The Birmingham experience

With the recent collapse of Southern Cross the issue of managing resettlement of older people has come into sharp focus. The received wisdom is that closing services and moving older people elsewhere can be very risky.

Several studies of older people’s transition from one care environment to another have shown the potential pitfalls. Too often health and social care services fail to deliver a planned and proactive approach to managing older people’s needs, resulting in poor care and a feeling amongst many service users of being cast adrift.

With this background – what of the experience in Birmingham, where the City Council has been involved in one of the largest closure programmes of local authority care home beds (and linked day centres) in Europe? This has involved the transfer of hundreds of older people to new special care centres, other forms of residential care and new housing-based provision.

We spent time trying to understand what this meant for older people and their families by talking to them about their experiences, and we also measured different aspects of their health and well-being before, during and after the moves. Although older people were often worried in advance, ultimately we found that for the majority of older people the process did not have a negative impact on their lives. Indeed, 77% of respondents suggested that life had got better or stayed the same as a result of resettlement.

Whilst the closure of homes in Birmingham was of course distressing at times for staff and service users, the process also seemed to show that you can minimise potential negative impacts by planning resettlement well and carrying it out sensitively.

The key findings collected one month and one year after resettlement showed that for most people the process did not have a negative effect on their lives.

• The majority of respondents suggested they felt valued and were happy with the control they had over their life at all stages of the study
• A number of respondents reported an increase in health related quality of life (59% people in care homes and 42% in day centres) and a further 31% (care homes) and 46% (day centres) reported a decrease
• 42% of respondents from each setting suggested that life had got better following the resettlement programme and a further 35% suggested life had stayed the same
• Of the 19% who suggested life had got worse following changes, around half suggested this was due to deterioration in their actual health rather than due to the services at their current care home

There are a clear series of lessons from the Birmingham experience for local authorities involved in closure programs in the future: things that, if done well, can mitigate the distress and disruption inherent in a transfer of care.

• Preparation and strategy: Having a clear strategy and policy that could be easily articulated to stakeholder groups was seen as important. This was particularly apparent with the policy around day centre closure, which was less clear and for many it felt like an ‘add on’ to residential home closures.
• Engagement and involvement: Involving key stakeholders upfront in initial decisions about services is important to success. Anxiety and stress is often increased when service users are facing a perceived loss or change to services, and it is important that people feel able to influence what happens to them during resettlement, even if they cannot influence the original decision to close a service.
• Implementation and operational capacity: Giving service users adequate assessment is crucial to making sure new services are effective. A key strength of the Birmingham process was a dedicated group of assessors with time and space to carry out detailed assessments, get to know people well, work closely with care staff and provide information and reassurance.

Closing care homes is never something to be embarked upon lightly – but it is a reality in many areas as service models change and as cuts bite. What we found is that the risks of a major decline in quality of life can be reduced and that some positive outcomes can be achieved if the process is conducted well. Looking at the Birmingham experience the lessons for other service providers can be summarised simply as follows: take the time to implement the programme properly, thereby allowing professionals to follow good practice – but most importantly realise that effective management of such difficult processes requires high levels of respect, communication and empathy with those affected.

Professor Jon Glasby
Professor of Health and Social Care and Director of Health Services Management Centre (HSMC)

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