medication support and/or assistance for the Service User.

7.4 Where sufficient documentation is not provided the Provider shall contact the pharmacist or Primary Care services to obtain the required documentation. Should the documentation not be provided following such a request the Provider should refer back to the Commissioner.

8 Infection prevention and control

8.1 The Provider shall ensure compliance with current guidance on the prevention and control of infections https://www2.rcn.org.uk/__data/assets/pdf_file/0006/481290/Infection_preventi on_Final.pdf

8.2 The Provider shall ensure the environment is maintained to a safe and hygienic standard and provide sufficient staffing and resources to achieve this.

9 Nutrition and hydration awareness

9.1 The Provider shall hold and enforce an appropriate policy on Nutrition and Hydration, the contents of which comply with the RCA2013 and all associated Regulations and Standards.

9.2 The Providers policy on nutrition and hydration will include awareness of how poor nutrition and hydration can impact upon a Service User’s health and wellbeing.

9.3 The Provider shall ensure that where staff are involved in food preparation they are required to have basic food preparation skills, including holding a Basic Food Hygiene Certificate level I, and able to support Service Users to follow a healthy balanced diet that is relevant to them as an individual, taking account of their wishes and preferences.

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10 Assessment and Support planning process

The Provider will ensure compliance with the assessment and support planning processes contained within the Adult Care Home Minimum Standards (October 2013, as amended).

10.1 The Support Planning process is person centred and outcome focused so that Service Users have a strong sense of being in control of their own services.

10.2 The Provider, in consultation and agreement with the Service User, shall determine the activities to meet the desired outcomes by using the Person Centred Support Planning process.

11 Out of hours contact

11.1 The Provider will make provision for 24 hour access to support from senior managers for urgent advice, support or decisions and shall provide staff with guidelines for contacting on island out of hours management support.

12 Risk Management and Risk Assessment

12.1 The Provider shall ensure that risk management strategies and risk assessments comply with the RCA2013, associated regulations and standards.

12.2 The Provider’s risk management strategies and risk assessments shall clearly identify and document positive risk taking in delivering the support package and must contain a balance that accounts for a Service User’s personal choices and freedoms.

12.3 Where a service user lacks the mental capacity to acknowledge and understand risk management strategies and risk assessments, the Provider shall ensure that they are communicated to and agreed by family members or a representative.

13 Data Protection

13.1 Providers will agree and sign in partnership with the Commissioner, the Commissioner’s data security document. This document will highlight the “Degree of access” and “type of information” that will be expected to be shared throughout the term of the contract. Including an information sharing agreement referencing the principles of the data protection act and a proportionate response to access to confidential information.

13.2 The Provider must ensure their record keeping system is compliant with Data Protection Legislation and data sharing agreements.

13.3 When a service user leaves the service the records should be forwarded to the Commissioner for retention in order to facilitate any service user access request in the future. The Provider should ensure they retain copies of information that they are obliged to keep under the legislation.

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The Provider will immediately provide any information requested by, or on behalf of the Commissioner, for any purpose connected with this Agreement or the conduct of the Provider’s duties relating to the provision of the Services, at no additional cost to the Commissioner and delivered in the spirit of cooperation.

14 Service Staffing and availability

14.1 The Provider shall comply with the RCA2013 associated regulations and standards in respect of staff and management recruitment, induction, training and supervision.

14.2 The commissioner will work closely with the provider to maximise the efficient use of resources to ensure best value.

14.3 The provider shall ensure that there is adequate and robust, local management arrangements in place including a local service manager and office base.

14.4 The Provider must ensure that when relief or bank staff are providing the service to a Service User they have been briefed on, and have received appropriate training to deliver, the care and support required to meet the Service User’s needs and intended outcomes.

14.5 In the event that there is evidence that the Provider is not maintaining the correct service capacity the Commissioner may, at its discretion, carry out an investigation.

14.6 The Provider shall co-operate and assist the Commissioner in this investigation.

14.7 Should the Commissioner determine, following such an investigation, that the Provider is failing to comply with its obligations under the Agreement this shall constitute a persistent failure to provide the Services to the standard required under the terms and conditions of this Agreement.

15 Involvement of Service Users

15.1 The Provider shall ensure that Service Users, their carers or citizen advocates, are kept fully informed on issues relating to their care and support at all times.

15.2 The Provider shall ensure the Service is provided in a sensitive way that is not based on the Provider’s assumptions. The Provider will acknowledge and listen to the Service User and, where appropriate, their carer or other citizen advocate.

15.3 The Provider must be able to evidence to the Commissioner in any monitoring process active engagement, consultation and decision making by Service Users (and their carers/ family where appropriate).

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15.4 The Provider must have and be able to demonstrate awareness of translation and interpretation arrangements available and how to access them in order to meet the foreign language, British Sign Language, Braille and easy read needs of Service Users. The provider will demonstrate how they will support those service users using alternative and augmentative methods of communication.

16 Adult Protection

16.1 Protection from abuse and risk of abuse

16.1.1 The Provider must comply with the Commissioner’s Inter Agency Adult Protection Policy and Procedures.

16.1.2 The Provider shall comply with the RCA2013, associated regulations and standards with respect to adult protection/safeguarding.

16.1.3 The Provider is required to participate in any Adult Protection investigations as directed by the Commissioner’s Investigating Officer. This can include attendance at Strategy and Planning & Monitoring meetings and any Review meetings.

16.1.4 Where the Provider’s Disciplinary procedures are deemed to be the appropriate route to deal with the alleged incident ongoing feedback to the Investigating Officer is required.

17 Behaviour that challenges services

17.1 The Provider shall have policy and procedures in place for Service Users whose behaviour challenges the Service which comply with the RCA2013, associated regulations and standards.

18 Urgent notifications

18.1 The provider shall comply with the requirements of the RCA2013, associated regulations and standards for reporting events to the Registration and Inspection Unit

18.2 The Provider shall notify the Commissioner or someone acting on their behalf by telephone on the same day, (and confirm in writing), if any of the following occur:

18.2.1 Significant events that affect the well-being of the Service User such as accident, personal injury, death of partner or close family relative.

18.2.2 Any safeguarding concern that arises.

18.2.3 A sudden deterioration in a Service User’s condition necessitating the need for an urgent review.

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18.2.4 Any unusual or unexpected challenging behaviour by the Service User whether verbal, physical or sexual.

18.2.5 If the Service User refuses to attend or carer prevents attendance at the service.

18.2.6 The Provider becomes aware of increasing needs or needs which are not being met within the current support plan.

18.2.7 The service user’s support needs have decreased.

18.2.8 Little or no progress is being made towards achieving the service user’s individual outcomes as specified in the plan.

Workforce Management: Policies and Procedures

18.3 Recruitment and selection

18.3.1 The Provider shall comply with all current, and subsequent, Isle of Man legislation with regard to employment.

18.3.2 The Provider must comply with the RCA2013 and all associated Regulations and Standards. This includes ensuring an appropriate number of Registered Nurses are available at all times to ensure the needs of service users are met.

18.3.3 Should the Provider have reason to report a member of staff under the Inter Agency Adult Protection Policy and Procedures (as amended) then they must comply with the reporting procedures contained within them.

18.3.4 The Provider shall ensure that only staff that are directly employed by the Provider are used to deliver services to the Commissioner’s Service Users. In exceptional circumstances, and only with the Commissioner’s consent, agency staff may be used subject to full compliance with RCA2013, associated regulations and standards.

18.3.5 The Provider must comply with the requirements of any equalities legislation and keep themselves up to date on any subsequent amendments to equality legislation.

18.3.6 If staffing levels fall below expected standards the provider should inform the Commissioner immediately

18.4 Supervision and appraisal

18.4.1 The Provider shall hold and enforce an appropriate staff supervision policy, the contents of which comply with the RCA2103, associate Regulations and Standards.

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18.5 Disciplinary procedures

18.5.1 The Provider shall ensure that there are robust disciplinary procedures in place that will protect vulnerable adults.

18.5.2 The Provider will ensure that all disciplinary matters are properly investigated and periodically reported to the Commissioner.

18.6 Confidential reporting/whistle blowing

18.6.1 The Provider shall hold and enforce an appropriate policy on confidential reporting and whistle blowing, the contents of which comply with the RCA2103, associated Regulations and Standards.

18.7 Policies and procedures

18.7.1 The Provider shall ensure that there are policies and procedures in place with a person centred emphasis, which promote feedback of Service User experience, and which ensure safe and appropriate working practices.

18.7.2 The Provider shall ensure that all policies and procedures are reviewed on a timescale that is appropriate to the content of the policy.

18.8 Staff training

18.8.1 The Provider must comply with the RCA 2013, associated Regulations and Standards.

18.8.2 The Provider shall be responsible for training its staff and the cost thereof.

18.8.3 The Commissioner and other agencies offer training courses from time to time on matters such as Safeguarding, First Aid, Administration of Medication, Food Hygiene etc. The Provider will have access to these courses, some of which may be charged for.

18.8.4 The Provider shall ensure that:

18.8.4.1 The learning and development needs of Staff are identified based on the needs of Service Users and the skills needed from staff to ensure that the service meets essential standards of quality and safety.

18.8.4.2 Staff have a learning and development plan in place from the point of induction based upon the needs identified and how those needs will be met.

18.8.4.3 The staff learning and development programme takes account of the working patterns of staff.

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18.8.4.4 Where learning and development is delivered by a trainer, that person has demonstrated that they are competent to do so and, where an accreditation scheme applies, are accredited to act as a trainer for the course being provided.

19 Dignity Standards

19.1 The Provider shall foster a culture to promote dignity. The Commissioner expects that high quality services that respect people's dignity and the Provider will:

19.1.1 Have a zero tolerance of all forms of abuse.

19.1.2 Support people with the same respect you would want for yourself or a member of your family.

19.1.3 Treat each person as an individual by offering a personalised service.

19.1.4 Enable people to maintain the maximum possible level of independence, choice and control.

19.1.5 Listen and support people to express their needs and wants.

19.1.6 Respect people’s right to privacy.

19.1.7 Ensure people feel able to complain without fear of retribution.

19.1.8 Engage with family members and relative carers as care partners.

19.1.9 Assist people to maintain confidence and a positive self-esteem.

19.1.10 Act to alleviate people’s loneliness and isolation.

20 Customer Care

20.1 The Provider shall ensure that all staff are issued with a ‘Code of Conduct’ that describes the standards of professional conduct and practice required of them.

20.2 The standards within the ‘Code of Conduct’ must be approved by the Commissioner in the first instance.

20.3 In accordance with the Service User’s Support Plan and to meet identified needs and outcomes the Provider shall ensure that they support Service Users to other services or agencies that can assist the Service User to; be a part of the community around them; engage in their local community network; identify areas of interest they are able to pursue; explore opportunities for following up their personal interests and identify ways to incorporate them into everyday life.

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21 Continuity of Care

21.1 The Provider shall match the requirements of the Service User with the most suitable staff.

21.2 The Provider shall make it a clear and acceptable aspect of staff tasks to support Service Users in fulfilling their emotional and social needs.

22 Economic Wellbeing

22.1 In accordance with the Service User’s Support Plan and to meet identified needs and outcomes the Provider shall ensure that Service Users:

22.1.1 Are in control of their resources so that they can make choices within the parameters of the provided service.

22.1.2 Signposted to the relevant agencies to avoid financial difficulties.

23 Financial Protection

23.1 The Provider shall hold and enforce an appropriate Financial Protection policy and procedure, the contents of which comply with the RCA2013, associated Regulations and Standards.

23.2 The Provider shall ensure that staff exercise due care in handling Service Users’ money. A record signed and dated by staff must be kept to account to the Service User and or their carer.

23.3 Where the Provider is involved in the formal management of the client’s monies, the Commissioner will make arrangements for external financial audit.

23.4 The Provider shall keep a record of attendance and service use, including receipt of any charges levied.

24 Quality Assurance - Monitoring

24.1 The Commissioner will regularly monitor the quality of care delivered by the Provider against this specification and the Provider will be required to provide all reasonable assistance to the Officer(s) of the Commissioner during the monitoring process.

24.2 The Commissioner reserves the right to directly obtain the views of Service Users regarding the quality of care delivered by the Provider.

24.3 The Commissioner reserves the right to directly obtain the views of Provider staff regarding the quality of care delivered by the Provider.

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24.4 The Commissioner reserves the right to directly observe the quality of care provided at the point of delivery without giving notice.

24.5 The Provider shall maintain an internal quality assurance system to ensure that the service is of the required standard and quality. The system shall include standard setting, monitoring management and review processes. The Provider shall give the Commissioner clear evidence of its quality assurance system.

24.6 The Provider shall complete a Care Quality Improvement Plan for each financial year which must be shared with the Commissioner.

24.7 The Provider shall carry out periodic surveys of Service User level of satisfaction. This will be done at least annually and results are to be shared with the Commissioner as part of the quality monitoring process.

24.8 The Provider will take part in the Commissioner’s annual Adult Social Care Survey (ASCS).

24.9 The provider will supply data in support of the Adult Social Care Outcomes Framework (ASCOF) on request by the Commissioner.

24.10 The Provider shall complete a quarterly quality return (each quarter of the financial year) which will include a minimum data set, in a format set, or agreed by the Commissioner.

24.11 The Commissioner will use the Adult Social Care Services, Care Quality Framework 2016 (as amended) to continually monitor and assess the quality of care being delivered by the provider. The Commissioner will make the Care Quality Framework available to the Provider.

25 Provider Annual Quality and Performance Return

25.1 The Provider is required to provide an annual quality and performance return to the Commissioner (although reporting on a more regular basis may be required), the date and format to be set by the Commissioner, but including:

25.1.1 The Providers Business/delivery plan for the following financial year. This shall clearly identify business objectives, timeframes for completion of objectives and Provider added value.

25.1.2 The Providers Care Quality Improvement Plan (which may be incorporated into the Business Plan) for the following financial year. This shall clearly identify objectives, with timeframes for completion, which will improve the quality of care delivered by the Provider.

25.1.3 Service User satisfaction Survey results and resulting actions taken by the Provider.

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25.1.4 Examples of Service Users maximising their independence, maintaining and learning or re-learning daily living skills.

25.1.5 Summary of training completed by all staff in the last 12 months.

25.1.6 Summary of staff turnover in the last 12 months expressed as a percentage of total workforce for the service. Turnover is number of leavers in the year/average number of people employed in the year x 100 = Turnover %.

25.1.7 Examples of how Service User input have resulted in changes/improvements to the service provided.

25.1.8 Examples of how outcomes from complaints have been used to improve service delivery.

25.1.9 Examples of how the results/outcomes from the annual Adult Social Care Survey have been included in service deliver plans.

25.1.10 Statistical data relating to accidents/incidents and safeguarding alerts, including:

25.1.10.1 Accident/incident/safeguarding alert by type/category and number there of

25.1.10.2 Identification of the service area

25.1.10.3 Results of root cause analysis and actions taken

25.1.10.4 Lessons learned

25.1.11 Information from the Annual Quality and Performance return will be used to benchmark the Service with that provided by other organisations.

25.1.12 Information from the Annual Quality Performance Return may be made available to Service Users, prospective Service Users and the general public.

25.1.13 The Commissioner reserves the right to ratify any information submitted by the Provider as part of its Annual Quality Performance Return and the Provider may be required to evidence this as part of any Commissioner audit.

26 Sharing of Quality Data

26.1 The Commissioner of Health and Social Care and the Registrations and Inspections Unit have open and transparent dealings with each other, which will result in routine sharing of information about the performance of the Provider.

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26.2 The Commissioner of Health and Social Care may also share appropriate information regarding the standard of the service with other agencies of Government, or their appointed representatives, that have an interest in improving the quality of care.

27 Performance Monitoring

27.1 The Commissioner will regularly monitor the performance of the Provider against this specification and the Provider will be required to provide all reasonable assistance to the Commissioner during the monitoring process.

27.2 The Provider shall keep records that ensure they can demonstrate their performance in meeting this specification. Records will show resource inputs, organisational processes and outcomes related to the service and Service Users.

27.3 Relationship Management

27.3.1 Day to day relationship management between the Commissioner and the Provider will be the responsibility of the Commissioner’s Adult Services Division.

27.4 Contract Performance

27.4.1 Contract performance will be judged against compliance with:

 This Form of Agreement and Service Specification  Isle of Man Adult Care Home Minimum Standards  The RCA2013 and associated Regulations  Established best practice in relation to supporting older people  The Provider’s own stated standards  Performance criteria considered in quarterly Partnership Meetings  The Adult Social Care Outcomes Framework

27.5 Providers Performance

27.5.1 The assessment of Provider performance will be a continuous process but will be formally assessed through:

 Performance Audits completed by the Commissioner  Meetings between the Commissioner and the Provider

27.5.2 Contract Performance Monitoring Meetings will be held between representatives of the Commissioner and the Provider.

27.5.3 Monitoring of the Provider’s performance in delivering the Service under this Form of Agreement will be carried out as follows:

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27.5.3.1 The Provider will submit the following reports;

 Quarterly summary reports for Contract Meetings.

27.5.4 Contract Meetings will consider a mix of data relating to inputs, outputs and outcomes and will include the following minimum requirements on which the Provider must produce a management report:

 Staffing Resources Deployed:  Staff employed (actual & WTE) including; o Commissioner and remaining with the Provider. o Numbers of staff recruited post commencement of contract.  Staff turnover/vacancies  Absence rates as a percentage of total staff hours  Evidence of staff completion of mandatory training  Evidence of refresher/updates for mandatory training  Numbers of staff, qualifications gained or working towards (QCF or equivalent etc.).  Confirmation of staff supervision  Guarantee of service delivery, i.e. sufficient relief/bank staff are available.  Buildings; Use, maintenance etc.  Service Activity data o Referrals received from Commissioner in the period o Evidence of referral response times o Total No of service users at end of Quarter (Referred by Commissioner) o Evidence of support planning with examples o Reviews undertaken in the period  Outcome Reports: Sample outcome reports evidencing the outcomes being achieved with each service user in accordance with support plans. 2 required for each Partnership Meeting.  Service user views including comments, compliments & complaints. This must include the number of complaints received by the Provider, action taken and outcomes.  Requirements and recommendations of the Registration & Inspection Unit.  Views of Other Professionals/Services  Commissioner’s own quality monitoring findings  Report on performance to budget.  Information on additional services operated by the Provider: o Number and charges levied o Other services take up and charges levied

27.5.5 The Provider shall have its own arrangements for monthly sampling of customer feedback. This shall include feedback on the quality and standard

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of service provided and any opportunities for improvement, and must share this information with the commissioner on request.

27.5.6 To avoid unnecessary duplication, the Commissioner will be pleased to receive forcontract meetings data from the Provider’s quality management systems, supplemented where necessary by additional information required.

28 Registration and Inspection Unit

28.1 The Provider must be registered under the requirements of the RCA2013 and associated regulations with the Registrations and Inspection Unit.

28.2 The Provider shall comply at all times with the requirements and recommendations of the Registrations and Inspection Unit. The Provider shall supply to the Commissioner details of any notices issued to them by the Registrations and Inspection Unit.

28.3 The Provider will make available to the Commissioner, upon receipt, copies of any Regulatory reports or reviews including those that have not yet been released to the public.

29 Complaints and Compliments

29.1 The Provider shall hold and enforce an appropriate complaints policy, the contents of which comply with the RCA2013, associated Regulations and Standards. A copy of the Provider policy shall be made available on request.

29.2 Where Service Users lack capacity or might struggle to make a complaint without support, the Provider shall signpost potential complainants to an appropriate (citizen) advocacy service.

29.3 The Provider shall maintain a log of complaints, concerns, compliments and suggestions, which will be available to the Commissioner at any time, showing:

29.4 Where a Service User has complained directly to the Provider, the Provider must make it clear that a complaint can be referred to, either the Commissioner, or the Registrations and Inspection Unit if the Service User is dissatisfied with the outcome of the Provider’s investigation.

29.5 The Provider shall make available to the Commissioner, on request, a summary of the number and type of complaints and their resulting outcomes and/or the log of complaints.

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Appendix i

Department of Social Care

Adult Services Values Statement

Commitment

 We will work together to achieve quality outcomes by providing person centred care and support.

Caring

 We will treat everyone with empathy, dignity and respect.

Integrity

 We will communicate openly, honestly and effectively with you and each other.

Accountability

 We will behave with professionalism and ensure we have the skills and knowledge to support you.

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Commissioner’s vision for adult social care in the Isle of Man

The vision is to make a positive difference to the lives of adults in the Isle of Man with care and support needs, and their carers set out in the following aims:

 Diversity - Provide a diverse range of high quality care and support to those who use services ensuring they are appropriate to their level of need.

 Independence - Enable service users to be as independent and self-reliant as possible by facilitating their interdependence with their local community and supporting them wherever possible at home and in family settings.

 Inclusion - Help those who use services to fulfil their aspirations as far as possible by assisting them to access facilities and opportunities open to the rest of the population (e.g. education, employment, recreation).

 Prevention - Focus on preventative and early intervention work to reduce the likelihood of service users requiring more intensive support and care in the future.

 Involvement - Encourage service users and their carers, managers and staff to play an active part in the design and delivery of care and support and in decisions about priorities.

 Resources - Ensure the most effective use of limited resources to deliver positive and sustainable outcomes for the people we serve.

 Partnership - Work in partnership with Government agencies and the third sector to ensure an integrated and holistic approach to how we all support people in need of social care.

 Understanding - Promote the public’s understanding of the challenges faced by services and those who use them.

 Safeguarding - Provide an appropriate and effective approach which safeguards the users of care, support and protection services.

 Governance - Develop robust systems of governance, legislation, information, performance management and technical support to deliver efficient and safe services and effectively manage key changes which ensure continuous improvement.

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Guiding principles

The Commissioner aims to promote improved health, independence and inclusion through the provision of care and support services which enable vulnerable adults to achieve as full and independent a life as possible.

There are a number of guiding principles that underpin this Specification: The Commissioner requires the provider to deliver the Services in a manner which evidences the following outcomes ;-

 Service Users are supported to maintain existing relationships and develop new ones where a need for this has been identified

 Enables and assists the Service Users to live as independently as possible by adopting an ‘enabling approach’ rather than a ‘doing for’ approach.

 Ensures the safety and welfare of Service Users is promoted at all times.

 Through the promotion of inclusivity promotes Service User self-esteem by participating in activities that are interesting, therapeutic and valued.

 Encourages the Service Users to express their own personal aspirations on the way they wish to live their lives and on the outcomes they would like to achieve.

 Enables individuals to exercise choice and control within available resources.

 Is sensitive to, and supportive to, the needs of carers – working in partnership with them to promote the well-being of the Service User.

 Provides a flexible and responsive service which is sensitive to Service User preferences and is delivered in a way that is appropriate to the Service User’s ethnic and cultural background.

 Promotes person centred practice supported through a strength based approach to support.

 Delivers care and support at all times with compassion and empathy in a respectful and non-judgemental way.

 Avoids and/or prevents an inappropriate admission to an acute setting by promoting and maintaining good health and wellbeing.

 Demonstrates best value and value for money through an evidence based approach

 Service Users are supported to move on from Services when they are no longer required

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Although there is no statutory requirement to consider social value within procurement, the Department recognises the importance of social value. Social value has been defined as “‘the additional benefit to the community from a commissioning/procurement process over and above the direct purchasing of goods, services and outcomes”. Whilst there are many examples of providers delivering social value available to illustrate this, there is no authoritative list of what these benefits may be. The reason for this flexible approach is that social value is best approached by considering what is beneficial in the context of local needs or the particular strategic objectives of a public body. It is the Commissioner’s intent that the provider will deliver added social value as part of the contract.

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Appendix 5: 18th March 2018 - MTTV Interviews with David Murray

91 92 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

MTTV Interview, 18th March 2018: ‘Operator demands enquiry into nursing home’ Part 1

https://www.manx.net/tv/mt-tv/watch/85223/operator-demands-enquiry-into-nursing-home- 1-;

Mr Paul Moulton: Well, joining me in the studio is Dave Murray, involved in health care. 165 You’re joining us today, Dave, because you’re actually looking to seek a public inquiry into what’s gone on at Salisbury Street, the residential nursing home.

Mr David Murray: Absolutely Paul. What I’m talking about here is how the Salisbury Street was procured in the first instance by the Government, the issues surrounding that – 170 Mr Moulton: Shall we just remind people: Government owned it, didn’t they? Then it was sold … The private sector built it. Were you involved in that?

Mr Murray: That’s correct. Yes. 175 Mr Moulton: And then the Government sought to get it back again, am I right?

Mr Moulton: Yes, absolutely. You know a lot of people say to me, ‘David, it’s very interesting that you and your investor co-directors built Salisbury Street and then suddenly it was sold to 180 the Government and you were paid out big money for that; and then coincidentally, you win the tender to operate it.’ I don’t think a great deal of people understand that there was a lot more to it than that. I mean that sounds quite fantastical. People sometimes say –

185 Mr Moulton: Well, I interviewed the now Chief Minister, Howard Quayle, who was head of Health. In fact we’ve put the video online – it’ll be next to this in one in the boxes – from 2016. And this is what … I know you’ve got a lot references that you want to bring up, about what he said then and what you’re saying, and this is why you’re not happy with it.

190 Mr Murray: Yes, I mean perhaps if I could just give an explanation of why Salisbury Street came about – what were our motives, what were our goals with Salisbury Street. Now, I’d built a home at Beaconsfield. I’d look for an investor, and we built that and the whole premise of that was that I would buy that investor out after three years, after mature trading. And that’s exactly what happened. 195 I wanted to do exactly the same in Douglas. I was introduced to a property developer by a friend of mine who had similar ideas. So we sat down, had a cup of coffee in Victoria Street. This particular chap, very, very dynamic, was prepared to put up 50% of the investment, and he introduced two other co-directors. One was a builder who, as a director of Salisbury Care Limited as it became, would oversee the local builders that got awarded the contract. And the 200 fourth member was another property developer well-known on the Isle of Man. So it was an excellent team. From my point of view, my job was to run Salisbury Street as a nursing home through our Adorn Domiciliary Care company.

______Interview Transcripts Page 5 93 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Moulton: So the Government had sold you the land at this stage, had they? 205 Mr Murray: Well, that’s right. I believe it belonged to one of the Government Departments.

Mr Moulton: Yes. And you did it, you built the thing.

210 Mr Murray: That’s right.

Mr Moulton: I mean, where is the problem now?

Mr Murray: Well, basically we went out to the banks. We put in £2 million, the bank put in 215 £3.3 million. So it actually cost round about £5.6 million, I think, as a top price. However, I’d left the company by the stage maybe the final figure was gleaned, but we’d set out our budgets were round about £5.3 million to £5.6 million.

Mr Moulton: And that’s what you built it for. But the Government, did they pay you 220 £8 million or something?

Mr Murray: Well, the company, not me. (Mr Moulton: No!) Because we’ll come on to that.

Mr Moulton: Yes, because I was questioning that, in the interview I kept asking, ‘Why are you 225 buying it back from the private sector?’ But he had answers for that.

Mr Murray: Well, exactly. So yes, they paid £7.9 million. And I think Minister Quayle at the time mentioned there was a pot of up to £8.1 million and they were looking to get that from the Government reserves. Yes, so that’s basically – 230 Mr Moulton: That’s right, it wasn’t in the Pink Book, of course, was it?

Mr Murray: It wasn’t in the Pink Book, no. And he used the reference of a ‘curveball’, which I thought was quite interesting because, to me, it was a curveball to the middle wicket of the 235 taxpayer, as hopefully I will be able to explain, which is very difficult.

Mr Moulton: I understand, but let’s keep it as simple as possible.

Mr Murray: Yes, of course. 240 Mr Moulton: So, what are your concerns then?

Mr Murray: Well, my concerns were that at that particular time, I think everyone should know, as Howard Quayle has said in his video, the hospital had a number of people building up 245 in the beds. (Mr Moulton: Bed blockers.) I think there were 36 to 38.

Mr Moulton: That’s right. It was people who –

Mr Murray: I don’t know if he referred to those particular people as bed blockers. There 250 were bed blockers and then there were people who needed nursing care places, (Mr Moulton: Okay.) but for them to pay for that, because they were solely funded by benefits, the private care homes wouldn’t take those clients into their homes. Therefore the Government had to step in and have places for people 100% funded, in other words.

______Interview Transcripts Page 6 94 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

255 Mr Moulton: That’s right. I remember now, he was going to have so many spaces in there for people on benefits and –

Mr Murray: That’s right, it was 40 and 28 for everyone else who might be partially funded or private. 260 Mr Moulton: And it had to be done because there was a backlog – was there? Was that the case, or not? Was there a backlog?

Mr Murray: Well actually, funnily enough, there wasn’t. 265 Mr Moulton: Do you know that definitely?

Mr Murray: Oh, I know that definitely because obviously I’m operating the home: nobody came in. 270 Mr Moulton: Oh, I see.

Mr Murray: Or very few people came in, should we say. A senior civil servant said to me, ‘We seem to have got our figures wrong.’ The need for 100%-funded beds through social services for 275 individuals – they got their sums wrong or their information wrong, that the older generations on the Isle of Man who needed these beds are actually a lot more affluent than they first thought.

Mr Moulton: So they could pay for it; they didn’t need to be subsidised by the taxpayer 280 completely. Is that what you’re saying? More private … ?

Mr Murray: What we’re saying is, they’re either partially funded, they would receive a certain amount of benefits and they would have private moneys or assets, which would go towards care. 285 If you look at it, there are three ways, aren’t there? Those individuals for Salisbury Street who were to go into the 40 beds that were 100% funded by the Government; and then there’s a sort of middle tier of how you would finance those beds, which is partially funded clients from the from the social services, with private money; and then those people who can afford it 100%. So the whole premise that Howard Quayle went to Tynwald with was that the Government 290 needed 40 beds for the specific category of people, that was solely –

Mr Moulton: And these people … ?

Mr Murray: They didn’t exist. 295 Mr Moulton: Well, did they go to other nursing homes maybe?

Mr Murray: I’m not saying they don’t exist, because they do.

300 Mr Moulton: They just didn’t come to you.

Mr Murray: Well, it wasn’t that. The 30 people had sort of evaporated by that stage. Maybe they were already housed in other nursing homes.

305 Mr Moulton: Did that alter your numbers and figures then?

______Interview Transcripts Page 7 95 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Murray: Well, it did. I think it was more embarrassing for the Government because obviously the whole premise of going to Tynwald was that these people wouldn’t be accommodated by nursing homes – which I’d also disagree with because we take plenty of 310 100%-funded clients through social services benefits. But going back to the point, there were very few came along, and it was actually two top civil servants said it to me. One said, ‘Well, we got our figures wrong’. The other said it just evaporated.

315 Mr Moulton: So this inquiry – what do you want the inquiry to look at?

Mr Murray: Well, the inquiry I would like them to look at is how they procured Salisbury Street, because as I say, it was going to be privately operated by my company. I was taken into a meeting, told by two senior civil servants that we would not be registered because we had 320 problems at another home, which obviously would have disastrous effects for my co-directors.

Mr Moulton: This is quite an allegation, then. You’re saying that you were forced into selling it. Is that what you’re saying?

325 Mr Murray: Well, it was coercion.

Mr Moulton: Coercion?

Mr Murray: Yes, coercion is probably the most accurate thing, because we’d been in a very 330 stressful meeting before. We were asked to stay behind for an informal meeting – and there are a couple of points here I can’t go into too much detail because it could be subject to legal action.

Mr Moulton: Absolutely. We don’t want any legal stuff here.

335 Mr Murray: But the main points were that they said that they wouldn’t register us. This is before any police investigation had been completed at our other home.

Mr Moulton: That’s all now finished, is it?

340 Mr Murray: Yes, absolutely.

Mr Moulton: It’s sorted out?

Mr Murray: Exactly. Well, we’re running Salisbury Street, so how could it? 345 But let me try and bring this round. So they basically said, ‘You’re not going to be registered’, and that, ‘We’re also meeting with your co-directors on Thursday.’ So this was the Monday and they wanted my resignation in writing. Yes. Quite amazing, isn’t it? Absolutely unbelievable. Well, you can imagine myself and my wife were absolutely horrified. We’d just been beaten 350 up in one meeting, went into another. I went into that meeting owning a 68-bedded home, I’d never talk to the directors about ever leaving or not operating, I’d invested money, everything was fine. I came out of that meeting having ‘jacks’ to my name – is the only word I can say! I immediately got onto the co-directors and told them that I wouldn’t be registered and this would have massive implications and ramifications for them. I was a very apologetic to them 355 because it was very, very embarrassing, (Mr Moulton: I can see that.) that I would pool my shares and that I would sell them back to them at the cost that I invested in them.

-- END OF PART 1 –

______Interview Transcripts Page 8 96 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

MTTV Interview, 18th March 2018: ‘Operator demands enquiry into nursing home’ Part 2

https://www.manx.net/tv/mt-tv/watch/85224/operator-demands-enquiry-into-nursing-home- 2-;

Mr Paul Moulton: Why are you calling for it now? This is something that happened back in 2013.

360 Mr David Murray: You’ve got to understand the amount of pressure that we were put under at that time, Paul. I mean, really, we were finished. The only reason we went back even to tender for it, because I would never have considered tendering for it again –

Mr Moulton: And you’ve got it now, have you? 365 Mr Murray: – I mean, I was scared of these people, to be quite honest!

Mr Moulton: Have you got it now then, or … ?

370 Mr Murray: How do you mean, have I got it now?

Mr Moulton: Are you running Salisbury Street? Are you involved in that? (Mr Murray: Yes.) You are.

375 Mr Murray: Yes, we won the tender. That’s the thing about it –

Mr Moulton: Okay, let’s get my head round it ... You lost –

Mr Murray: One minute, we’re not good enough and next minute we are. Perhaps maybe 380 that’s because at the end of the day, they were a little bit over judicious with us in that meeting. Perhaps – and this is only my own admission, this is all mine –

Mr Moulton: And I appreciate you being careful on your wording because this is for other people to look into. (Mr Murray: It is.) 385 So you are wanting an inquiry to find out why things happened the way they happened?

Mr Murray: Well, I would like to know who authorised two senior civil servants to ask questions about a totally separate company for an investment in Salisbury Street.

390 Mr Moulton: Do you think Howard Quayle was … ? Well, he was just telling us on that interview what he knew. Do you think he is personally involved?

Mr Murray: No, look, I mean the Ministers take their briefings from the senior civil servants. And at that time, it had been the Health Minister, and I’m sure that would be from the DHSC. It 395 really depends what he’d been told. But I’m sure those officials who interviewed us wouldn’t be telling Howard Quayle – I wouldn’t have thought, anyway. (Mr Moulton: Okay.) But the point is –

______Interview Transcripts Page 9 97 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Moulton: Anything else from this? 400 Mr Murray: Yes, there’s quite a few points actually, Paul. So, let me just try and re-track here. So we’ve had the meeting. We’ve been coerced out of it. That’s right, so I want to go back to the point that they made that they were meeting with our co-director later on. I mean, Howard Quayle said in there, because you asked him a question, ‘Well, did the care home operators 405 approach you?’ and he said, ‘No, no, no.’ Well, actually, the Government approached my co-directors because basically they wanted to clear the way because there was no operator involved. Then it was clear for them to discuss their problems with bed blocking and 40 beds and people needing this. And of course they hadn’t invested in new infrastructure, as Howard Quayle himself said in a recent interview, I think it was with yourself, about this investment should been 410 going on for many years.

Mr Moulton: Well, Glenside had been pulled down that stage and this was obviously the replacement. Now they are looking at Glenside again, aren’t they? Do they need that space?

415 Mr Murray: Well, it is interesting … I mean, we’ll go back to those other points because we’re missing something –

Mr Moulton: Sorry, I know I’m –

420 Mr Murray: Let’s just talk about quickly about Glenside. Howard Quayle did go on record in your interview to say they had to buy Salisbury Street from the point of view that it was too good to miss and that it would be cheaper for them to buy that home than to build at Glenside a nursing home there. Well, I find that very hard to believe because if we can build it for £5.6 million and we’re using Manx trades – 425 Mr Moulton: But it was ready to go, wasn’t it? Glenside hadn’t been –

Mr Murray: It was ready to go but this isn’t the point he’s making. He said that there were 40 people waiting for the beds – or sorry, 38 people waiting for the beds – and that they could not 430 build it as cheaply as they could buy it from Salisbury Street Care Home.

Mr Moulton: Right, I questioned that, though, didn’t I?

Mr Murray: You did question it, but I don’t think you got an answer to that. 435 Mr Moulton: Well no, because I can only go with what he says!

Mr Murray: From what I see of it is that if they already owned the land at Glenside and it was a 60-bed, rather than 68-bed, which would be cheaper because it’s so much per bed, say, it 440 would be cheaper. But if the Government with all its buying power couldn’t build it for the same price as local developers, I find that amazing.

Mr Moulton: I know I’ve moved you around very fast –

445 Mr Murray: But the other point, can I just … ?

Mr Moulton: Yes –

Mr Murray: I just want to go back to Glenside. It almost seemed in the interview that 450 Glenside was going to be the nursing home that was going to be built. It’s not, actually. From

______Interview Transcripts Page 10 98 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

what I can see of any record, at any time, it was never going to be a nursing home. It was going to be an adult care home without nursing and it was going to re-house people from Reayrt ny Baie and Sweetbriar, which, if you combine their registrations for beds, is round about 63; and the new Glenside, Summerhill, is 60 beds. They’re just going to be moved sideways. 455 So all that talk in that interview about, ‘Well, this is better news because we’ll take Salisbury Street and we can build a nursing home at Glenside’, well it was never going to be a nursing home and it’s only rehousing. So the actual complement of beds is down by three. So it’s not going forward – because you asked that question about, ‘Well, presumably the next one is Glenside as a nursing home’, and Howard Quayle actually refers to it as a nursing 460 home. I’ve never known that it was going to be a nursing home.

Mr Moulton: We’ve still go the points … Are there any other points … ? I know there was so much in that video that you were clamouring at! You can watch that other video, we have put it back up online. 465 Mr Murray: So I just want to say, well, how are things going now at Salisbury Street?

Mr Moulton: Let’s do that. How are they going?

470 Mr Murray: Well exactly, thank you, Paul! The premise was that the 40 beds would be for service users solely derived from benefits. I mean if I could just draw quickly something to attention, which is the statement here, on the Government website, of 10th May:

In an innovative move, the contract stipulates that 40 rooms will be available for older people whose nursing care can only be funded through benefits …

That’s not actually happening. 475 So, because there were very few people that were available to take those beds, and as I said before, the Isle of Man older people are more affluent –

Mr Moulton: Yes, it’s £850-ish that the Government puts in each – ?

480 Mr Murray: No, the beds are £812.10 for each one of those. And Adorn have paid a contract for all 40 beds, whether they’re full or not – as simple as that.

Mr Moulton: So you get the money regardless? (Mr Murray: Absolutely.) Oh, okay!

485 Mr Murray: Okay. Yes.

Mr Moulton: I didn’t know that!

Mr Murray: Well, that’s exactly how it happens. 490 So what’s been happening is that those partially funded individuals receiving care there are funding their beds … Sorry, they’re going into those 40 beds when perhaps they should be in the 28 beds. Well not ‘perhaps’; they were always supposed to be in the 28 beds,

Mr Moulton: In the private. 495 Mr Murray: When you say private, I mean it’s just how they’re funded. I think ‘private’ is a very good word, really.

Mr Moulton: It’s the same thing – you pay towards it.

______Interview Transcripts Page 11 99 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

500 Mr Murray: Exactly, it’s all about funding. There are three main categories: those individuals who solely derive a place in there and the Government pays for all their bed costs. That’s what the 40 beds were all about and that’s why they went to Tynwald for £7.9 million. The middle ground who should be in the 28 beds pay from a mixture of social benefits and private funds. And then of course there’s the private funders, where everything is paid privately. 505 So you’ve got in these 40 beds, now, people who have private assets – wealthy people in there. You have partially funded people and very few 100%.

Mr Moulton: And yet the Government is still paying you for those beds.

510 Mr Murray: Oh, the Government’s paying us for the beds, but my point is why is the taxpayer yes paying for those beds, when the people in those beds … that’s how all nursing homes are funded? This home was bought on the premise, for those people who couldn’t get places in other nursing homes because no care home would take them at the £812.10. 515 Mr Moulton: Okay. Dave, I mean there’s so much in this. Are there any other things we’ve missed or things that you want to get to because we have had, I know, quite a long interview here?

520 Mr Murray: Well, it is, but just a quick couple of points. The Treasury are still spitting out benefit payments to clients’ families, for example. So people are going into these beds, families are still receiving benefits and procurement are paying us the bed rate. Which basically means that if I took myself as an example and I was a semi- funded client and I had £400 of benefits, then if the bed is £812.10, I’d be paying another 525 £412.10 out of my personal moneys. Now, the Government will be paying the £400 to that individual – maybe to the family or maybe into their own bank account or whatever. This is not happening in all cases, but it is happening. Then what should happen is that £400 should be reconciled against the £140,000 we’re getting a month for these beds, or the £812. But it’s not. 530 And the other point is then that if that person is only getting £400 in benefits, they have to make up the other £412.10, they’re not paying the top-up to the Government to cover that bed.

Mr Moulton: Who are they paying it to?

535 Mr Murray: Nobody. It’s not being paid. And they shouldn’t be in that bed in the first place. That’s the whole point – they should be in the 28 beds. I mean, do you understand what I’m saying there?

Mr Moulton: Right, yes. And you want an inquiry into all this, as well? 540 Mr Murray: Oh, absolutely! Because to me it’s mismanagement of taxpayers’ money. I mean the purchase is all wrong.

Mr Moulton: But I mean, aren’t you happy getting this money? Why are you rocking the 545 boat, almost?

Mr Murray: Well, actually the whole funding model for this was based on the fact that the 28 beds from partially funded and fully private-funded clients would fill up very quickly and this would make the home very secure for a financial model. But what’s happening is where we 550 should have been probably full within four months, we’ve only got 15 private clients –

______Interview Transcripts Page 12 100 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Moulton: So you need more people.

Mr Murray: Well, the clients that we’ve got that are 100% funded are funding that care. But 555 they’re almost as rare perhaps as the 100% DHSC clients who are 100% -

Mr Moulton: Okay, are you going to the new –

Mr Murray: There’s just one last thing, Paul. (Mr Moulton: Okay.) 560 The other mismanagement thing is that none of the clients within the last eight to nine months of the home being open have received their personal allowances. And this has caused a lot of consternation for the home –

Mr Moulton: Oh, is this the money you get for toiletries and things like that? 565 Mr Murray: Yes, well that’s right. It’s for personal expenditure. It was never in the contracts that we’d ever deal with that. The Government were to pay that to clients, clients’ families through smart cards.

570 Mr Moulton: So they would buy their own stuff.

Mr Murray: Yes, so the clients’ families or the individual clients would have that money paid into their account and they could draw it down. They could put some into our safe, for example, if they wanted us to look after liquid cash – 575 Mr Moulton: And what’s going on here, then?

Mr Murray: Well, what’s happening is that they’ve just not got it. So we’ve had irate clients coming to us, saying – 580 Mr Moulton: ‘Where’s my money?’

Mr Murray: – ‘Where’s my money?’ Now, the Treasury had sent out a letter stating that Adorn was being paid the benefits. 585 Mr Moulton: This is your company.

Mr Murray: Which was totally wrong. Yes. After about six or seven months, I think it was back in November, they finally sent out a letter to the families to say, ‘Well, actually that was a 590 big mistake’ and they apologised to the families – they didn’t apologise to us, we didn’t get a letter – but saying that the Treasury had it and they would make this money up. But that was back in November and it still hasn’t happened.

Mr Moulton: So the money’s not got to the people. 595 Mr Murray: It’s not got to the people. So I think it’s quite scandalous, really.

Mr Moulton: Well, there’s so many things there. Are you going to the new Health Minister about this? Are you talking to – ? 600 Mr Murray: Yes, I was actually listening to him on Manx Radio today at 12 o’clock and he seems a very intelligent, articulate man who wants to make a –

______Interview Transcripts Page 13 101 MTTV INTERVIEWS: SALISBURY STREET NURSING HOME

Mr Moulton: So you’re going to follow this up? 605 Mr Murray: Well, I’m asking for a public inquiry. I mean if that’s how it works, great. I’d love to meet with him. But he did say that more people need to put their head above the parapet and talk about where the failings are. There a massive amount of failings with the financial management of Salisbury Street and how it was procured, and that’s what I’d like to see sorted 610 out.

Mr Moulton: Okay. And once again, just so you know, the interview is up there with Howard Quayle that we did in June 2016, when he was in charge of Health. You can see what he said and what’s gone ahead today. And the story will obviously continue. 615 Mr Murray: Oh, yes – absolutely.

Mr Moulton: Thank you.

620 Mr Murray: Thank you, Paul.

-- END --

______Interview Transcripts Page 14 102 Appendix 6: 19th March 2018 - Department of Health and Social Care Statement to Isle of Man Newspapers

103 104 Government statement - Salisbury Street

“The Government is already taking several steps to tackle the rising cost and shortage of nursing care places. We have announced a fundamental review into the sustainability of funding both nursing and residential care, and it is why Salisbury Street was purchased.

Alongside the review, we have announced plans to build a new residential care home to replace Glenside in Douglas.

Notes to editors:

The provider is correct in saying that there are very few people who rely solely on benefits to fund their beds - for this reason the threshold has been set at 95%.

105 106

Appendix 7: 20th to 26th March 2018 - Isle of Man Examiner News Article ‘Public Money ‘Squandered’ on Care Home’

107 108 109 110

Appendix 8: 22nd March 2018 - Isle of Man Today Online Article ‘Taxpayers’ Cash Squandered says Care Home Boss’

111 112 13/08/2020 Taxpayers' cash squandered says care home boss | News |

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Taxpayers' cash squandered says care home 15 boss Read comments

Thursday, 22 March 2018 - Health

A care operator is demanding a public inquiry into alleged ’mismanagement’ of taxpayers’ money over a Douglas care home.

The government-owned but privately- operated Salisbury Street care home opened in June last year - and was heralded as a way of tackling ’bed blocking’ at Noble’s Hospital.

But Dave Murray, director of Adorn Dave Murray, director of Adorn Domiciliary Care. Credit: MTTV Domiciliary Care which won the tender to operate the home, claims the Department of Health and Social Care over-estimated demand for beds and that government never needed to buy the facility for £7.9m in the first place.

He has called for a public inquiry into how the government procured Salisbury Street. ’I’m asking for a public inquiry. In my opinion it’s the mismanagement of taxpayers’ money. Taxpayers have a right to know how their money is spent.’

Tynwald approved the purchase of home for £7.9m in June 2016.

But Mr Murray, who was part of the private consortium Salisbury Care Ltd that built the facility, revealed that the development cost £5.3m to £5.6m to build.

He believes government paid over the odds for the home and claims he was ’coerced’ into selling his stake in the consortium.

As part of the contract awarded to Adorn, 40 of the 68 beds were to be made available to those who were solely reliant on state benefits to fund their nursing care costs.

The move was designed to tackle an issue of bed-blocking at Noble’s Hospital, where patients were unable to be discharged as they didn’t have a nursing home place they could afford.

Other nursing homes were charging more than the £812.10 per week, which was the maximum paid by the state in benefits. But Mr Murray claims in the event very few of people in this category came in, and that a number of the 40 beds are now occupied by those who partially fund their own care costs.

And yet the taxpayer still pays £812.10 a week per bed whether they are full or not.

’A senior civil servant said to me "we seem to have got our figures wrong", he said.

’My point is why is the taxpayer paying for those beds? The government didn’t need to spend £7.9m.’ 113 www.iomtoday.co.im/article.cfm?id=39372&headline=Taxpayers%27 cash squandered says care home boss§ionIs=news&searchyear=2018 13/08/2020 Taxpayers' cash squandered says care home boss | News | But in a statement, the DHSC said: ’The Salisbury Street home was independently valued and a model put in place Support Local Watch our local news video to ensure that anyone solely reliant on benefits would be able to access nursing care facilities. Buy Photos ’Since the beginning of the contract, three-quarters of the beds have been in constant use, as we modelled. We Order photos from our newsp also receive rent from the care home operator.’

A 10% increase in the nursing care contribution was announced in the Budget. But there is evidence that already care homes have increased their fees in response.

The DHSC said: ’The government is already taking several steps to tackle the rising cost and shortage of nursing care places.

’We have announced a fundamental review into the sustainability of funding both nursing and residential care, and it

’Alongside the review, we have announced plans to build a new residential care home to replace Rearyt Ny Baie residential home on the site of the former Glenside home.’

Mr Murray claims there is evidence of government paying twice at Salisbury Street - funding benefits for partially funded residents but also paying the £812.10 rate for the bed. He also alleged some residents are not paying the balance between their benefit and the care home fee.

Mr Murray said the original intention had been for Salisbury Care to build the facility and have Adorn run it, without any involvement of the government.

But half way through its construction, he said he was called into a meeting with DHSC officers who told him the home would not be registered.

He felt he had no choice but to sell his stake in the consortium and the facility was subsequently sold to the government. He said ’given the pressure we were put under’ he believes the consortium was ’coerced’ into selling the home to government.

complaint

The DHSC confirmed an independent investigator is reviewing the complaint that Mr Murray was allegedly ’coerced’ by two civil servants into selling his stake in Salisbury Care.

It said after the purchase of Salisbury Street, it received offers from private investors/operators, including the current operator, to buy the facility at the price paid by government.

The DHSC explained that the block purchase of beds was necessary to attract an operator to provide 40 beds at benefit rates.

For the government to break even, 75% of the beds need to be filled over the course of the five-year contract. Since the beginning of September, there has not been a period when less than 75% of the commissioned beds were not occupied.

The DHSC said the Mr Murray was correct in saying that there are very few people who rely solely on benefits to fund their beds - and for this reason the threshold has been set at 95% of care costs to be met from benefits.

Regulations are being laid before Tynwald next week to enable the department to charge residents for the 5% contribution.

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Appendix 9: 2018 to 2020 - Tynwald and House of Keys Questions regarding Salisbury Street

115 116 TYNWALD COURT, TUESDAY, 17th APRIL 2018

HEALTH AND SOCIAL CARE

31. Salisbury Street Nursing Home – Empty beds; payments to Adorn Domiciliary Care Ltd

The Hon. Member for Ramsey (Mr Hooper) to ask the Minister for Health and Social Care:

How many beds were unoccupied at Salisbury Street Nursing Home each week from the start of the contract until 30th September 2017; and how much was paid to Adorn Domiciliary Care Ltd for those empty beds?

The Minister for Health and Social Care (Mr Ashford): Salisbury Street Care Home with Nursing opened to residents on 8th May 2017. To break even, the Department requires average occupancy to be at 75% over the term of the five year Agreement with the operator. In any new Care Home it is expected that the beds become used gradually. This is not least because the Minimum Standards for Adult Care Homes require admissions to be carefully planned and managed. https://www.gov.im/media/1356010/2017-adult-care-homes-standards-v2.pdf The admissions process includes information provided to potential residents and their families about the ethos, facilities and services available in the home so that an informed decision can be made on whether this is the right home for them. In advance of each admission, the home’s registered person has to carry out a comprehensive and thorough pre-admission assessment with each potential resident. It is not practical for more than two or three assessments to be carried out each day. Wherever possible it is recommended that a staged admissions process is made available for the person being accommodated. Visits to the home are facilitated and people are introduced to staff members and fellow residents. People are able to stay for meals and join in activities where practicable. It is therefore inevitable that it takes some time for a Care Home to become fully occupied.

Total No of No of Commissioned Empty W/C Beds Beds

8-May-17 36 30 15-May-17 36 29 22-May-17 36 29 29-May-17 36 29 5-Jun-17 36 29 12-Jun-17 36 29 19-Jun-17 36 28 26-Jun-17 36 26 3-Jul-17 36 24 10-Jul-17 36 24 17-Jul-17 36 24 24-Jul-17 36 23 31-Jul-17 36 22 7-Aug-17 36 21 14-Aug-17 36 19 21-Aug-17 36 17

______Hansard Extract Page 1 www.tynwald.org.im/business 117 TYNWALD COURT, TUESDAY, 17th APRIL 2018

28-Aug-17 36 15 4-Sep-17 36 10 11-Sep-17 36 8 18-Sep-17 35 4 25-Sep-17 35 4

The total cost of the empty beds from the start of the contract until 30th September was £360,573.

______Hansard Extract Page 2 www.tynwald.org.im/business 118 HOUSE OF KEYS, TUESDAY, 26th JUNE 2018

2.9. Salisbury Street Nursing Home – Unoccupied beds and cost

The Hon. Member for Douglas South (Mrs Beecroft) to ask the Minister for Health and Social Care:

How many beds were unoccupied at Salisbury Street Nursing Home each week from the week commencing 2nd October 2017 until the week commencing 28th May 2018; and how much was paid to Adorn Domiciliary Care Ltd for those empty beds?

The Minister for Health and Social Care (Mr Ashford): Table 2.9A below shows occupancy levels and costs for unoccupied beds at Salisbury Street Care Home.

Table 2.9A Total No of No of Commissioned Cost of Empty W/Ending Residents No of Empty Beds Beds Occupancy Beds 2-Oct-17 28 7 35 80% 5,685 9-Oct-17 29 6 35 83% 4,873 16-Oct-17 30 5 35 86% 4,061 23-Oct-17 30 5 35 86% 4,061 30-Oct-17 32 3 35 91% 2,436 6-Nov-17 31 9 40 78% 7,309 13-Nov-17 31 9 40 78% 7,309 20-Nov-17 33 7 40 83% 5,685 27-Nov-17 33 7 40 83% 5,685 4-Dec-17 34 6 40 85% 4,873 11-Dec-17 33 7 40 83% 5,685 18-Dec-17 34 6 40 85% 4,873 25-Dec-17 34 6 40 85% 4,873 1-Jan-18 35 5 40 88% 4,061 8-Jan-18 36 4 40 90% 3,248 15-Jan-18 38 2 40 95% 1,624 22-Jan-18 40 0 40 100% 0 29-Jan-18 36 4 40 90% 3,248 5-Feb-18 36 4 40 90% 3,248 12-Feb-18 34 6 40 85% 4,873 19-Feb-18 34 6 40 85% 4,873 26-Feb-18 32 8 40 80% 6,497 5-Mar-18 34 6 40 85% 4,873 12-Mar-18 35 5 40 88% 4,061 19-Mar-18 35 5 40 88% 4,061 26-Mar-18 33 7 40 83% 5,685 2-Apr-18 34 6 40 85% 5,116 9-Apr-18 32 8 40 80% 6,821 16-Apr-18 31 9 40 78% 7,673 23-Apr-18 33 7 40 83% 5,968 30-Apr-18 33 7 40 83% 5,968

______Hansard Extract Page 1 www.tynwald.org.im/business 119 HOUSE OF KEYS, TUESDAY, 26th JUNE 2018

7-May-18 36 4 40 90% 3,410 14-May-18 36 4 40 90% 3,410 21-May-18 37 3 40 93% 2,558 28-May-18 37 3 40 93% 2,558 Totals 196 85% 161,238

______Hansard Extract Page 2 www.tynwald.org.im/business 120 TYNWALD COURT, TUESDAY, 16th JUNE 2020

12. Salisbury Street Care Home – Capital and revenue expenditure

The Hon. Member for Douglas Central (Mr Thomas) to ask the Minister for Health and Social Care:

At what price and on what terms the Isle of Man Government purchased Salisbury Street Care Home in 2016; what capital and revenue expenditure in respect of the conversion and operation of this property and facility has been incurred since; and if he will make a statement?

The President: In that case, Question 12, Mr Thomas.

Mr Thomas: Thank you, Mr President. To ask the Minister for Health and Social Care: at what price and on what terms the Isle of Man Government purchased Salisbury Street Care Home in 2016; what capital and revenue expenditure in respect of the conversion and operation of the property and facility has been incurred since; and if he will make a statement?

The President: I call on the Minister to reply.

The Minister for Health and Social Care (Mr Ashford): Thank you, Mr President. I promise it is a briefer one this time. In relation to Salisbury Street Care Home, it was purchased for £7.9 million exclusive of VAT, being £7.55 million exclusive of VAT with respect to the property and £350,000 exclusive of VAT in respect to the fixtures and fittings. Expenditure in respect of the conversion and operation of this property and facility that has been incurred since is as follows: 2016-17, £6,347.16; 2017-18, £31,356.15; 2018-19, £4,033.96; 2019-20, £4,099.69; 2020-21, £7,267.34. And that makes a total, if my maths is correct, Mr President, over those five years of £53,104.30.

______Hansard Extract Page 1 www.tynwald.org.im/business 121 122 TYNWALD COURT, TUESDAY, 16th JUNE 2020

33. Salisbury Street Nursing Home – Unoccupied beds and cost

The Hon. Member for Douglas Central (Mr Thomas) to ask the Minister for Health and Social Care:

Pursuant to his Answer in the House of Keys on 26th June 2018, if he will update table 2.9A provided in respect of unoccupied beds and cost of the Salisbury Street Nursing Home?

The Minister for Health and Social Care (Mr Ashford): Updated table as follows:

Tynwald Question RE Salisbury St Vacancies from w/c 4th June 2018

No Total No of Cost of empty W/Comm empty Commissioned Occupancy Residents beds beds beds

04-Jun-18 39 1 40 98% £852.61 11-Jun-18 40 0 40 100% £0.00 18-Jun-18 38 2 40 95% £1,705.22 25-Jun-18 39 1 40 98% £852.61 02-Jul-18 40 0 40 100% £0.00 09-Jul-18 40 0 40 100% £0.00 16-Jul-18 40 0 40 100% £0.00 23-Jul-18 40 0 40 100% £0.00 30-Jul-18 40 0 40 100% £0.00 06-Aug-18 40 0 40 100% £0.00 13-Aug-18 40 0 40 100% £0.00 20-Aug-18 40 0 40 100% £0.00 27-Aug-18 39 1 40 98% £852.61 03-Sep-18 38 2 40 95% £1,705.22 10-Sep-18 40 0 40 100% £0.00 17-Sep-18 38 2 40 95% £1,705.22 24-Sep-18 38 2 40 95% £1,705.22 01-Oct-18 36 4 40 90% £3,410.44 08-Oct-18 36 4 40 90% £3,410.44 15-Oct-18 38 2 40 95% £1,705.22 22-Oct-18 38 2 40 95% £1,705.22 29-Oct-18 39 1 40 98% £852.61 05-Nov-18 39 1 40 98% £852.61 12-Nov-18 40 0 40 100% £0.00 19-Nov-18 39 1 40 98% £852.61 26-Nov-18 40 0 40 100% £0.00 03-Dec-18 39 1 40 98% £852.61 10-Dec-18 39 1 40 98% £852.61 17-Dec-18 40 0 40 100% £0.00 24-Dec-18 40 0 40 100% £0.00

______Hansard Extract Page 1 www.tynwald.org.im/business 123 TYNWALD COURT, TUESDAY, 16th JUNE 2020

31-Dec-18 39 1 40 98% £852.61 2019 07-Jan-19 39 1 40 98% £852.61 14-Jan-19 39 1 40 98% £852.61 21-Jan-19 38 2 40 95% £1,705.22 28-Jan-19 38 2 40 95% £1,705.22 04-Feb-19 39 1 40 98% £852.61 11-Feb-19 39 1 40 98% £852.61 18-Feb-19 38 2 40 95% £1,705.22 25-Feb-19 37 3 40 93% £2,557.83 04-Mar-19 38 2 40 95% £1,705.22 11-Mar-19 37 3 40 93% £2,557.83 18-Mar-19 38 2 40 95% £1,705.22 25-Mar-19 38 2 40 95% £1,705.22 01-Apr-19 38 2 40 95% £1,705.22 08-Apr-19 39 1 40 98% £873.04 15-Apr-19 39 1 40 98% £873.04 22-Apr-19 36 4 40 90% £3,492.16 29-Apr-19 37 3 40 93% £2,619.12 06-May-19 38 2 40 95% £1,746.08 13-May-19 40 0 40 100% £0.00 20-May-19 40 0 40 100% £0.00 27-May-19 40 0 40 100% £0.00 03-Jun-19 39 1 40 98% £873.04 10-Jun-19 38 2 40 95% £1,746.08 17-Jun-19 40 0 40 100% £0.00 24-Jun-19 39 1 40 98% £873.04 01-Jul-19 40 0 40 100% £0.00 08-Jul-19 40 0 40 100% £0.00 15-Jul-19 39 1 40 98% £873.04 22-Jul-19 39 1 40 98% £873.04 29-Jul-19 40 0 40 100% £0.00 05-Aug-19 40 0 40 100% £0.00 12-Aug-19 40 0 40 100% £0.00 19-Aug-19 39 1 40 98% £873.04 26-Aug-19 40 0 40 100% £0.00 02-Sep-19 38 2 40 95% £1,746.08 09-Sep-19 39 1 40 98% £873.04 16-Sep-19 40 0 40 100% £0.00 23-Sep-19 40 0 40 100% £0.00 30-Sep-19 40 0 40 100% £0.00 07-Oct-19 40 0 40 100% £0.00 14-Oct-19 40 0 40 100% £0.00

______Hansard Extract Page 2 www.tynwald.org.im/business 124 TYNWALD COURT, TUESDAY, 16th JUNE 2020

21-Oct-19 40 0 40 100% £0.00 28-Oct-19 39 1 40 98% £873.04 04-Nov-19 40 0 40 100% £0.00 11-Nov-19 40 0 40 100% £0.00 18-Nov-19 40 0 40 100% £0.00 25-Nov-19 40 0 40 100% £0.00 02-Dec-19 40 0 40 100% £0.00 09-Dec-19 40 0 40 100% £0.00 16-Dec-19 40 0 40 100% £0.00 23-Dec-19 40 0 40 100% £0.00 30-Dec-19 39 1 40 98% £873.04 2020 06-Jan-20 40 0 40 100% £0.00 13-Jan-20 40 0 40 100% £0.00 20-Jan-20 40 0 40 100% £0.00 27-Jan-20 40 0 40 100% £0.00 03-Feb-20 40 0 40 100% £0.00 10-Feb-20 40 0 40 100% £0.00 17-Feb-20 40 0 40 100% £0.00 24-Feb-20 40 0 40 100% £0.00 02-Mar-20 40 0 40 100% £0.00 09-Mar-20 40 0 40 100% £0.00 16-Mar-20 40 0 40 100% £0.00 23-Mar-20 40 0 40 100% £0.00 30-Mar-20 40 0 40 100% £0.00 06-Apr-20 40 0 40 100% £0.00 13-Apr-20 40 0 40 100% £0.00 20-Apr-20 40 0 40 100% £0.00 27-Apr-20 40 0 40 100% £0.00 04-May-20 40 0 40 100% £0.00 11-May-20 40 0 40 100% £0.00 18-May-20 40 0 40 100% £0.00 25-May-20 40 0 40 100% £0.00 01-Jun-20 39 1 40 98% £882.63 08-Jun-20 40 0 40 100% £0.00

______Hansard Extract Page 3 www.tynwald.org.im/business 125 126

Appendix 10: September to October 2018 Correspondence with Department of Health and Social Care

127 128 Questions Asked

From: Joann Corkish Sent: 21 September 2018 17:09 To: Ashford, David (MHK); Couch, Malcolm Subject: Questions from PAC re Salisbury Street Nursing Home

Dear Minister and Chief Executive

With respect to the Salisbury Street Nursing Home project the Public Accounts Committee would like to ask the Department the following:

1. How much did the home cost to build; 2. What were the terms of the pre-purchase valuation and what was the result; 3. Were there any additional payments made, above and beyond the agreed purchase price by IOMG, after the purchase in order to bring the home to operating standards? 4. Please provide a schedule detailing all payments made in connection with this project; how much, who was paid, when payments were made and what the payments were for? 5. We have been advised that, during the build period, Mr Murray a member of the Salisbury Care Board, was advised that a licence to run the facility would not be granted to Adorn Domiciliary Care, who are licenced to operate other facilities; if this is correct who told him this, when and why? 6. The Board then sold the facility to IOMG and he is now running the facility, how did this situation come about? 7. Please supply copies of the independent investigation papers into Mr Murray’s complaint to DHSC. 8. With respect to the 40 DHSC beds: a. how was the number of beds estimated; b. what are the arrangements for funding these beds; c. what has the occupancy been; d. how is the 75% break-even calculated?

In addition the Committee would also like the following questions to be asked directly of the Registrations and Inspections Unit. Would you be able to forward to the appropriate divisional manager or, if you would prefer and can provide the name of the appropriate officer I am happy to email them directly.

1. Please can you provide copies of the Inspection and Registration process for a new care facility. 2. Please provide copies of all the documentation and correspondence relating to the registration and inspection of the Salisbury Street facility. 3. We have been advised that, during the build period, Mr Murray a member of the Salisbury Care Board, was advised that a licence to run the facility would not be granted to Adorn Domiciliary Care, who are licenced to operate other facilities; if this is correct who told him this, when and why? 4. The Board then sold the facility to IOMG and he is now running the facility, how did this situation come about?

If replies could be provided by 2nd October 2018 this would be most helpful.

129 Many Thanks Jo ______Mrs Joann Corkish Third Clerk of Tynwald Legislative Buildings Douglas Isle of Man IM1 3PW

[Contact details redacted]

130 Part 1 Reply to The R&I Questions 1 & 2

From: Couch, Malcolm Sent: 01 October 2018 15:26 To: Joann Corkish; David Ashford Subject: RE: Questions from PAC re Salisbury Street Nursing Home

Dear Jo

This is a reply to your second group of questions: or rather, questions 1 and 2, as I will deal with the others when I reply to your first group.

The registration regulations are attached. They must be adhered to by any new facility. The related application forms are also attached.

Once the forms have been submitted, and all checks have been completed, the Registration and Inspection Unit makes a visit to ensure compliance with regulatory requirements and to interview the people proposed as registered manager and responsible person. The inspector then confirms registration, or otherwise.

Inspection reports are available online here.

Best regards Malcolm

Malcolm Couch Chief Executive Department of Health & Social Care | Isle of Man Government Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA [Contact details redacted]

131 Archived: 02 October 2018 15:05:22 From: Couch, Malcolm Sent: 02 October 2018 14:26:39 To: Joann Corkish Cc: David Ashford Subject: RE: Questions from PAC re Salisbury Street Nursing Home Importance: Normal Attachments: New Care Home Salisbury Street Douglas 24 May 2016.pdf ;Salisbury St costs 2018-10-01.xlsx ;PDM - Investigation (6Apr18).docx ;SOCIAL AFFAIRS POLICY REVIEW COMMITTEE.DOCX ;

Dear Jo

I am now responding to the first group of questions.

1. The government holds no information in respect of the costs of the construction of the Salisbury Street nursing home.

2. The valuation was managed on behalf of the DHSC by the government valuation and asset management unit, and an external party was engaged following a procurement process. The valuation is attached. I would draw the Committee’s attention to the legal notice on page 15 of the report.

3. Please find attached a workbook derived from the government accounting system which details the project payments.

4. Covered under answer 3.

5. Covered under answer 7.

6. The department conducted a procurement exercise and Adorn was the successful party.

7. The report of the investigation into Mr Murray’s complaint is attached. It is not practical to copy the supporting files of papers, and these can be made available for your inspection on behalf of the Committee should that be necessary.

8. With respect to the 40 DHSC beds: a. the number of rooms required was estimated based on a number of factors (a decrease in the number of beds available on the Island, increasing demand and the lack of availability of rooms where the fees were covered by maximum social security benefit levels) – a strategic document prepared as a briefing for the Social Affairs Policy Review Committee is attached for additional background information; b. the department commissions the rooms and the residents are all people who have been assessed as needing nursing care and where their social security benefit entitlement exceeds 95% of the weekly charge of £852.61; c. from 23 May 2018 all DHSC rooms have been occupied, with very short periods between a room becoming vacant and being occupied by a new resident – and occupancy of the commissioned rooms rose steadily to this point following the opening of the home; and, d. this figure came simply from comparing the room charges receivable with the amount payable to commission the rooms.

Best regards Malcolm

Malcolm Couch Chief Executive Department of Health & Social Care | Isle of Man Government Crookall House, Demesne Road, Douglas, Isle of Man, IM1 3QA [Contact details redacted]

cid:[email protected]

132

REGULATION OF CARE (REGISTRATION) REGULATIONS 2013

135 134 Regulation of Care (Registration) Regulations 2013 Index

REGULATION OF CARE (REGISTRATION) REGULATIONS 2013

Index Regulation Page

PART 1 – INTRODUCTION 5 1 Title ...... 5 2 Commencement ...... 5 3 Interpretation ...... 5

PART 2 – REGISTRATION APPLICATIONS 6 4 Registration applications: prescribed information...... 6 5 Applications for provider registration: prescribed documents and information ...... 7

PART 3 – REGISTER ABOUT REGISTERED PERSONS AND RESPONSIBLE PERSONS FOR CARE SERVICES 7 6 Contents of register ...... 7

PART 4 – AMENDMENT OF REGISTRATION 7 7 Amendment applications: prescribed information ...... 7

PART 5 – SURRENDER OF REGISTRATION BY REGISTERED PROVIDERS OTHER THAN CHILDMINDERS 7 8 Surrender application: prescribed information ...... 7 9 Conditions ...... 8

PART 6 – FEES 9 10 Registration application fees ...... 9 11 Amendment application fees ...... 9

PART 7 – EXCEPTION FROM SUPERVISION AND MANAGEMENT CONDITIONS 9 12 Exception from supervision and management conditions: maximum prescribed leave ...... 9

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Index Regulation of Care (Registration) Regulations 2013

SCHEDULE 1 11 INFORMATION WHICH AN APPLICATION FOR PROVIDER REGISTRATION MUST GIVE 11

SCHEDULE 2 13 INFORMATION WHICH AN APPLICATION FOR MANAGER REGISTRATION MUST GIVE 13

SCHEDULE 3 14 DOCUMENTS WHICH MUST ACCOMPANY OR BE INCLUDED WITH AN APPLICATION FOR PROVIDER REGISTRATION 14

SCHEDULE 4 17 DOCUMENTS WHICH MUST ACCOMPANY OR BE INCLUDED WITH AN APPLICATION FOR MANAGER REGISTRATION 17

SCHEDULE 5 18 REGISTRATION APPLICATION FEES 18

SCHEDULE 6 20 AMENDMENT APPLICATION FEES 20

SCHEDULE 7 21 REGISTER ABOUT REGISTERED PERSONS AND RESPONSIBLE PERSONS FOR CARE SERVICES 21

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Regulation of Care (Registration) Regulations 2013 Regulation 1

Statutory Document No. 0337/13

Regulation of Care Bill 20123

REGULATION OF CARE (REGISTRATION) REGULATIONS 2013

Laid before Tynwald: 15 October 2013 Coming into Operation: 17 October 2013

The Department of Social Care makes the following Regulations under sections 57, 67(1)(a), 75(c), 82(b), 107(2) and 161 of the Regulation of Care Act 2013.

PART 1 – INTRODUCTION

1 Title These Regulations are the Regulation of Care (Registration) Regulations 2013.

2 Commencement These Regulations come into operation on 17 October 2013.

3 Interpretation (1) In these Regulations — “the Act” means the Regulation of Care Act 2013; “adult care home” has the meaning given in section 16; “amendment application” has the meaning given in section 74(1); “applicant” means a person making a registration application under section 57. “care service” means — (a) an agency which section 7 provides is a care service; or (b) an establishment which section 8 provides is a care service; “child” has the meaning given in the Schedule to the Act; “child (secure accommodation) establishment” has the meaning given in section 23; “childrens home” has the meaning given in section 22(1);

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Regulation 4 Regulation of Care (Registration) Regulations 2013

“designated agency” has the meaning given in section 7(1). “DSC” means the Department of Social Care; “inspector” has the meaning given in section 111(3). “manager registration” has the meaning given in section 39(1). “nominee” means the individual proposed to be the care service’s responsible person under section 57(2)(a) in relation to an application for provider registration. “notice of surrender application” means a notice by the registered provider stating that the registered provider has made, or intends to make, a surrender application. “offender accommodation service” has the meaning given in section 30(1). “proposed effective date of surrender” means the date requested by the registered provider as the date on which the surrender application is to take effect. “provider registration” has the meaning given in section 38(1). “qualified medical practitioner” has the meaning given in section 8 of the Medical Act 19851 “registered manager” has the meaning given in section 39(2). “responsible person” has the meaning given in section 62(2). “responsible person change” has the meaning given in section 66(2)(b)(ii;) “service recipient” has the meaning given in section 120(d)(ii). “statement of purpose” means the written statement containing the information specified in Schedule 3. “surrender application” has the meaning given in section 80(a). “urgent cancellation” has the meaning given in section 89(1)(c). (2) In these Regulations a reference to a numbered section is to the section of the Act bearing that number.

PART 2 – REGISTRATION APPLICATIONS

4 Registration applications: prescribed information (1) Schedules 1 and 2 prescribe the matters in respect of what information is required, and the information to be provided for provider and manager registration. (2) Schedule 1 specifies the information which must be given if the application is for provider registration.

1 1985

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Regulation of Care (Registration) Regulations 2013 Regulation 5

(3) Schedule 2 specifies the information which must be given if the application is for manager registration.

5 Applications for provider registration: prescribed documents and information (1) Schedule 3 and 4 prescribe the documents which must be included or accompany a registration application. (2) Schedule 3 specifies the documents which must be included or accompany an application for provider registration. (3) Schedule 4 specifies the documents which must be included or accompany an application for manager registration.

PART 3 – REGISTER ABOUT REGISTERED PERSONS AND RESPONSIBLE PERSONS FOR CARE SERVICES

6 Contents of register The register must include the information prescribed in Schedule 7.

PART 4 – AMENDMENT OF REGISTRATION

7 Amendment applications: prescribed information An amendment application must contain — (a) the name, address and contact details of the care service which is the subject of the amendment application; (b) the name, address and contact details of the registered person of the care service which is the subject of the amendment application; (c) details of the amendment sought.

PART 5 – SURRENDER OF REGISTRATION BY REGISTERED PROVIDERS OTHER THAN CHILDMINDERS

8 Surrender application: prescribed information A surrender application must contain — (a) the name, address and contact details of the care service whose provider registration is being surrendered; (b) the name, address and contact details of the registered provider.

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Regulation 9 Regulation of Care (Registration) Regulations 2013

9 Conditions (1) A surrender application must be — (a) sent or delivered to DSC — (i) not less than 3 months before the proposed effective date of surrender; or (ii) within such shorter period (if any) before that date as may be agreed with DSC; and (b) accompanied by the information specified in paragraph (4). (2) The registered provider must give notice of any surrender application to each of the persons specified in paragraph (3) within 7 days of making the application, excluding any person to whom the provider gave such notice in the 3 months before making the application. (3) Those persons are — (a) current service recipients; and (b) persons who appear to the registered provider to be representatives of service recipients. But a person mentioned in this paragraph need not be given notice if it is impracticable to do so. (4) That information is — (a) the proposed effective date of surrender; (b) a statement as to the arrangements (if any) that have been made by the registered provider to ensure that on and after— (i) the date of surrender application; and (ii) the proposed effective date of surrender, service recipients will continue to be provided with similar accommodation (if any) and services as those provided to them in the establishment or by the agency at the date on which the surrender application is made; (c) the registered provider’s reasons for making the surrender application; (d) particulars of any notice of surrender application given to any person referred to in paragraph (3); (e) if the registered provider has not given notice of the surrender application to — (i) each service recipient; and (ii) a person who appears to the registered provider to be a representative of each service recipient; a statement as to whether there were any circumstances which prevented the registered person from giving (or made it impracticable for them to give) notice of surrender application to

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Regulation of Care (Registration) Regulations 2013 Regulation 10

any of those persons before the date on which the provider made the surrender application; (f) if the registered provider has made a surrender application less than 3 months before the proposed effective date of surrender, a report as to whether — (i) the establishment or agency has ceased to be financially viable; or (ii) is likely to cease to be financially viable within the next following twelve months. (5) The registered provider must provide DSC with any other information or documents that DSC may reasonably require in relation to the provider’s surrender application.

PART 6 – FEES

10 Registration application fees Schedule 5 sets out the prescribed fees for which a registration application must be accompanied by for the purposes of section 57(1)(e).

11 Amendment application fees Schedule 6 sets out the prescribed fees which an amendment application must be accompanied by for the purposes of section 75(1)(d).

PART 7 – EXCEPTION FROM SUPERVISION AND MANAGEMENT CONDITIONS

12 Exception from supervision and management conditions: maximum prescribed leave The maximum leave prescribed for the purposes of section 67(1)(a) (exception from supervision and management conditions) is 3 months.

MADE

CHRIS ROBERTSHAW Minister for Social Care

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142 Regulation of Care (Registration) Regulations 2013 SCHEDULE 1

SCHEDULE 1

INFORMATION WHICH AN APPLICATION FOR PROVIDER REGISTRATION MUST GIVE

PART I — INFORMATION ABOUT THE APPLICANT

1. If the applicant is an individual — (a) the applicant’s full name, date of birth, address, telephone number and electronic address; (b) details of the applicant’s professional or technical qualifications and experience relevant to the care service for which registration is sought; (c) details of the applicant’s employment history, including the name and address of the applicant’s present employer and of any previous employers; (d) details of any disciplinary proceedings relating to the care of children or adults that the applicant is currently subject to; (e) the names and contact details of two referees; (f) details of any conviction by a criminal court, (whether in the Island or elsewhere) of any offence committed by the applicant, other than a traffic offence; (g) details of any investigations and/or proceedings relating to the care of children or adults under any Act of Tynwald, or any other British Islands legislation that the applicant is currently subject to; and (h) the name and address of any other care service which the applicant has, or has had, a business interest and the details of that interest.

2. If the applicant is a body corporate — (a) the name of the body corporate and the address of the registered office or principal office of the body corporate and the current telephone number and electronic address of the body corporate; (b) the full name, date of birth and current address, telephone number and electronic address of — (i) the individual proposed to be the body corporate’s responsible person; and (ii) the directors of the body corporate; (c) details of the individual proposed to be the body corporate’s responsible person’s professional or technical qualifications and experience relevant to the care service for which registration is sought; (d) details of the individual proposed to be the body corporate’s responsible person’s employment history, including the name and address of the applicant’s present employer and of any previous employers;

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SCHEDULE 1 Regulation of Care (Registration) Regulations 2013

(e) details of any disciplinary proceedings relating to the care of children or adults that the individual proposed to be the body corporate’s responsible person is currently subject to; (f) the names and contact details of two referees for the individual proposed to be the body corporate’s responsible person; (g) details of any conviction by a criminal court (whether in the Island or elsewhere) of any offence (other than a traffic offence) committed by – (i) the individual proposed to be the body corporate’s responsible person; and (ii) the directors of the body corporate; (h) details of any investigations and/or proceedings relating to the care of children or adults under any Act of Tynwald, or any other British Islands legislation currently being undertaken against — (i) the individual proposed to be the body corporate’s responsible person; and (ii) the directors of the body corporate; (i) the name and address of any other care service which the individual proposed to be the body corporate’s responsible person has, or has had, a business interest and the details of that interest.

3. If the applicant is a partnership — (a) the name and address of the partnership; and (b) in relation to each partner, the information specified in paragraph 1(a) to (h).

PART II — INFORMATION ABOUT THE ESTABLISHMENT OR AGENCY

4. Details of the category and if applicable the sub-category of care service for which registration is sought.

5. Whether any other businesses is or will be carried out in the same premises as the care service.

6. The number and age range of service recipients for whom the care service is proposed to be provided (other than where the care service is an independent clinic).

7. If the application is for childminder registration — (a) the full name of any person who assists in looking after any such child; and (b) the full name (s) of any person who lives or is likely at any time to be living at premises where the registered person looks after children.

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Regulation of Care (Registration) Regulations 2013 SCHEDULE 2

SCHEDULE 2

INFORMATION WHICH AN APPLICATION FOR MANAGER REGISTRATION MUST GIVE

1. The applicant’s full name, date of birth, current address, telephone number and e- mail address (if any).

2. Name, address, telephone number and e-mail address (if any) of the establishment or agency.

3. Details of professional or technical qualifications and experience relevant to the care service for which registration is required.

4. Details of the applicant’s employment history, including the name and address of the applicant’s present employer and of any previous employers. 5. Details of any disciplinary proceedings relating to the care of children or adults that the applicant is currently subject to.

6. Details of any business the applicant carries on or manages or has carried on or managed.

7. The name and addresses of two referees — (a) who are not relatives of the applicant; (b) each of whom is able to provide a reference as to the applicant’s competence to carry on an establishment or agency of the same description as the establishment or agency; and (c) one of whom has employed the applicant for a period of at least 6 months, Sub-paragraph (c) does not apply if either — (i) the application is for childminder registration; or (ii) it is impracticable to obtain a reference from a person who fulfils that requirement.

8. Details of any conviction by a criminal court (whether in the Island or elsewhere) of any offence, other than a traffic offence, committed by the applicant.

9. Details of any investigations and/or proceedings relating to the care of children or adults under any Act of Tynwald, or any other British Islands legislation, that the applicant is currently subject to.

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SCHEDULE 3 Regulation of Care (Registration) Regulations 2013

SCHEDULE 3

DOCUMENTS WHICH MUST ACCOMPANY OR BE INCLUDED WITH AN APPLICATION FOR PROVIDER REGISTRATION

PART I – DOCUMENTS ABOUT AN APPLICANT

1. If the applicant is an individual or partnership — (a) certificates or other suitable evidence relating to the applicant’s professional or technical qualifications, so far as those qualifications are relevant to providing services for persons for whom services are to be provided at the establishment or by the agency (to be provided in person by the applicant); (b) Disclosure and Barring Service (DBS) form and fee (to be provided in person by the applicant); (c) criminal conviction certificate (to be provided in person by the applicant); (d) a report by a qualified medical practitioner on the mental and physical health of the applicant; (e) the signed consent form allowing DSC to obtain a reference from the applicant’s bank expressing an opinion as to the applicant’s financial standing; (f) a certificate of insurance for the applicant in respect of liability which may be incurred by the applicant in relation to the establishment or agency in respect of death, injury, public liability, damage or other loss.

2. If the applicant is a body corporate — (a) certificates or other suitable evidence relating to the individual proposed to be the body corporate’s responsible person’s professional or technical qualifications, so far as those qualifications are relevant to providing services for persons for whom services are to be provided at the care service (to be provided in person by the individual proposed to be the body corporate’s responsible person); (b) Disclosure and Barring Service (DBS) form and fee (to be provided in person by the individual proposed to be the body corporate’s responsible person); (c) a criminal conviction certificate for the individual proposed to be the body corporate’s responsible person (to be provided in person by the individual proposed to be the body corporate’s responsible person); (d) a report by a registered medical practitioner on the mental and physical health of the individual proposed to be the body corporate’s responsible person’s; (e) The signed consent form allowing DSC to obtain a reference from the body corporate’s bank expressing an opinion as to the body corporate’s financial standing;

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Regulation of Care (Registration) Regulations 2013 SCHEDULE 3

(f) A certificate of insurance for the body corporate in respect of liability which may be incurred by the body corporate in relation to the establishment or agency in respect of death, injury, public liability, damage or other loss.

3. If the application is for childminder registration for any person over 16 who lives, or is likely at any time to be living, on any premises on which the applicant is, or is likely to be, child minding — (a) Disclosure and Barring Service (DBS) form and fee (to be provided in person); and (b) a criminal conviction certificate (to be provided in person).

PART II – DOCUMENTS ABOUT AN ESTABLISHMENT OR AGENCY

4. For all applicants — (a) a record of the policies and procedures for the care service; (b) a business plan for the care service; (c) a copy of the last two annual reports and accounts of the care service (if any); (d) an organisational chart for the staff employed by the care service.

5. For an establishment — (a) a site plan of the interior and exterior of the property; (b) evidence confirming compliance with the regulations on water supply and water fittings relating to safe storage and outlet temperatures to prevent legionellosis and scalding; (c) an electrical inspection certificate showings the premises comply with the current electricity at work regulations and wiring regulations; (d) certificate or report that shows compliance with current gas safety regulations; (e) a report that shows compliance with current food hygiene regulations; (f) a fire risk assessment and where applicable, a report on any recommendations issued by the relevant fire authority; (g) where applicable, a copy of the lease of the premises of the care service; (h) where applicable, a certificate of lift safety; (i) the statement of purpose of the care service.

6. The statement of purpose under paragraph 5(i) must include the following information — (a) the organisational structure of the care service;

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SCHEDULE 3 Regulation of Care (Registration) Regulations 2013

(b) whether the service requires a manager to be registered; (c) the relevant qualifications and experience of the registered provider and any registered manager; (d) the number, relevant qualifications and experience of the staff working at the care service; (e) the age range of service recipients that the care services intends to meet; (f) the range of needs that the care service intends to meet; (g) whether nursing is to be provided; (h) any criteria used for admission to the care service; (i) for residential care services, the numbers and sizes of the rooms in the home; (j) for residential care services, the arrangements made for service recipients to engage in social activities, hobbies or interests; (k) the arrangements made for consultation with service recipients and/ or their representative about the quality of the care service; (l) the fire precautions and the associated emergency procedures at the care service; (m) the arrangements made for dealing with complaints about the service, including those made by staff members about quality of care and service recipient welfare issues; (n) the procedures for the protection and safeguarding of children and vulnerable adults as appropriate; (o) details of the arrangements for the storage and administration of medicines at the care service; (p) details of the arrangements for meeting the service recipients’ health needs; (q) the arrangements for setting out a service recipient’s plan of care and how that plan is reviewed; (r) details of any specific therapeutic techniques used at the care service and arrangements made for their supervision; (s) the arrangements made for service recipients to engage in their chosen faith; (t) details of how the care service intends to respect privacy, dignity and promote independence and choice and, if these values are restricted either through judicial process or the service user’s best interests, the arrangements in place to monitor and review such restrictions.

7. But the requirements in paragraphs 4, 5(a) to (d) and 6 (a), (b), (f), (g), (h) and (q) to (t) do not apply if the application is for childminder registration.

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Regulation of Care (Registration) Regulations 2013 SCHEDULE 4

SCHEDULE 4

DOCUMENTS WHICH MUST ACCOMPANY OR BE INCLUDED WITH AN APPLICATION FOR MANAGER REGISTRATION

1. The following must accompany or be included with an application for manager registration — (a) certificates or other suitable evidence relating to the applicant’s professional or technical qualifications so far as those qualifications are relevant to providing services for persons for whom services are to be provided at the establishment or by the agency (to be provided in person by the applicant); (b) a completed Disclosure and Barring Service (DBS) form with the appropriate fee; (c) a criminal conviction certificate (to be provided in person by the applicant); (d) a report by a qualified medical practitioner on the mental and physical health of the applicant.

2. The items in paragraph 1(a) to (c) must be provided in person by the applicant.

V012 Page 17 149

SCHEDULE 5 Regulation of Care (Registration) Regulations 2013

SCHEDULE 5

REGISTRATION APPLICATION FEES

1 Child minder registration The prescribed fee for childminder registration is £75.

2 Provider registration for agency or independent clinic which is a care service The prescribed fee for provider registration in respect of a designated agency or an independent clinic is shown in Table 1.

Table 1

Care service description Fee fewer than 3 persons are employed on a full-time basis £1,000 3 or more but fewer than 16 persons are employed on a full- £1,100 time basis any other agency or independent clinic £1,200

3 Provider registration for establishment which is a care service (1) The prescribed fee for provider registration in respect of an adult day centre, a child day care centre or a mental health day centre is shown in Table 2.

Table 2

Care service description Fee operating less than 60 days per year £100 fewer than 10 approved places £300 10 or more but fewer than 21 approved £350 places any other adult day centre, child day care £400 centre or mental health day centre

(2) The prescribed fee for provider registration in respect of an adult care home, a childrens home, a child (secure accommodation) establishment, an independent hospital, an offender accommodation service or a residential family centre is shown in Table 3.

Table 3

Care service description Fee fewer than 20 approved places £1,400 20 or more but fewer than 41 approved £1,600 places

Page 18 V012 150

Regulation of Care (Registration) Regulations 2013 SCHEDULE 5

any other adult care home, childrens home, £1,800 child (secure accommodation) establishment, independent hospital, offender accommodation service or residential family centre

4 Manager registration for agency which is a care service The fee for manager registration in respect of designated agency is £400.

5 Manager registration for establishment which is a care service The fee for provider registration in respect of an establishment specified in section 8 of the Act is £400.

V012 Page 19 151

SCHEDULE 6 Regulation of Care (Registration) Regulations 2013

SCHEDULE 6

AMENDMENT APPLICATION FEES

1 Childminder registration The prescribed fee for childminder registration is – (a) in respect of a minor amendment, £25; (b) in respect of another amendment, £75.

2 Agency or independent clinic which is a care service The prescribed fee in respect of an agency or independent clinic which is a care service is – (a) in respect of a minor amendment, £50; (b) in respect of another amendment, £100.

3 Establishment which is a care service (1) The prescribed fee in respect of an establishment which is a care service is – (a) in the case of an adult day centre, a child day care centre or mental health day centre – (i) in respect of a minor amendment, £50; (ii) in respect of another amendment, £100. (b) in the case of an adult care home, a childrens home, a child (secure accommodation) establishment, an independent hospital, an offender accommodation service or a residential family centre – (i) in respect of a minor amendment, £100; (ii) in respect of another amendment, £650. In this Schedule – “minor amendment” is an amendment which, in the opinion of DSC, if the application for the amendment sought were granted would involve no material alteration in the register kept under section 107; and “major amendment” is another amendment.

Page 20 V012 152

Regulation of Care (Registration) Regulations 2013 SCHEDULE 7

SCHEDULE 7

1. The register must include — (a) the full name, address and date of registration of the registered provider of each care service; (b) the full name, address and date of registration of the registered manager of each care service. (c) if the registered provider is a body corporate, the full name and address of the care service’s responsible person; (d) the date and details of any improvement notice given to the care service’s registered provider; (e) the date and details of any compliance notice given to the care service’s registered provider; (f) the date of any surrender of the provider’s registration in relation to the care service; (g) the date of any suspension of the registration of the care service’s registered provider or registered manager; (h) the date of any cancellation of the registration of the care service’s registered provider or registered manager.

2. The register shall also include – (a) the name, address and contact details of the care service; (b) the category and purpose of the care service; (c) the sub-category of provision of the care service; (d) the details of any decided conditions imposed on registration under section 60.

V012 Page 21 153

Explanatory Note Regulation of Care (Registration) Regulations 2013

EXPLANATORY NOTE (This note is not part of the Regulations)

These Regulations are made under sections 57, 67(1)(a), 75(c), 82(b), 107(2) and 161 of the Regulation of Care Act 2013 and prescribe a number of matters relating to the registration of persons under Part 3 of that Act (registration of independent care services).

Part 1 (regulations 1 to 3) introduces the Regulations and contains their title, commencement and interpretation provisions.

Part 2 (regulations 4 and 5 and Schedules 1 to 3) specify the prescribed information and prescribed documents which must be given with a registration applications.

Part 3 (regulations 6 to 9 and Schedule 6) prescribe the information which must be included in the register of details about registered persons and responsible persons in relation to independent care services and require certificates of registration to be returned to the DSC following cancellation, including an offence for failure to do so in certain circumstances.

Part 4 (regulation 10) prescribes the information which an application to amend certain matters must give.

Part 5 (regulations 11 and 12) prescribes the information which must be given with an application to surrender provider registration and the other conditions to be satisfied for surrender to be effective.

Part 6 (regulations 13 and 14 and Schedules 4 and 5) prescribe the fees payable on making a registration application or to amend an existing registration.

Part 7 (regulation 15) prescribes 3 months as being the maximum period of leave which the responsible person or registered manager may take in a period of 12 months for the supervision and management conditions under section 66 of the Regulation of Care Act 2013 not to apply (provided appropriate alternative supervisory and management arrangements are in place).

Schedule 1 gives details of the information an application for provider registration must give to DSC.

Schedule 2 gives details of the information an application for manager registration must give to DSC.

Schedule 3 gives details of the documents which must be included with, or accompany an application for provider registration.

Schedule 4 gives details of the documents which must be included with, or accompany an application for manager registration.

Page 22 V012 154 c

Regulation of Care (Registration) Regulations 2013 Explanatory Note

Schedules 5 and 6 give details of registration and amendment application fees

Schedule 7 gives details of the information which DSC will hold in relation to the register about registered and responsible person’s for care services on the Island.

V012 Page 23 155

156

Department of Health and Social Care Rheynn Slaynt as Kiarail y Theay

Application for Registration- Individual/Partnership/Body Corporate

Please complete in BLOCK CAPITALS and in black ink. This form should be completed by: -  all applicants who wish to register as a provider of an independent care service.

This form should be completed by the intended registered person or a person with the authority to represent the registered person (see the notes to help complete ‘Application for Registration form’ for more information). In addition, an application form should be completed by each person connected with the application including: -  the manager in charge of the day to day running of a care service (to complete a ‘Application for Registration Manager form)  all individuals making up a body corporate – this includes: partners; directors; trustees; committee members.  Partnership - additional partners other than the nominated person completing the form.

If you need any help completing this form, please contact us on (01624) 642422

Type of Application

Are you applying as (please tick one box only) An Individual A Partnership A Body Corporate Description of Care Service

Please tick a box

Adult Care Home with nursing Adult Day Care Centre

Adult Placement Agency

Child Care Agency

Child Day Care Centre Child Day Care Centre Forest School

Children’s Home

Child (secure accommodation) establishment

Domiciliary Care Agency Are you intending to provide a service to children. Please tick box if yes? Fostering Agency

Independent Clinic

Independent Hospital

Independent Medical Agency

Nurses Agency

Offender accommodation service

Residential Family Centre

Voluntary Adoption Agency

159

SECTION 1 - General information on the Service

Name of care service

Address of care service

Postcode

Telephone number

Email address

Are you currently registered with the Registration and Inspection Unit? Yes No

If Yes, please give the name and address of the registered service: Name

Address

Postcode

Date of registration / /

If No, please give proposed date of opening of the service on the Isle of Man / /

Have you/the organisation ever been registered with another registration Yes No authority as a provider of care e.g. NCSC, CQC, Ofsted?

If Yes, please provide the following details: Name of Registering Authority

Address of Registering Authority

Postcode

Name of the Registered Service

Address of Registered Service

Postcode

‘Individual’ or ‘partnership’ applicants go to SECTION 2

‘Body corporate’ applicants to SECTION 3

158 2

SECTION 2 - Applicant details - Individual / Partnership Application

As the Provider will you also be managing the service? Yes No

Title (please tick one or specify) Mr Mrs Miss Ms Other

Full Name

Any other names by which you have been known

Date of birth / /

Telephone number

Email address

We will communicate with you by email unless you indicate no No

Do you require a work permit? Yes No

Current Address

Postcode

I have lived here from / /

Date from / / Date to / / Previous Address (last 5 years) Date from / / Date to / / Date from / / Date to / / Date from / / Date to / / Date from / / Date to / /

Partnership Application

Please list below partners, if applicable. If the service is to be run by a partnership, each partner listed is to complete a form, please request from Registration and Inspection.

Title First Name(s) Surname Date of birth Position Contact with Service recipients

Yes No

Please go to Section 4

159 3

SECTION 3 - Applicant details - Body Corporate Name of the Body Corporate

The Registered Office/Principal Office of the body corporate

Name

Address

Postcode

Telephone number

Company registered number

Email address

Do you wish Registration & Inspection to communicate with you electronically? Yes No

If the organisation is a subsidiary of a holding company Please provide the details of the registered or principal office of the holding company

Name

Address

Postcode

Telephone number

Email address

Company registered number

Please provide details of any other subsidiary/ies of the holding company on a separate sheet.

Please list below all persons who are members of the body corporate making application to become the ‘Registered Provider’ as a body corporate.

Title First Name(s) Surname Date of birth Position Contact with Service recipients

Yes No

Please continue on a separate sheet if necessary. 160 4

SECTION 3 continued. Applicant details - Body Corporate To be completed by the Nominee as the body corporate’s Responsible Person The Nominee must be an officer of the body corporate who is responsible for supervising the overall management of the service.

Title (please tick one or specify) Mr Mrs Miss Ms Other

Name

Any other names by which you have been known

Date of birth / /

Telephone number

Do you require a work permit? Yes No

Email address

Do you wish Registration & Inspection to communicate with you electronically? Yes No

Current Home Address

Postcode

I have lived here from / /

Date from / / Date to / / Previous Address (last 5 years) Date from / / Date to / /

Date from / / Date to / /

Please go to SECTION 4

161 5

SECTION 4 - All applicants - details continued The registered person and the manager may be the same person; if you are not the manager of the service the manager must complete an Application for Registration Manager application.

Current employment details Name of employer

Employer address

Postcode

Telephone number

Job Title

Responsibilities

Date commenced / / Full Time Part Time

Previous employment - Please enclose a comprehensive Curriculum Vitae including all past employment history since leaving full time education. Please explain any gaps and provide reasons for leaving each job.

Have you ever been employed by a person registered under any Act on the Isle of Yes No Man or related jurisdictions registered for looking after adults or children?

If Yes, please provide details:

Have you ever been subject to disciplinary action, formal hearing, suspension and/ Yes No or dismissal from a place of employment? If Yes, please provide details:

Have you ever been subject to refusal or cancellation of registration in health and Yes No social care regulation for children or adults in any jurisdiction? If Yes, please provide details:

162 6

SECTION 4 - continued

Do you have or have you ever had a business interest in any other care service? Yes No

If Yes, please provide details: Name of care service

Address of care service

Postcode

Telephone number

Email address

Please detail your professional, or care qualifications that are relevant to the services that are to be provided at the establishment or agency

Date Name of examining body Qualification obtained

Original certificates or other suitable evidence relating to qualifications are to be provided in person by the applicant.

Registration with professional bodies

Please provide the following information if registered with a professional body

Professional body Date of Registration Level of Registration PI Number Expiry Date (if applicable)

Examples of professional bodies would include, the General Medical Council, the General Social Care Council or the Nursing and Midwifery Council

163 7

SECTION 4 - continued Relevant work experience Please complete if you are either the Responsible Person or the Provider who is also managing the service. Please give details of the relevant experience and ability you have which will enable you to manage the establishment: Management of this specific type of service

Experience of work with service recipient group proposed

Staff management and support

Day to Day administration

164 8

SECTION 4 - continued

Referees

Please give the name and address of two referees:  they must not be related to you;  our reference request will ask for details of your competence to provide the service for which you are applying for;  one of the referees must be your current or last employer.

Referee 1: Name

Job title

Address

Postcode

Telephone number

Capacity in which you are known to referee

Referee 2: Name

Job title

Address

Postcode

Telephone number

Capacity in which you are known to referee

Please go to Section 5

165 9

SECTION 5 - The Service Proposed use: Please indicate the days and times the provision is to be operated.

Will this be: All year round School term times only School holidays only

Other Occasional

If other or occasional, please provide details:

An indication of the size of the proposed service, (for example number of users including age group)

Please state: The total number of service recipients who will be on the premises at any one time

Age Range Proposed maximum number

Will you have sole use of the premises? Yes No

If No, please provide details:

Is the premises currently used for the proposed provision? Yes No

If Yes, please provide details:

166 10

SECTION 5 - continued Please state any separate facilities for use by staff:

Are meals to be provided? (this includes packed lunches):

Property ownership Please provide: The name and address of the person/company who owns the premises if different from the applicant:

Name

Address

Postcode

Name and address of parties with financial interest in the premises and/or the business: (e.g. Loan company)

Name

Address

Postcode

Name and address of professional advisers (e.g. Accountants, solicitors) from whom confirmation of ownership and financial arrangements can be sought: Name

Address

Postcode

Insurance Please enclose with this Application a copy of a Certificate of Insurance to cover Employers Public Liability

Rented property

If you are renting a property for the establishment, please enclose a copy of the lease or Short Particulars with this application.

Please go to Section 6

167 11

SECTION 6 - Description of premises Please enclose a site plan of the interior and exterior of the property

Location of premises (Please indicate distance from local amenities, for example, shops, post office, park)

Condition of premises (please ) Purpose built Converted for use To be developed

Building work (if property is to be developed/under construction)

Does the premises have planning approval for the proposed provision? Yes No

If Yes, please enclose a copy of the approval notice. If No, please give details of pending action:

What is the projected date of completion? / /

Use of premises Is any other business to be carried on in the same premises as those of the service? Yes No

Does the premises have occupied accommodation not connected to the care service? Yes No If Yes, please provide details:

For providers using domestic premises - e.g. Children’s Homes, Learning Disability Homes Purpose built House Flat

Other Please detail:

168 12

SECTION 6 - continued

For non-residential services and body corporate where files/documents not held at the service. Please describe arrangements that exist for:

Out of hours emergency access

Out of hours telephone contact

Please provide the name and contact details of the principal keyholder:

Please go to Section 7

169 13

SECTION 7 - Security Arrangements

Please provide a statement as to the security arrangements for the purpose of:

Safeguarding access to information/records held by the service (both on and off site)

Restricting access from adjacent premises or, when the premises form part of a building, from other parts of the Building (if applicable)

Please go to Section 8

170 14

SECTION 8 - Staffing Please fill in details of all staff aged sixteen or over, including maintenance and domestic staff. Please continue on a separate sheet if necessary, or provide a separate staffing list showing the information requested below. Title Full name Date of Birth Proposed position Qualifications

Suitability of staff Please confirm that you have or will obtain for the following for each member of staff: Already Will Comments obtained obtain

Information relating to their relevant qualifications, skills and experience

A statement that they are physically and mentally fit for the work which they are to perform Proof of identity (i.e. A copy of a birth certificate, passport, driving licence)

A recent photograph

Two satisfactory references

A Disclosure and Barring Service (DBS) check for each member of staff

Please state how you have satisfied or intend to satisfy yourself that the qualifications, skills and experience of all staff are suitable and authentic.

171 15

SECTION 9 - Disclosure and Declarations

Please note that further information may be required by the Registering Authority to establish the financial viability of the establishment.

Have you ever: been involved as an owner or manager of, or had a financial interest in, a voluntary or registered service whose registration has been refused or cancelled? Yes No

If you have answered YES to the above questions, please supply below the dates, circumstances, outcomes, the name of the local authority area in which you were living and, if applicable, any social services departments from other local authorities who were involved. (Please use an additional sheet of paper if necessary)

Are you disqualified from registration as listed in the Regulation of Care Act 2013 Sections 43, 44, 45 and 46? Yes No

If you have answered YES please provide details:

Are you applying for an exemption from disqualification? Yes No Please see the Regulation of Care Act 2013 Section 47 If you have answered YES please provide details:

172 16

SECTION 9 - continued Disclosure Document - Criminal Convictions & Investigations

You are required to declare any convictions, cautions, conditions/unconditional discharges and bindovers. This includes declaring all ’spent convictions’ in accordance with the Rehabilitation of Offenders Act (Exemption Order) 2001 and Rehabilitation of Offenders Act (Exemption Order) 1975 (UK).

A criminal conviction will not necessarily lead to a refusal of your application. However, failure to disclose any convictions could lead to either your application being refused or, if your application is successful, cancellation of your registration if it is subsequently learnt that you had a criminal conviction at the time you made the application.

Have you ever:  been convicted of a criminal offence, cautioned or bound over by any court? Yes No

 Are you currently under police investigation? Yes No

If Yes, please give details:

In addition, please indicate whether you have ever been:

 subject to child protection enquiry/investigation? Yes No

 subject to adult protection enquiry/investigation? Yes No

 Investigation/proceeding under any Act on the Isle of Man or any Act in other Yes No jurisdictions?

Employed by, or in any way associated with, an establishment/agency which has been the subject of:

 Police investigation Yes No

 Registration and Inspection Unit investigation Yes No

 Child Protection investigation Yes No

 Adult Protection investigation Yes No

If Yes to any of the above, please give details including dates:

173 17

Please complete and sign the declaration below:

I hereby declare that the information detailed above is accurate to the best of my knowledge. I understand that it is an offence knowingly to make a statement which is false or misleading in a material respect in this application or any of the documents submitted with this form as part of this application.

In making this application for registration under the Regulation of Care Act 2013. I agree to comply with the Act and all associated regulations. I agree to comply with the standards in place for the service.

I understand that the Department of Health and Social Care will undertake any background searches it feels appropriate, including criminal conviction checks, personal and financial references and social service checks to ascertain suitability.

I understand in order to carry out the background searches the Department may seek information from the following: Social Service records, Child protection registers, Health Services, Mental Health Services, International Social Services, Ministry of Defence, previous employers, the lists kept under the Disclosure and Barring Scheme.

Other organisations which may be contacted include: the NSPCC, Ofsted, other previous registering authorities, the Probation Service, the Work Permit Office, Immigration, the Electoral Roll and any other organisations the Department believes it is necessary to approach in order to reach an opinion as to the suitability of an applicant.

Signed Individual / Responsible Person / Partner

Print Name

Date / /

Issued by: Registration and Inspection Unit Department of Health and Social Care Ground Floor, Hill Street, Douglas Isle of Man IM1 1EF

Tel: +44 1624 642422

Email: [email protected]

174 18

Department of Health and Social Care Rheynn Slaynt as Kiarail y Theay

Application for Registration- Manager

Please complete in BLOCK CAPITALS and in black ink. This form must be completed by the proposed manager of the service, not by an organisation on the manager’s behalf. Section 1 - General information on the Care Service

Name of Care Service

Address of Care Service

Postcode

Telephone number

Email address

Are you currently registered with the CQC or Ofsted? Yes No

Are you currently registered with the IOM Department of Health and Social Care? Yes No

If Yes, Please give the following details: Registered Service

Address

Postcode

Name of Registered Provider

Section 2 - Personal information

Full Name & Title

Other names by which you have been known

Date of birth / /

Telephone number

Email address

Address

Postcode

I have lived here from / /

Previous Address Postcode

Date from / / Date to / /

Please provide the details of all other addresses where you have lived in the last 5 years. If applicable please continue on a separate sheet.

Do you require a work permit? Yes No

177

Current employment details

Name of employer

Employer address

Postcode

Telephone number

Job Title

Responsibilities

Date commenced / / Full Time Part Time

If you already manage the establishment/agency to which this application applies, / / please state date commenced

Will you also be responsible for the management of any other establishment/ agency/service not included in this application? Yes No If Yes, please provide details

Have you ever been employed by a person registered under any Act on the Isle of Yes No Man or related jurisdictions registered for looking after adults or children?

If Yes, please provide details:

Have you ever been subject to disciplinary action, formal hearing, suspension and/ Yes No or dismissal from a place of employment? If Yes, please provide details:

176 2

Have you ever been subject to refusal or cancellation of registration in health and Yes No social care regulation for children or adults in any jurisdiction? If Yes, please provide details:

Have you ever been employed by a registered care establishment/agency/service? Yes No If Yes, please provide details

Please detail your professional, or care qualifications that are relevant to the services that are to be provided at the establishment or agency

Date Name of examining body Qualification obtained

Original certificates or other suitable evidence relating to qualifications are to be provided in person by the applicant.

Registration with professional bodies Please provide the following information if registered with a professional body Professional body Date of Registration Level of Registration PI Number (if applicable) Expiry Date

Please give details of any previous application to register an establishment/agency as a responsible individual or manager. Name of area to which Capacity (Responsible Date of Application Outcome application is made individual/ manager) (approved/refused)

177 3

Relevant work experience

Please give details of the relevant experience and ability you have which will enable you to manage the establishment/ agency:

Management of this specific type of service

Experience of work with clients proposed

Staff management and support

Day to day administration

178 4

Referees

Referee 1: Name

Job title

Address

Postcode

Telephone number

Capacity in which you are known to referee

Referee 2: Name

Job title

Address

Postcode

Telephone number

Capacity in which you are known to referee

Declaration of interests a) Do you have any current financial or managerial interest in any other care Yes No service? b) Have you ever been registered for, or been the proprietor or manager of, any Yes No care service? If YES please provide details: Name and address of establishment/agency Nature and extent of interest

179 5

SECTION 3 - Disclosure and Declarations

Have you ever: been involved as an owner or manager of, or had a financial interest in, a voluntary or registered service whose registration has been refused or cancelled? Yes No

Are you disqualified from registration as listed in the Regulation of Care Act 2013 Sections 43, 44, 45 and 46? Yes No If you have answered YES please provide details:

Are you applying for an exemption from disqualification? Yes No Please see the Regulation of Care Act 2013 Section 47

If you have answered YES please provide details:

180 6

SECTION 3 - continued Disclosure Document - Criminal Convictions & Investigations

You are required to declare any convictions, cautions, conditions/unconditional discharges and bindovers. This includes declaring all ’spent convictions’ in accordance with the Rehabilitation of Offenders Act (Exemption Order) 2001 and Re- habilitation of Offenders Act (Exemption Order) 1975 (UK).

Have you ever:  been convicted of a criminal offence, cautioned or bound over by any court? Yes No

 Are you currently under police investigation? Yes No

If Yes, please give details:

In addition, please indicate whether you have ever been:

 subject to child protection enquiry/investigation? Yes No

 subject to adult protection enquiry/investigation? Yes No

 Investigation/proceeding under any Act on the Isle of Man or any Act in other Yes No jurisdictions?

Employed by, or in any way associated with, an establishment/agency which has been the subject of:

 Police investigation Yes No

 Registration and Inspection Unit investigation Yes No

 Child Protection investigation Yes No

 Adult Protection investigation Yes No

If Yes to any of the above, please give details including dates:

181 7

Please complete and sign the declaration below:

Signed

Print Name

Date / /

Issued by: Registration and Inspection Unit Department of Health and Social Care Ground Floor, St George’s Court, Hill Street, Douglas Isle of Man IM1 2SF

Tel: +44 1624 642422

Email: [email protected]

182 8 Date Type What Who How much When Cost Centre code Item code Item code description 14/03/2017 Journal Search fee Manx Telecom £40.00 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal Property search DEFA £100.00 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal Advert for 3 weeks National Care Association £250.00 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal Advert for 3 weeks IOM Newspapers £344.64 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal M&E review Jul 17 B&M Consulting £5,600.00 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal M&E review Aug 17 B&M Consulting £16,100.00 2016/17 1924020301 56050101 Business Advisory 14/03/2017 Journal M&E review Sep 17 B&M Consulting £4,060.00 2016/17 1924020301 56050101 Business Advisory 06/04/2017 Pcard Waste paper bins Paperstone £143.23 2017/18 1924030501 36010199 Fixtures and Fittings 10/04/2017 Invoice Mar 2017 costs Manx Utilities £907.18 2017/18 1924030501 34020101 Energy Costs - Electricity 20/04/2017 Pcard Place mats Amazon £134.85 2017/18 1924030501 36010199 Fixtures and Fittings 20/04/2017 Pcard Plate covers Nisbets £135.32 2017/18 1924030501 36010199 Fixtures and Fittings 21/04/2017 Pcard Place mats Amazon £8.99 2017/18 1924030501 36010199 Fixtures and Fittings 25/04/2017 Invoice Vertical blinds RCC Enterprises Ltd £2,260.00 2017/18 1924020301 36010101 Furnishings 25/04/2017 Invoice Gas Dec 16 - Mar 17 Manx Gas £2,523.24 2017/18 1924030501 34030101 Energy Costs - Gas 10/05/2017 Invoice Gas Mar 17 - May 17 Manx Gas £495.11 2017/18 1924030501 34030101 Energy Costs - Gas 10/05/2017 Invoice Apr 2017 costs Manx Utilities £641.46 2017/18 1924030501 34020101 Energy Costs - Electricity 19/05/2017 Invoice Deep clean of building Ultimate Cleaning £1,170.00 2017/18 1924020301 37010103 Contract Cleaning Total £34,914.02

PRE START DATE

183 184 Date Type What Who How much When Cost Centre code Item code Item code description 25/05/2017 Pcard Coat hangers Shopfitting warehouse £86.00 2017/18 1924030501 36010199 Fixtures and Fittings 02/06/2017 Invoice 15 x mobile shower chair Performance Health Int £1,243.20 2017/18 1924020301 51010107 Clinical Equipment 02/06/2017 Invoice 3 x toilet seat & frame Nottingham Rehab Supplies £66.00 2017/18 1924020301 51010107 Clinical Equipment 08/06/2017 Invoice Catering supplies Star Services Ltd £5,189.86 2017/18 1924030501 51010799 Catering supplies 12/06/2017 Invoice 1 x mobile shower chair Performance Health Int £88.80 2017/18 1924020301 51010107 Clinical Equipment 18/07/2017 Invoice 3 x gas cylinder trolley Hospital Metalcraft £332.22 2017/18 1924020301 51011007 Clinical Equipment 18/12/2017 Invoice 10 x toilet seat and frame Nottingham Rehab Supplies £220.00 2017/18 1924020301 51010107 Clinical Equipment 25/05/2017 Pcard Slide sheets Complete Care Shop £149.93 2017/18 1924020301 51010599 Operational Equipment 26/06/2017 Invoice 20 x overbed tables Renray Healthcare £3,172.20 2017/18 1924030501 52010199 Furniture Purchase 28/06/2017 Pcard White goods Dixons £177.47 2017/18 1924020301 51010599 Operational Equipment 22/12/2017 Pcard Net slings Complete Care Shop £1,169.08 2017/18 1924020301 51010599 Operational Equipment 19/02/2018 Invoice 1 x bed extenders Renray Healthcare £175.22 2017/18 1924020301 51010599 Operational Equipment 13/03/2018 Invoice 1 x bed extenders Renray Healthcare £175.22 2017/18 1924020301 51010599 Operational Equipment 15/03/2018 Pcard Cushions & bed bumpers Complete Care Shop £826.80 2017/18 1924020301 51010599 Operational Equipment 20/03/2018 Invoice Bariatric slings Arjo UK Ltd £1,150.00 2017/18 1924020301 51010599 Operational Equipment 26/03/2018 Invoice 1 x bed extenders Renray Healthcare £175.22 2017/18 1924020301 51010599 Operational Equipment 31/03/2018 Invoice Credit for DoI costs Department of Infrastructure -£1,113.25 2017/18 1924020301 51010599 Operational Equipment 31/03/2018 Invoice 4 x bed extenders Renray Healthcare £1,226.54 2017/18 1924020301 51010599 Operational Equipment 31/03/2018 Invoice 3 x food trolleys Star Services Ltd £9,139.54 2017/18 1924020301 51010599 Operational Equipment 31/03/2018 Invoice DoI costs Department of Infrastructure £32,317.15 2017/18 1924020301 51010599 Operational Equipment 23/08/2017 Invoice Digital hoist scale MK Scalles Ltd £495.00 2017/18 1924020301 51010799 Equuipment monitoring 26/04/2018 Invoice 1 x bed extenders Renray Healthcare £175.22 2018/19 1924020301 51010599 Operational Equipment 01/05/2018 Invoice 28 x overbed tables Renray Healthcare £4,441.08 2018/19 1924020301 51010599 Operational Equipment 11/05/2018 Invoice 1 x bed extenders Renray Healthcare £175.22 2018/19 1924020301 51010599 Operational Equipment 18/05/2018 Pcard Moved sheets Complete Care Shop £279.00 2018/19 1924020301 51010599 Operational Equipment 18/05/2018 Pcard Chair raisers Complete Care Shop £41.70 2018/19 1924020301 51010599 Operational Equipment 12/06/2018 Pcard 8 x commode chairs HNRS Healthcare £886.00 2018/19 1924020301 51010599 Operational Equipment 12/06/2018 Pcard Bed bumpers Complete Care Shop £469.50 2018/19 1924020301 51010599 Operational Equipment 10/07/2018 Invoice Patient standing aid Arjo UK Ltd £840.00 2018/19 1924020301 51010599 Operational Equipment 03/09/2018 Invoice Bariatric hoist NHS Supply Chain £6,393.21 2018/19 1924020301 51010599 Operational Equipment 31/07/2018 Invoice Legal Fees Quinn Legal £2,090.00 2018/19 1924020301 56060113 Legal Fees 31/07/2018 Invoice Legal Fees Quinn Legal £396.00 2018/19 1924020301 56060113 Legal Fees 31/07/2018 Invoice Legal Fees Quinn Legal £1,296.00 2018/19 1924020301 56060113 Legal Fees 01/05/2018 Invoice Roof inspection survey Mullen Consulting Ltd £978.00 2018/19 1924020301 56100207 Surveys 23/05/2018 Invoice Dye Test fee Manx Utilities Authority £1,500.00 2018/19 1924020301 56100207 Surveys Costs incurred still to be charged Department of Infrastructure £3,206.00 Total £79,629.13

POST START DATE

185 Date Type What Who How much When Cost Centre code Item code Item code description 23/09/2016 Invoice Deposit payment on sale Callin Wild £790,000.00 2016/17 G19-072-03-13-02 182140101 Land from Vote 15/12/2016 Invoice Completion payment Callin Wild £6,920,946.45 2016/17 G19-072-03-13-02 182140101 Land from Vote 22/05/2018 Invoice Retention costs re sale of property Salisbury Care Ltd £197,000.00 2018/19 G19-072-03-13-02 182140101 Land from Vote Total £7,907,946.45

CAPITAL COST

186 SOCIAL AFFAIRS POLICY REVIEW COMMITTEE

BRIEFING NOTES – FUNDING OF RESIDENTIAL AND NURSING CARE, AND AVAILABILTIY OF CARE BEDS

1.0 Funding of Care

In May 2015 the DHSC was notified that every nursing home in the Isle of Man had set fees higher than the maximum amount of social security benefits payable: effectively ending the availability of state funded nursing care overnight. Whilst it was possible in a limited number of cases for social work staff to negotiate placements immediately following that change, this is no longer possible.

Currently, the maximum amount payable by social security for nursing home care is made up of a combination of attendance allowance, retirement pension, nursing care contribution and income support. The total maximum payable is £845. This takes into account the increase in benefit rates at 1 April 2017.

 Income support is subject to a financial assessment and so some claimants will not actually be awarded it.

 Attendance allowance and the nursing care contribution are universal benefits assessed on need only.

 Some people do not qualify for a full state retirement pension.

 Some pensioners are entitled to additional pension: but this serves only to reduce the amount of income support payable, so £819.80 per week is the maximum which any older person can receive in benefits.

 This maximum amount is funded from both the National Insurance Fund (pension and nursing care contribution) and from general revenue (income support and attendance allowance).

Although obviously subject to change, approximately half the older people in residential and nursing care on the Island are self funding, with the remaining 50% being wholly reliant on benefits to fund their care.

Those homes on the Island who provide nursing care currently charge between £860 and £924 per week, leaving individuals who are wholly reliant on state support unable to access care. Anyone requiring care over and above the minimum may be liable to an additional charge in most homes.

We are yet to receive any uplift in charges notifications from private homes; this is normally advised in May.

187 NURSING HOMES

HOME ADDRESS TEL NO COST ABBOTSWOOD *& Crossag Road, Ballasalla, 822310 £920.00 EMI IM9 3DZ BEACONSFIELD Jurby Road, Ramsey, IM8 810851 £926.03 (+DHSC rate 3PH £825.00) BROOKFIELD Claughbane Drive, Ramsey, 817867 £884.00 IM8 2RE ELDER GRANGE Fuchsia Lane, Douglas, IM2 626282 £896.00 7EB KINGS REACH Alkest Way, Ramsey, IM8 816929 £580.00 residential - 3NX £840 nursing ***not accepting admissions MARATHON COURT * Victoria Road, Douglas, IM2 674445 £860.00 4RQ SPRINGFIELD GRANGE Stevenson Way, Farmhill, 616808 £896.00 (EMI) Douglas, IM2 2EL CASTLE VIEW (EMI) Ballatessan Meadow, Peel, 841400 £924.00 IM5 1DX *means some double rooms available

2.0 Availability of Care Beds

There have been no state funded nursing care beds on the Island since the closure of the White Hoe in 2003; with all nursing home care provided since that time by the private sector.

Whilst the Government has continued to deliver residential care from three resource centres across the Island, thus influencing the cost of care across all sectors, there has been no such control on the costs of nursing care, with those costs traditionally increasing year on year ( keeping pace with increases in benefits ). However, until April 2017, there had been no increase in benefits for two years, and as a result, nursing care costs have exceeded benefits available since 2015.

Up until the purchase of Salisbury Street home, and the block contracting of beds at benefit rates, there has been no Government ‘lever’ to enable management of market costs. It is clear that allowing the market to set the cost is unsustainable in the longer term, as the escalation of nursing care costs over the last 14 years has demonstrated.

There has been some discussion regarding the net growth or loss of beds in the residential and nursing care system over the past ten years. Contrary to popular belief, there has been a loss of 10 beds only since the introduction of the Regulation of Care Act 2013, with most losses occurring more than three years ago.

 153 beds have closed in the last decade, and 128 new beds have opened (including 28 DHSC beds).

188  The DHSC plans to replace the existing 45 bed unit at Reayrt ny Baie with a 60 bed unit on the old Glenside site.

Demand for nursing home beds has been increasing recently, coupled with a significantly lower demand for residential care (although the availability of residential care beds is affected by those awaiting transfer to nursing care).

These changed patterns of demand are probably driven by: the demographic shift which has been forecast in various reports for more than 10 years; and, people being discharged from hospital with higher care needs. The availability of services required to support complex packages of care in the community has reduced over the last 12 months as a result of the increased number of cases and complexity of care demand. It is the paucity of the community health and social care offering that has arguably led to the premature placement of some older people in residential and nursing home care.

The sustainability of the care market has been affected by rising costs and limited workforce availability.

Significant work has been undertaken to understand the likely profile of demand for care beds over the next ten years. We have estimated that by 2026 another 411 care beds will be required, if we continue to admit people at the current rate. Further work is required to confirm the impact of the latest population changes from the census, but these are more likely to increase the bed requirements rather than decrease.

3.0 The Immediate Challenge

The consequences of nursing home charges exceeding benefit rates are significant and bring with them substantial costs elsewhere in the care system, not all of which are borne by the state and not all of which are direct cash losses.

 There are a number of cases where benefits recipients requiring nursing care can only pay for their care through recourse to carer or family contributions. This places significant financial strain on families, who also face the prospect of charges increasing year on year. Such situations can affect the process of discharge from hospital: with the likelihood that people will remain as inpatients, awaiting a move to a nursing home.

 There are people in residential homes whose care needs cannot be met in the longer term, but who cannot afford to transfer to nursing home care. This phenomenon of people remaining in residential care beyond the point where transfer to nursing home care is indicated will also reduce the residential care capacity on the Island – again with a knock on impact on the demand for hospital care for those unable to be supported at home.

 Hospital care, being part of the NHS, is free to the consumer at the point of delivery. The cost of nursing home care in the community will probably result in an increased number of patients with no achievable discharge pathway inappropriately occupying a hospital bed. This blocks hospital services for others and puts the entire nursing care cost onto the taxpayer.

189  DHSC homes are funded net of income and are required to increase income on an annual basis. This is not possible in respect of those who are funded from benefits. If Government maintains such income increase targets, they can only be met by self- funders paying more, who will then effectively be subsidising those who are state- funded.

The Department reviewed all of the short term actions which could be undertaken to alleviate the pressure on beds at Nobles hospital and on other non-nursing care providers. The decision to purchase Salisbury Street with the express intention of block purchasing care with nursing was agreed by the Social Policy and Children’s Committee, Council of Ministers and Tynwald. This, however will not resolve the issue in the long term.

5.0 A Longer Term View We face a set of circumstances which whilst presenting an immediate challenge, are an indicator of a systemic challenge to the way in which care is funded on the Isle of Man. There is a need to review the longer term arrangements for funding care.

 There is evidence that the aggregate number of residential and nursing home beds has reduced over the last 15 years. There has been some growth, but this has been in more expensive nursing home provision. This is a common trend across England and Wales (The Care Home Market in Wales: Mapping the Sector. Public Policy Institute for Wales. October 2015).

 The increased costs associated with providing care and meeting regulatory standards (Regulation of Care Act 2013) have been coupled with benefits rising at lower rates.

 Both the DHSC and the private sector have struggled to recruit nursing staff, leading to over-reliance on bank and agency staff: as is common across England and Wales. There is evidence to suggest that the recruitment of non-qualified staff is now also becoming increasingly difficult.

 Levels of need have risen significantly over the last five years: “five years ago most of the residents at a nursing home could eat their own dinner, walk at least a short way, and take themselves to the lavatory. Now hardly any patients in a care home can do that. Most require two members of staff to help them wash etc. The number of care staff needed has doubled, Nursing homes are becoming more like hospices” (The Care Home Market in Wales: Mapping the Sector. Public Policy Institute for Wales. October 2015).

 The costs of being a care provider are rising because: o the fee structure does not allow for differences in need – which means that as physical needs rise, the care home often seeks to move the resident on; o there is more complexity of need and frailty – often leads to shorter length of stay – this may result in placement voids, but may also result in the balance of care needs rising overall, and the costs rising as a direct consequence; o capital investment is very costly – and many of our homes have relatively poor accommodation which would not meet current registration standards if they were seeking to enter the market today; and, o fees for regulatory activities have risen in the UK and are likely to rise here.

 Our strategic intentions – development of ‘extra care’ housing etc. aimed at keeping people out of care for longer - mean that those going into care have more complex

190 needs and this, over time, alters the balance in a home. Unit costs rise with the complexity of the needs of residents.

 There is reluctance among some care home residents to move to nursing homes, and this may be one of the issues leading to ‘bed blocking’ at Noble’s Hospital.

 Requiring everyone to go through a threshold assessment is likely to result in the care needs of those who are self-funding being higher than has previously been the case. This may have an impact on the overall care needs within homes, and this may, in itself, increase costs.

6.0 Options for Action in the Longer Term

These options need to be considered in the context of the DHSC five-year strategy.

 At present there are no alternative schemes to assist people fund their own care. A person’s property is considered in the financial assessment when determining a benefit award. A Manx equity release scheme could be considered, including a mechanism for putting a charge against a person’s property, to help them pay for their own care.

 The relationship between care provision and the National Insurance fund could be reconsidered. If people who should be in care cannot afford the fees, they may remain in hospital: fully funded by the government. A hospital stay may cost approximately £250/day; and it makes more financial sense to fund £800/week in a nursing home: possibly via the National Insurance Fund. For the person concerned, we would want to carry out some form of financial assessment and possibly provide an equity release scheme as mentioned above.

 There is the option of the DHSC starting to provide nursing home care directly again.

 Government could consider providing support for the development of social enterprises in the social and nursing care sector. This could include the transfer of DHSC care homes into a ‘not for profit’ arm’s length organisation: enabling greater flexibility in the delivery and development of the care market. To do this, Government would need to recognise its role as an enabler, and take a strategic view of the broader resources at its disposal to facilitate such a shift, including available development sites. There are proposals in development to use the old prison site on Victoria Road to issue an invitation to the market to discuss development of care and extra care services on this site. This prior information notice will allow an initial market assessment to take place.

 Annual review of market risk should be undertaken across all providers, including an understanding of financial stability, occupancy rates and care levels, funding sources and length of stay, satisfaction and vacancy rates. This will produce information to inform commissioning intentions and assist in identifying and managing failing service providers.

 Alternative funding of long term care through, for example, an insurance type scheme or additional direct or indirect taxation could be considered. The longer term funding of residential and nursing care is subject to a report to Tynwald in July 2017 in the first instance

Cath Hayhow, Director 3 May 2017

191 192

Appendix 11: May 2019 - Correspondence with Treasury

193 194 Nina Lowney

From: [Officer name and contact details redacted] on behalf of Randall, Caldric [Caldric Randall] Sent: 15 May 2019 12:22 To: Nina Lowney; Randall, Caldric Cc: Alfred Cannan; Joann Corkish; Subject: RE: Salisbury Street Nursing Home

Good Afternoon Nina

In response to your below email:

The Personal Allowance along with other payments for individuals in Salisbury Street Nursing Home was suspended for a period as questions had been raised over the legality of the payments being made to the DHSC in relation to those individuals. It was determined by Treasury that we should however continue to pay the personal allowance to the individual’s while the questions over the legal basis for the other payments were sorted out. The personal allowance payments were made to the individuals along with the backdated amount to cover the period the payments were suspended for.

The letter of apology that was sent to Mr Murray was unconnected to this issue and resulted from an error in a letter that was sent to some residents of the home in which we incorrectly stated that their fee was being paid directly to the home when it was in fact being paid directly to the DHSC.

Kind regards

[Officer name redacted]

Executive Support and Research Officer to the Treasury Minister and Chief Financial Officer The Treasury, Corporate Strategy Division 3rd Floor, Government Office Bucks Road Douglas Isle of Man IM1 3PU

 Please don't print this email unless you really need to

From: Nina Lowney Sent: 02 May 2019 13:38 To: Randall, Caldric Cc: Cannan, Alfred (MHK); Corkish, Joann Subject: Salisbury Street Nursing Home

Dear Chief Financial Officer

1 195 The Public Accounts Committee of Tynwald is inquiring into the Salisbury Street Nursing Home project. One of the matters that has been brought to its attention is that clients at the nursing home did not, for a time, receive their personal allowances from IOM Government. The Committee understands that a letter was sent by the Treasury to nursing home clients incorrectly advising that the benefit had been paid to Adorn Domiciliary Care and then that a further letter was sent to clients in November 2017 apologising for this mistake.

At its last meeting, the Committee agreed to write to the Treasury to request its explanation of the matter regarding the non-payment of personal allowances and whether it had since written a letter of apology to David Murray / Adorn Domiciliary Care for the error.

I would be grateful to receive a reply by Wednesday 15th May 2019.

Kind regards Nina

Nina Lowney Assistant Clerk Office of the Clerk of Tynwald Legislative Buildings Finch Road, Douglas Isle of Man, IM1 3PW [Contact details redacted]

Isle of Man. Giving you freedom to flourish

WARNING: This email message and any files transmitted with it are confidential and may be subject to legal privilege. You must not copy or deliver it to any other person or use the contents in any unauthorised manner without the express permission of the sender. If you are not the intended addressee of this e- mail, please delete it and notify the sender as soon as possible.

No employee or agent is authorised to conclude any binding agreement on behalf of any of the Departments or Statutory Boards of the Isle of Man Government with any party by e-mail without express written confirmation by a Manager of the relevant Department or Statutory Board.

RAAUE: S’preevaadjagh yn çhaghteraght post-l shoh chammah’s coadanyn erbee currit marish as ta shoh coadit ec y leigh. Cha nhegin diu coipal ny cur eh da peiagh erbee elley ny ymmydey yn chooid t’ayn er aght erbee dyn kied leayr veih’n choyrtagh. Mannagh nee shiu yn enmyssagh kiarit jeh’n phost-l shoh, doll-shiu magh eh, my sailliu, as cur-shiu fys da’n choyrtagh cha leah as oddys shiu.

Cha nel kied currit da failleydagh ny jantagh erbee conaant y yannoo rish peiagh ny possan erbee lesh post-l er son Rheynn ny Boayrd Slattyssagh erbee jeh Reiltys Ellan Vannin dyn co-niartaghey scruit leayr veih Reireyder y Rheynn ny Boayrd Slattyssagh t’eh bentyn rish.

2 196 Appendix 12: 2016 to 2017 - Media coverage regarding a death at Beaconsfield Nursing Home

197 198 News Report from 3FM Website – 7 May 2016

https://www.three.fm/news/isle-of-man-news/inquest-hears-nursing-home-resident-died- of-pneumonia/

199 21/08/2020 Family speak out after shocking revelations about elderly woman's treatment at nursing home | News |

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Family speak out after shocking revelations about elderly woman's treatment at nursing home

Friday, 21 July 2017 - Health

The family of an elderly dementia victim have spoken out at the care she received at an island nursing home - after she was found tied up in her nightie on two occasions shortly before her death.

When Eileen Ranson’s mum Glenda Critchley, who had advanced dementia, died in December 2015 just a few weeks short of her 96th birthday the family initially thought it was case of accepting the inevitable and celebrating a long life well lived.

But then events took a sudden and shocking turn.

Eileen said: ’Mum died on December 15 and I was relieved because she was in a weary state, she’d had enough, she wasn’t going to recover. I wanted her to be released from the torment of the dementia. Glenda Critchley ’She died on the Tuesday night so we started to plan a funeral: it was just before Christmas so we couldn’t have it until early January and we were going ahead with that.

’Then on the Saturday morning at nine o’clock the doorbell went and there were two police officers there who came to explain that there had been some complaint about the home. They didn’t tell us exactly what, but there were concerns about my mother’s care.

’Obviously it was quite shocking to hear that.’

It turned out that one of the staff from Beaconsfield had reported finding Glenda being restrained by being tied up in her nightie just a few days before she died.

Eileen said: ’I was shocked and saddened when I was told the detail of what had happened to my frail, helpless 95- year-old mother and this has lived with me ever since.’

Police at the time described her death as ’unexplained’.

Five members of staff at the home were suspended while a joint investigation was carried out by police and the Department of Health and Social Care’s Safeguarding adults team.

The investigation concluded that Glenda’s treatment at Beaconsfield was not a contributory cause to her death.

This was confirmed at the inquest into her death when Coroner John Needham concluded she had died of natural causes, primarily from aspiration pneumonia as a result of her dementia.

Giving evidence at the inquest, a member of staff at the nursing home described coming into Glenda’s room in the morning at the start of her shift.

200 www.iomtoday.co.im/article.cfm?id=34886&headline=Family speak out after shocking revelations about elderly woman%27s treatment at nursing … 1/4 21/08/2020 Family speak out after shocking revelations about elderly woman's treatment at nursing home | News | She said she was horrified to pull back the covers and find her nightie had been tied in such a way that she couldn’t move.

’The back of the nightie had been pulled between her legs and tied to the front of the nightie in three knots on top of each other,’ she said. ’There was no chance Glenda would have been able to undo it. The top of the nightie was also tied.

’Her arms had been put inside with her elbows bent. The right shoulder of the nightie had been pulled around the back of her neck and been tied in three big knots again.’

The Coroner found the issues of restraint were not connected or contributory to her death. He also found no distinct evidence to back up allegations of over-medication.

But in relation to the tied-up nightie, he said: ’I’m satisfied this was an inappropriate use of restraint in respect of Glenda and the evidence is that it shouldn’t have occurred.’

The Coroner said that because the issues of restraint were not connected to her death, he was not in a position to make a recommendation. But he said it was ’not something to be repeated in the care of anyone’.

A statement from the DHSC reads: ’The department responded promptly to concerns regarding Beaconsfield, both from a regulatory and safeguarding perspective, and continues to work with this provider to respond to concerns about care.’

Adorn Domiliciliary Care Ltd, which runs Beaconsfield, was offered the chance to comment but it has chosen not to do so.

BACKGROUND: GLENDA’S LIFE

Glenda, who had lived in Blackburn, Lancashire, lost her husband, Bruce, in 1990 and became very lonely.

Eileen and her husband, Richard, invited her to come and live with them in Laxey.

Glenda also had a son, Bill, four grandchildren and five great-grandchildren To them, Glenda was a much-loved mum and ’Nana’.

They remember her love of dogs, her lemon drizzle cake and prize-winning parkin, and her little garden with the strawberry patch.

In her early 90s Glenda began to show the first sign of dementia and the highly intelligent woman, who had once won a scholarship to Liverpool University and loved reading and crosswords, began to decline.

Eileen recalls: ’Eventually it got to the stage where she was incontinent. It took two people to bathe her and she couldn’t be left alone.

’When it got to the point where she could no longer walk we just couldn’t cope.’

Like many families in this position it still wasn’t an easy decision to put Glenda into nursing care. After looking around at several options they chose a private nursing home, Beaconsfield in Ramsey, where she had already had spells of respite care, and she went to live there in December 2014.

Although the home lacked a specialist dementia unit, Eileen said: ’She went in because she couldn’t walk and I had assumed that, being a nursing home, they would be able to help her regain some of her mobility. She did initially but then she would forget that she couldn’t walk and she would try to walk and she fell quite badly a couple of times.’

In August 2015, social services became involved after an officer from the registrations and inspection team went into the home and said that it wasn’t meeting Glenda’s psychological needs. She was made an adult protection case.

Eileen said Beaconsfield wrote to her to say it was terminating the contract as its staff could no longer cope with her mum.

The Ransons were left with few options.

They tried a number of other homes in the island but couldn’t find anywhere to take Glenda. At one point it was suggested that the family might fork out a further £1,000 a week to pay for extra carers to go into the home.

Eileen says: ’She wasn’t easy latterly. I could understand that: she shouted out, she did peculiar things. Social services couldn’t find anywhere else for her in the island, they were even talking about sending her to England.

’Whilst we were concerned about the findings of the registrations and inspection team we didn’t want her to have to move at that stage in her life. All the agencies and professionals thought that Beaconsfield should be able to cope with more training and more awareness, so they were trying to offer this support.’

The Ransons appreciate that there are a number of very good specialist dementia units on the island but their experience with Glenda’s care has left them feeling that a number of issues around elderly nursing care should be resolved.

201 www.iomtoday.co.im/article.cfm?id=34886&headline=Family speak out after shocking revelations about elderly woman%27s treatment at nursing … 2/4 21/08/2020 Family speak out after shocking revelations about elderly woman's treatment at nursing home | News | Dementia is not exactly a rare condition these days and one might imagine that, if a nursing home that was costing around £4,000 a month could not cope, then Social Services or other concerned agencies should be able to find a place somewhere that was suitable.

’It was a systematic failure. I just hope lessons can be learned,’ says Eileen and she adds: ’If you read this in the paper you would think: "Gosh, I wouldn’t have thought anything like that went on in the Isle of Man" would you?’

STATEMENT FROM THE DEPARTMENT OF HEALTH AND SOCIAL CARE:

Mrs Glenda Critchley

The Department of Health and Social Care (DHSC) wishes to extend its sympathies to Mr and Mrs Ranson following Mrs Critchley’s death and what then must have been a very difficult period leading to the inquest earlier this year.

The DHSC’s Registration and Inspection Unit (R&I) is a stand-alone regulator which ensures compliance with the regulations and standards associated with the Regulation of Care Act 2013. As part of its role, R&I is required to carry out regular, unannounced inspections of all regulated services, including those in the private sector such as the Adorn Domiciliary Care Limited Beaconsfield Tower Nursing Home (Beaconsfield). Reports of these inspections are publicly available.

An inspection by R&I in August 2015 (which led to a report published in January 2016 - link) identified that Beaconsfield was not meeting Mrs Critchley’s care needs; and the concerns were such that an ’adult protection’ referral was made to the DHSC Adult Social Care Safeguarding Team.

The DHSC worked with Beaconsfield through the autumn of 2015, bringing together specialists from Mental Health Services, Social Care and R&I to support the home in meeting Mrs Critchley’s care needs.

Whilst the department provides specialist dementia care services for people with challenging behaviour, it does not provide any nursing care - this has been traditionally offered by the private sector.

Improving standards of care is always a partnership between the regulator and the service provider; but the care provider is required to ensure that they are able to meet the needs of their residents at all times.

Each provider must have a ’statement of purpose’ which specifies the type and level of care that they are able to provide. This is intended to help families when selecting a home, and is used by the regulator to ensure that providers are reaching an acceptable standard of care.

With regard to Mrs Critchley, approaches were made to other nursing home providers in the Isle of Man, with the support of social work staff, but her family concluded that a move would not have been in Mrs Critchley’s best interests at that time.

Both R&I and the Adult Safeguarding Team have continued to work with Beaconsfield to ensure that regulations and standards are met.

The department’s powers to intervene in a private care provider are limited to those in force under the Regulation of Care Act. However, the department is currently developing the legal framework for the Safeguarding Board, which is independently chaired, and place upon all relevant bodies a duty to co-operate, and to raise awareness of the need to safeguard and protect vulnerable children and adults. It is planned that this will be open to consultation later this year.

There are more than 800 rooms in residential and nursing homes in the Isle of Man, and the majority of those providing care for older people do so very effectively. The DHSC is currently reviewing its specialist dementia services as there is currently a greater need for those people in the earliest stages of dementia who can remain in standard residential home but with enhanced care and they are looking to shift the focus of their resources accordingly.

The DHSC will continue to work with care providers across the island to promote high quality care.

If anyone has concerns about any care service, they can contact either the R&I Team or the Adult Safeguarding Team by calling 686179 or via email [email protected]

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202 www.iomtoday.co.im/article.cfm?id=34886&headline=Family speak out after shocking revelations about elderly woman%27s treatment at nursing … 3/4

Appendix 13: October to December 2020 - Correspondence with Department of Health and Social Care

203 204 Archived: 07 January 2021 15:12:26 From: [Officer name redacted] Sent: 07 December 2020 15:34:39 To: Joann Corkish Cc: Magson, Kathryn; David Ashford Subject: Salisbury Street Update - PAC Importance: Normal Attachments: Sailsbury Street Update 7 12 2020.docx ;

Hi Jo

Please see attached as requested.

Kind Regards

WARNING: This email message and any files transmitted with it are confidential and may be subject to legal privilege. You must not copy or deliver it to any other person or use the contents in any unauthorised manner without the express permission of the sender. If you are not the intended addressee of this e-mail, please delete it and notify the sender as soon as possible. P Please consider the environment. Do not print off this e-mail unless absolutely necessary – thank you.

Isle of Man. Giving you freedom to flourish

WARNING: This email message and any files transmitted with it are confidential and may be subject to legal privilege. You must not copy or deliver it to any other person or use the contents in any unauthorised manner without the express permission of the sender. If you are not the intended addressee of this e-mail, please delete it and notify the sender as soon as possible.

205 Department of Health and Social Care

Salisbury Street

Information request from Public Accounts Committee

The Public Accounts Committee are seeking further clarification in respect of the provision of DHSC (departmental beds) and the implementation of the contractual arrangements with the provider from 2017.

The purpose of this paper is to provide clarity on information previously provided ( email dated 8 October 2020 attached) and to further answer questions from the Committee as outlined below.

1. Committee Comment

8 May 2017 to 10 Dec 2017: Social Security pay client benefits directly to DHSC, unrecovered amount (£223,441) : DHSC unaware that vires to pay a third party for nursing care does not exist.

1.1 DHSC Response:

The Department were aware of this prior to 10th December 2017. The end date cited was taken as a financial position for accounting purposes within the 2017-18 year. Pension entitlement was returned by DHSC to Social Security via journal at year end 31 March 2018.

An internal review of Departmental Papers has identified the chronology of events in respect of Salisbury Street identified the Department was aware of the vires issue in August 2017. The Department considered Salisbury Street Occupation Plan on 4th August 2017, at that time prompted by concerns over under-occupation.

What followed thereafter was consideration of the lack of vires by both the Attorney General Chambers and the Department. A number of solutions were identified within the following months. The final outcome was the resultant changes to legislation to permit the DHSC to charge for nursing care fees under the Adult Social Care (Charges) Regulations and additional changes to Social Security Administration Act 1992 (as outlined below).

2. Committee Question

What was the impact of the 2018/0036: Social Security Administration Act 1992 (Application) (Amendment) Order 2018 and Which benefits could not be paid due to the lack of vires?

2.1 DHSC response:

The DHSC has consulted with Social Security Division of Treasury to confirm the scope of this legislation.

The Social Security Administration Act 1992 (Application) (Amendment) Order 2018, amended section 5 of the Social Security Administration Act 1992 as it has effect in the Island.

206 New provision was inserted into section 5 by the Order enabling regulations to be made providing for the circumstances and manner in which benefit may be paid to a Department other than the Treasury in respect of a beneficiary for any purpose, including meeting the costs arising from that Department exercising a statutory function in respect of the beneficiary.

The DHSC did receive benefits directly until the beginning of December. Those benefits which could not be paid thereafter due to the lack of vires were:

 Income Support allowances towards care home fees  Nursing Care Contribution,  Attendance Allowance were not due whilst the claimant had no contractual liability to pay for their care (prior to April 2018).

Retirement Pensions, and any Incapacity Benefit which were not payable based on any care needs or fee liability were paid to the resident directly during this period.

SD 2018/0079 Adult Social Care (Charges) Regulations 2018 provides the legal vires for the DHSC to charge clients for nursing care.

3. Committee Question

How were fees paid to DHSC Dec 17 – Apr 18? Clarification sought on what the following statement means: “benefits being withheld “

3.1 DHSC Response

Benefits which were not due (as outlined above) were stopped until April 2018. So there was an overall saving to Treasury in withholding these benefits for the period.

4. Committee Question

Some of the beds are not funded by 95%+ benefits. A general response is sought as to the type of situations where this may be necessary

4.1 DHSC Response:

The Social Security Division of Treasury has already provided the full breakdown for the financial assessment of an individual. The DHSC doesn’t hold the full detailed financial assessment (i.e. the calculation of benefit entitlement) by individual. However the Adult Social Care Team work with colleagues in Social Security and the Individual (or their Representative) to establish their benefit entitlement. It is noted, the process can be lengthy and an individual can be placed in a bed, based on their needs prior to the commencement of benefit payments. This is a contractual matter for both the DHSC and the Provider where there may be a delay in payment. Invoice payment in arrears is the process that prevents any significant impact of this process and financial assessment.

A number of scenarios are outlined below which occur where the beds are not funded by 95% + benefit and the remainder is recovered directly from the clients:-

Individuals where private pension exists which reduces their income support payable, but notwithstanding that still do not have sufficient funds to pay for the private room; or

207 Capital held in a property which is on the market for sale, will reduce the amount of benefit payable, but the individual are unable to access the cash to help fund their care.

It is noted the 95% threshold isn’t contractual with the provider. The Department have considered this threshold and it has been noted in August 2017 the Department had flexibility to increase or decrease the funding eligibility criteria at its discretion.

5. Committee Question

Was the agreed contract amount paid to the provider throughout?

5.1 DHSC Response:

Yes, the DHSC has continued to provide the contracted amount throughout. This information has previously been provided to the Committee in confidence on 8 October 2020.

6. Committee Question

Does the £223,441 unrecovered include the £61,551?

6.1 DHSC Response:

Yes, this is included. The DHSC have not been able to recover the fees due and the vires wasn’t applicable retrospectively. There has been no evidence the retrospective position was considered for the accounting period 2017-18.

208 8 October 2020 DHSC Response

From: [Officer name redacted] Sent: 08 October 2020 16:46 To: Joann Corkish Cc: Magson, Kathryn David Ashford Subject: Response for PAC: Salisbury Street

Dear Jo,

Further to our recent email exchange, I would be grateful if you could issue to the Committee as requested.

The information provided below is to assist the Public Accounts Committee in their consideration of matters relating to Salisbury Street. Whilst the Department recognises the Committee can call for any evidence, the DHSC requests that this information is not published without further consultation with us; this is commercially sensitive and DHSC will need to consult with the contracted parties on this matter ahead of future publication or disclose by the Committee.

1. The Committee would like to understand how this 75% figure was arrived at.

The DHSC share the information requested in respect of the 75% breakeven position in confidence given there are two legal agreements in place which govern the relationship between the DHSC and the provider.

The two agreements between the DHSC and Provider cover:

1. Lease of Salisbury Street Care Home; and 2. Agreement for Care Home with Nursing

2. Payment and Recoupment The Committee want to understand how IOMG have paid for the beds at Salisbury Street; and if applicable how IOMG recoups this cost from the benefit recipients.

Please can you explain how the payment to Adorn, and recoupment, has worked since April 2017 and what effect, if any, SD 2018/0079, which came into force on 9 April 2018, had on the process.

209 Salisbury Street opened on the 8th May 2017 and the DHSC pay the provider an agreed contract value which is under the block bed purchase agreement referred to above.

From May 2017 benefits were paid directly by Social Security, Treasury to the DHSC; these ceased at the beginning of December 2017. Payments were suspended in December 2017 as the DHSC and Social Security identified that the DHSC did not have the vires to charge for care provided by a third party, and as a result, the Social Security, Treasury did not have the legal vires to pay Income Support allowances towards care home costs, or make direct benefit payments to the DHSC.

The impact of SD 2018/0079 was to establish a legal basis to enable the DHSC to charge the client the nursing care fee. Once the client had a liability to the DHSC for their care, Social Security were able to reinstate the allowances towards the care costs, and where appropriate, make direct payments to DHSC for their care fee.

From the 9th April 2018 the DHSC have invoiced clients and this can be settled either partly or in full by benefits paid directly from Social Security. Any differences in benefits received are settled by direct payment from the client.

3. The Committee would like to know if there were any occupied beds funded by IOMG where the cost was not recovered from clients; if so please advise the cost per month from April 2017 to date.

As described above, fees were partially met by benefits paid directly by Social Security to the DHSC until the beginning of December 2017. There is a lag between a resident securing a commissioned bed and the payment of benefit by Social Security, Treasury (either directly to the Client; or to the DHSC) due to the necessity of conducting a full financial assessment of benefit eligibility. Nursing care fees may also be only partially met by benefits due to the total benefits amounting to less than the nursing fees incurred; in this case there is a top up payment required direct by the Client.

For the period of May 2017 to December 2017, there was a recovery of payment from the DHSC to Social Security of £61,551 equivalent to the pension payments made by Social Security, on behalf of the clients. This was recovered as the client had no liability to pay the fee, and the pension was therefore entitled to be paid to them.

For the period May 2017 to December 2017, taking into account these pension payments which were returned to the client, the amount that could not be recovered was £223,441. This amount was recorded in the financial statements of the DHSC in the 2017/18 financial year. Due to the timing of benefits actually being received by the DHSC, at this date there was also an amount due of £41,991 that was expected to be paid by Social Security with the retention of benefits discussed below.

It should be noted that this figure is based on a financial position taken from a DHSC perspective using the 10th December 2017 as an assumed date that benefits were paid to. The DHSC do not hold the information to be able to reconcile the amounts not recovered from an overall IOM Government position.

From the beginning of December 2017 until the 8th April 2018 certain benefits which had been payable to the clients based on them being liable for care home fees were not paid, the retention of these benefits showed in the financial statements of Treasury in the 2017/18 financial year. As the DHSC do not hold the information to be able to ascertain the value that could not be recovered from clients at Salisbury Street during this period which includes any backdated payments, an illustrative value is provided based on the average value of the benefits withheld by Social Security and the average number of clients who were in commissioned beds.

210 The average value of benefits withheld totalled £646.21 per week and the fee for nursing care was £812.10, meaning there was a potential deficit of £165.89 per week. For the remaining 17 weeks until the 8th April this totals £92,898.

From the 9th April 2018 any debts outstanding are still being pursued as part of the debt recovery process and no debts have been written off.

211 212

Appendix 14: 4th September 2020 - Department of Health and Social Care Salisbury Street Data Snapshot of Commissioned Beds and Client’s Benefits Payments

213 214 Salisbury street residents Fee = £882.63 Data snapshot at 04 Sep 2020 Benefits due calculations are independent of the fee level which needs to be covered. CAP TARRIFF - PRIVATE first £13k TOTAL TOTAL ASS'D Excl then £1 ASS'D prop of fee AA NCC SDA II IBL DLA RP IS type IS amount (benefits) INCOME CAPITAL pw per £250 INCOME covered by bens 1 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £220.99 ISP £470.95 £935.19 £0.00 £0.00 £0.00 £935.19 100% 2 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £264.28 ISP £394.48 £902.01 £33.18 £0.00 £0.00 £935.19 100% 3 £0.00 £160.00 £92.95 £0.00 £0.00 £145.50 £0.00 ISP £516.99 £915.44 £0.00 £29,887.40 £67.55 £982.99 100% 4 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £144.44 ISP £402.87 £852.81 £144.63 £0.00 £0.00 £997.44 96% 5 £0.00 £160.00 £0.00 £0.00 £0.00 £105.35 £35.80 ISP £628.14 £929.29 £0.00 £16,315.80 £13.26 £942.55 100% 6 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £209.20 ISP £482.74 £935.19 £0.00 £0.00 £0.00 £935.19 100% 7 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £201.40 ISP £475.54 £920.19 £0.00 £0.00 £0.00 £920.19 100% 8 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £205.50 ISP £371.44 £820.19 £0.00 £38,006.21 £100.02 £920.21 93% 9 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £19.66 ISP £672.28 £935.19 £0.00 £0.00 £0.00 £935.19 100% 10 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £344.23 ISP £256.63 £844.11 £91.08 £0.00 £0.00 £935.19 95% 11 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £216.68 ISP £466.42 £926.35 £0.00 £0.00 £0.00 £926.35 100% 12 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £205.83 ISP £477.23 £926.31 £0.00 £0.00 £0.00 £926.31 100% 13 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £192.71 ISP £490.74 £988.95 £0.00 £0.00 £0.00 £988.95 100% 14 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £207.97 ISP £460.83 £974.30 £23.14 £0.00 £0.00 £997.44 100% 15 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £234.42 ISP £457.52 £935.19 £0.00 £0.00 £0.00 £935.19 100% 16 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £221.26 ISP £433.26 £897.77 £37.42 £0.00 £0.00 £935.19 100% 17 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £216.68 ISP £437.49 £897.42 £37.77 £0.00 £0.00 £935.19 100% 18 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £229.97 ISP £453.57 £926.79 £8.40 £0.00 £0.00 £935.19 100% 19 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £205.70 ISP £474.36 £923.31 £11.88 £0.00 £0.00 £935.19 100% 20 £55.80 £160.00 £0.00 £18.20 £0.00 £0.00 £208.53 ISP £483.41 £925.94 £0.00 £0.00 £0.00 £925.94 100% 21 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £205.94 ISP £472.92 £922.11 £13.08 £0.00 £0.00 £935.19 100% 22 £0.00 £160.00 £0.00 £0.00 £0.00 £83.25 £264.72 ISP £196.89 £704.86 £200.33 £20,541.12 £30.16 £935.35 79% 23 £0.00 £160.00 £0.00 £0.00 £114.15 £105.35 £0.00 ISS £562.79 £942.29 £0.00 £0.00 £0.00 £942.29 100% 24 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £0.00 ISS £621.89 £927.39 £55.05 £0.00 £0.00 £982.44 100% 25 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £251.78 ISP £427.43 £922.46 £12.73 £0.00 £0.00 £935.19 100% 26 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £239.01 ISP £322.10 £866.61 £68.83 £28,505.12 £62.02 £997.46 98% 27 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £212.72 ISP £399.23 £855.20 £79.99 £0.00 £0.00 £935.19 96% 28 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £31.38 ISP £542.61 £817.24 £102.95 £0.00 £0.00 £920.19 91% 29 £0.00 £160.00 £0.00 £0.00 £114.15 £145.50 £0.00 ISS £562.79 £982.44 £0.00 £0.00 £0.00 £982.44 100% 30 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £265.55 ISP £426.39 £935.19 £0.00 £0.00 £0.00 £935.19 100% 31 £0.00 £160.00 £0.00 £0.00 £120.85 £145.50 £0.00 ISS £556.09 £982.44 £0.00 £0.00 £0.00 £982.44 100% 32 £0.00 £160.00 £0.00 £0.00 £0.00 £145.50 £0.00 ISS £676.94 £982.44 £0.00 £0.00 £0.00 £982.44 100% 33 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £218.97 ISP £447.74 £909.96 £25.23 £0.00 £0.00 £935.19 100% 34 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £259.62 ISP £188.87 £691.74 £243.45 £0.00 £0.00 £935.19 78% 35 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £178.32 ISP £354.82 £776.39 £158.80 £0.00 £0.00 £935.19 88% 36 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £209.40 ISP £427.43 £880.08 £55.11 £0.00 £0.00 £935.19 99% 37 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £167.94 ISP £510.33 £921.52 £0.00 £0.00 £0.00 £921.52 100% 38 £83.25 £160.00 £0.00 £0.00 £0.00 £0.00 £83.26 ISP £596.49 £923.00 £0.00 £0.00 £0.00 £923.00 100%

AA Attendance Allowance RP Retirement Pension NCC Nursing Care Contribution IS Type Income Support Type SDA Severe Disablement Allowance ISS IS Sick (under pension age) II Industrial Injuries ISP IS Pensioner IBL Long Term Incapacity - under state pension age IS Amount Income Support Amount DLA Disability Living Allowance 215 216

Appendix 15: 6th September 2019 Manx Radio report ‘Plans for a 73-Bed Care Home on Woodbourne Road’

217 218 17/10/2020 Plans for 73-bed care home on Woodbourne Road - Manx Radio

Plans for 73-bed care home on Woodbourne Road

Friday, September 6th, 2019 12:52pm

Former DHA headquarters site earmarked

Plans have been lodged to demolish the former headquarters of the Department of Home Affairs on Woodbourne Road and replace it with a 73-bed care home.

Homefield Care Limited wants to spend more than £5 million building the new facility, creating 60 jobs in the process.

It's been designed to provide primary nursing care, but will also cater for the dementia and residential care 'required by the local market'.

The company won the option to purchase the site in a government tender process, but the sale will only take place should the plans be approved.

If the bid is successful, it's estimated that bed spaces will be available in the new home in 2021.

In the plans, which were drawn up by by McGarrigle Architects, it's said the three-story building will be of 'high quality' to 'enhance' the surrounding conservation area.

The lack of care bed spaces available to meet local demand is also highlighted, with the applicant describing many existing facilities as 'past their sell-by date'.

It's hoped this proposed development will go towards meeting this demand. https://www.manxradio.com/news/isle-of-man-news/plans-for-73-bed-care-home-on- woodbourne-road/ - accessed 17 Oct 2020 219

2019 Planning Applications for Site

1https://services.gov.im/planningapplication/services/planning/planningapplicationdetails.iom?ApplicationRef erenceNumber=19%2F00960%2FCON, accessed 17 Oct 2020

2https://services.gov.im/planningapplication/services/planning/planningapplicationdetails.iom?ApplicationRef erenceNumber=19%2F00959%2FB, accessed 17 Oct 2020

220

Appendix 16: September 2015 Business Case and Explanatory Memorandum for the Construction of Summerhill View

221 222 223 [Signed: Howard Quayle]

[Signed: David Quirk]

[Signed: Malcolm Couch]

[Signed: Peter Faragher]

[Signed: Cath Hayhow]

[Signed: Adrian Tomkinson]

224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 239 240 241 242 243 244 Explanatory Memorandum to Tynwald Members

Issued by the Department of Health and Social Care

To the Hon Stephen Rodan OBE MLC, President of Tynwald and the Hon Council and Keys in Tynwald assembled

1. Title of measure

Older Persons Residential and Resource Centre – Summerhill View

2. Changes in policy

No changes in policy are required or affected by this proposed construction.

3. Effects of the measure

To construct a 60 bed residential facility to replace Reayrt ny Baie, an existing Douglas based facility that is no longer fit for purpose and does not comply with the national minimum care standards under the Regulation of Care Act (2013).

4. Reasons for the measure

The Department of Health and Social Care (DHSC) remains committed to the provision of care at the right time in the right location. Despite a significant commitment to the transformation of the point of care towards an integrated model, the DHSC recognises the need to ensure its facilities remain fit for purpose and able to meet the needs of its service users.

Over the last decade the provision of adult social care has remained a key strategic objective for ongoing capital investment into on-island facilities. This includes the provision of non-residential and residential care services across the Island.

In May 2011, the then Department of Social Care (henceforward the Department of Health and Social Care) submitted to Treasury details of a proposed Business Case for new residential complexes for older residents to meet future care needs.

The first of these proposals is for the construction of a 60 bed residential facility and Day Care Unit in the East/Douglas to replace the outdated accommodation at Reayrt ny Baie, and enable the transfer of Sweetbriar dementia care unit back into the residential care service from Thie Meanagh.

The modernisation/replacement of residential accommodation for older people and re-provision of residential care to meet current and future standards, particularly with regard to changing models of care and standards set down by the Regulation of Care Act (2013), is one of the Department’s key strategies.

245 At that time, the programme of rebalancing older person’s services, approved in principle by the Council of Ministers, recognised a need to change how care was delivered for older people to enable this to be financially viable into the future with a growing older population.

More recently the Independent Health and Social Care Review (Sir Johnathan Michael 2019) has identified the need to move services out of hospital and into the community with an emphasis on the integration of services around the needs of the individual. Furthermore, this Review also recognised the current model is highly centralised with services for people with more acute needs predominantly being provided in nursing homes and residential homes, rather than in their own homes.

The Department is however very aware that the Island community is heavily dependent on residential care to support its older community. There is a clear recognition that whilst entry to residential care may be delayed for some older residents as a result of enhanced care provided by people in their own homes, when this is required it will be for those with more complex needs. Current residential facilities only cater for such needs in a very limited manner. The Department’s actions reflect the view that Government should focus its intervention on those with the most complex needs, acknowledging also that services can be provided by partner organisations which may even be capable of adding value where Government can’t.

The report “Transforming Adult Social Care in the Isle of Man” in 2011 commissioned from Tribal Group plc highlights a number of challenges for the Department in the provision of care for older residents up to 2026.

 the population of the Isle of Man will grow by 10%  the number of people aged 60+ will grow faster, by 35%  the number of people aged 65-74 will increase by 63%  the “super-elderly” group (people aged 85+) will increase by 47%  there is an over reliance on residential care (compared with UK) for over 65 year olds with a large percentage of residents being supported in private sector beds through income support payments. There will be a continued need for residential care but the Department’s aim is that it is targeted at people with a higher level of dependency for clients at admission and thereby maintaining capacity at current levels rather than increasing provision in line with the demographic forecast.  the provision of sheltered housing on the Island is limited and there is no Extra Care housing to enable people to live more independently than they would in a care home.  the cost to fund each residential care place in the Isle of Man is around £33,000 per annum while average home care can be delivered for around £4,000 per user and possibly even avoided if the user could participate in a reablement programme.  a much smaller number of people were put through reablement programmes to enable them to regain their residential independence than in the UK although this has been addressed through the development of a Reablement Service.

The report also highlights that best practice guidance issued by the Audit Commission in England states that no more than 40% of adult social care budget

246 should be spent on residential care. In the IOM the figure is currently much higher. 76% of the older person’s budget is spent on residential care, but this only serves 15% of the number of such service users. This is to be compared with home care which uses 19% of the older people’s budget but serves 70% of services users.

As a result of the Department’s revised and developing care strategies for older people, the residential facilities which are required for people with more complex needs will be different from those which characterised the former Glenside, Residential Home, Victoria Road, Douglas and those currently available at Reayrt ny Baie, Douglas and the Sweetbriar dementia care unit, formerly part of the Glenside complex but now occupying Thie Meanagh Unit 2 (elderly dementia care unit). New facilities will need to be developed to be able to support residents with higher levels of dependency and greater care needs resulting in a need for larger en-suite bedrooms / bathrooms, more wheelchair accessible rooms, tracking and hoisting facilities etc.

The Reayrt ny Baie residential accommodation does not meet present needs. Bedrooms are too small to meet the needs of residents who have any kind of mobility issues or higher than average dependency levels. Similarly the en-suite toilet facilities are insufficient in size for use by any but the most able people with inadequate space for residents to be assisted by carers if required (resulting in residents having to utilise a shared bathroom). In addition the lifts, which are in the central core of the building, are inadequate for wheelchair use and the corridors are extremely narrow, again giving rise to difficulties for those residents requiring wheelchairs.

Alternative options have been considered for Reayrt ny Baie to bring it in line with acceptable standards. These include:-

 Do nothing. This is not an acceptable option. The building does not meet the minimum standards set by the Regulation of Care Act (2013), neither does it meet the needs of residents it is intended to serve.  Refurbish existing facilities. This has been done to some degree with the complete refurbishment of community areas, creation of quiet and TV lounges and replacing bathroom equipment. However, it does not address the key issues of room and en-suite facilities being of insufficient size, or issues with corridor width and lifts. In addition, consideration would also have to be given to the effect on residents of decanting the facility if further work was to be carried out and the significant cost implications involved.  Remodel/convert existing facilities. To remodel facilities to meet current standards would require as a minimum the loss of a third of the rooms to convert into en-suite facilities with the bedrooms on either side increased in size. It would still leave an issue with corridors and lifts in the central core. This would make units of 10 bedrooms, reducing care fee income by a third. However, staffing costs would remain at similar levels (a 10 bed unit would require more or less the same staff establishment as a 15 bed unit). It would result in significant capital cost, reduced income and no reduction in revenue cost while barely meeting minimum standards.  Externalise service. In the current building this is not a possibility as a new provider would not be able to register the service under the Regulation of Care Act (2013). An independent sector provider is unlikely to be found who would build a facility meeting minimum standards. There have been no

247 new residential facilities built on the Isle of Man (although some providers have built limited capacity alongside existing nursing homes) in the last decade. Nursing care offers a far greater return on investment due to the higher care fees that can be charged.  Re-provide on a new site. This is the most viable option in terms of meeting the Department’s aim to maintain residential care at current levels, meet minimum standards, and meet the needs of residents.

The new development will enable the reintegration of the Sweetbriar Unit which in turn will provide Older People’s Services with greater operational flexibility and in the longer term create capacity for specialist dementia care and support services in Thie Meanagh (current prevalence rates demonstrate there will be a significant increase in the requirement for these services). The availability of Unit 2 in Thie Meanagh has allowed the Department to close Gardner House early (Gardner House was a ward based EMI Unit that was unfit for purpose. Its early release allowed Ramsey & District Cottage Hospital to remodel), temporarily close Gansey Unit when there was a staffing shortage, and move Sweetbriar Unit in to facilitate the closure of Glenside Resource Centre.

The new development will also need to provide accommodation for a day centre capable of accommodating up to twenty people. Reayrt ny Baie currently hosts the day centre for older peoples on its top floor. Day centres are a key preventative strategy to avoid people entering residential care prematurely by offering support, valued activity, and socialisation. Being in a Resource Centre has distinct advantages in that it can take advantage of catering services, and provide a community presence for the home.

The new accommodation will also need to be set out in separate units to cater for different levels of care, particularly for residents with dementia, and to provide operational flexibility i.e. the ability to change the use of individual units based on demand rather than restructure the whole facility. These requirements will also have to be reflected externally in garden and sitting areas where some areas may need to be dementia friendly.

As part of the development of the business case the Department has reviewed the potential of two sites within the Douglas Area which it believes could accommodate a 60 bedroom residential facility and Day Care centre (see attached Glenside and former Prison site/Eastcliffe site: Report to Treasury).

As a result of the review the Department has concluded that the use of the former Glenside Resource Centre (demolished in 2015) site on Victoria Road and creation of a new 60 bed residential unit will meet the Department’s needs going forward. This conclusion was reached because the study undertaken by Kay Associates (Architects) in 2014 of the former Glenside site demonstrated that it could accommodate the Department’s requirements and it is already zoned for residential care use so gaining planning permission should not present a planning risk. The alternative site considered, the former prison site, could also potentially accommodate the Department’s requirements but it is not zoned for residential use so any planning application could be open to challenge.

The proposed development proposals are a fundamental part of the Department’s proposals to modernise adult care services on the Isle of Man and ensure that these are sustainable and financially viable into the future. The Department’s objective is to

248 provide services for the most vulnerable and needy in line with the three core aims of Government and the proposed project will enable the Department to deliver this care into the future as planned.

The Department proposes to increase the percentage of care delivered to older people in the community though ongoing transformation and development of integrated care and support more older residents in this way. It will also continue to provide reablement support to residents who need to relearn skills lost through illness to enable them to continue to live at home. This will reduce the previous reliance on residential care as a solution in such circumstances.

It should be noted that two Planning appeals were held prior to this which substantially impacted on progress (and cost) of the project, delaying the scheme by nearly three years.

5. Resource implications

The total estimated capital cost to construct a 60 bed residential facility and day centre is £11,200.00. Members should note that £751,000 for design fees and enabling works has already been approved as a column 2 item and that the £11,200,000 is in addition to the £750,000 already approved.

It is widely recognised that increases in need are placing additional demands on service provision and the Department will seek to manage, where possible, from existing resources and the cost of providing heat, light, power and maintaining the budget from within Department of Infrastructure budgets should reduce as a consequence of the new build being far more energy efficient than the existing building.

Treasury concurrence has been sought and granted as part of the capital programme procedures. Treasury Board gave support and approval for this scheme on 28th April 2020.

6. Tynwald procedure

[Reference: Older Persons RRU - Summerhill on page 35 of the Isle of Man Government Budget 2020-21 under the heading Department of Health and Social Care, Full capital Programme including 2020-21 Approvals; Appendix 5 – Full Capital Programme including 2020-21 Approvals on page 106 under the heading Adult Services, Older Persons RRU – Summerhill].

249 250 Appendix 17: 1st April 2017 - Salisbury Care Limited Annual Return

251 252 [Address redacted]

[Address redacted]

253 [Address redacted]

[Address redacted] [Address redacted] [Address redacted] [Address redacted]

254 [Signature: J D Wormald]

255 256 Appendix 18: 12th March 2021 - Correspondence from Kathryn Magson, Interim Chief Executive, Department of Health and Social Care

257 258

Office of the Chief Executive th Department of Health and Social Care HQ 12 March 2021 Crookall House, Demesne Road Douglas, Isle of Man IM1 3QA

[Contact details redacted] Mrs Joann Corkish Clerk to the Committee

Sent via email: [email protected]

Dear Mrs Corkish

Re: Standing Committee of Tynwald on Public Accounts: First Report for the Session 2021-2021: Salisbury Street Nursing Home

Thank you for the opportunity to review the confidential draft of the aforementioned Report. Following a full review by the department political members and officers, I can confirm there are no further redactions which the Department would request in the draft report.

I would however offer the following comment to the Committee in respect of the extensive work undertaken to assist in the interpretation and validity of conclusions and recommendations presented in the draft report, which I trust the Committee will find useful.

1. “Potential Loss …in excess of £600,000” (Draft Report Printed Page 2; paragraph 4) “We note with concern that the Department in conjunction with Treasury acted outside of vires leading to a potential loss to the taxpayer in excess of £600,000, split almost evenly between paying for empty beds and paying twice through benefits.”

The Department considers this is misrepresenting the losses stated in the report which are cited at £223, 441 and £92,898 respectively. Which states “DHSC estimate the financial loss to Government as a result of these issues [vires] as £223,441 between May and Dec 2017 and £92,898 between December 2017 and April 2018” (Printed page 14; Paragraph 54).

The report does cover bed occupancy rates and the cost of empty beds has been calculated based on the contact value per bed, which is provided in the report. However there is no reference to the corresponding income received by the DHSC as rent from the provider under a separate contract of the use of the premises between the DHSC and Provider.

The agreed rent paid by the Provider to the Department was part of the tender process and based on the profit estimated on the basis of guaranteed income for the 40 block beds and the ability to charge a private rate on the remaining 28 beds. There is a contract for the block beds and a separate lease to cover the agreed rent. The Department notes this model affords rental income to be offset against a vacancy factor of the block bed contract so that the arrangement breaks even.

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The beds were not paid for twice through benefits. The Department paid the agreed cost of a bed to the provider as part of a block bed contract and Social Security continued to pay benefits to clients where they did not have the vires to retain them and/or the DHSC could not invoice for care services.

2. “Breakeven Calculation (Draft Report Printed Page 12; paragraph 44) “Our view is it is inappropriate to offset rental income against the cost of beds; Therefore, while it is somewhat academic as occupancy levels have remained high, it is our view that the basis for this offset calculation is flawed. We are not aware of circumstances where the Department supports clients at a level greater than the maximum benefit rate, as such the only true break even position is when the beds are 100% occupied by 100% benefit funded residents.”

The arrangement and calculation of rent ties in with the block bed contract and the ability of the provider to charge for private beds. Due to the nature of the services being provided 100% occupancy is highly unlikely and it was assumed that the income would cover the fact that there will be vacant beds some of the time.

Even if clients are not on 100% of benefits the Department can still charge the difference (subject to the usual invoice/debt recovery process).

3. “95% Threshold Benefit Funding” (Draft Report Printed Page 14; paragraph 52) “We conclude that, while the 95% threshold appears to have been informally acknowledged as the threshold, there was no contractual agreement regarding the minimum percentage of benefit funding required in order for a client to qualify for a DHSC commissioned bed; in theory therefore anyone in receipt of any social security benefit, including only a state pension, could legally occupy a DHSC bed”

This issue is linked to the wider reform required to govern the long-term funding solutions required for nursing and residential care that has been identified most recently by Sir Jonathan Michael and subsequently is being considered further by the Social Policy and Children’s Committee (SPCC) in respect of solutions and options for wider community and political consideration.

4. Independent Regulation (Draft Report Printed page 22; paragraph 81) “the Department is not the appropriate body to regulate both Manx Care and the Independent Care sector”

The Committee have noted the proposed Manx Care Bill places independent Regulation within the remit of the new Department of Health and Social Care, but conversely considers the governance of the same should not fall within the Department. This later position is contrary to the Sir Johnathan Michael Review (2019) which Tynwald unanimously supported which has been the prime mover behind the supporting legislation which provides for external independent inspection of Manx Care services.

Yours sincerely [Signature: Kathryn Magson]

Ms Kathryn Magson Interim Chief Executive Department of Health and Social Care

260 Parliamentary Copyright

Available from:

The Tynwald Library Legislative Buildings DOUGLAS Isle of Man, IM1 3PW British Isles February 2021

Tel: 01624 685520 E-mail: [email protected] Price: £25.55