Health and Social Care Committee

Inquiry into residential care for older people


RC47 – Royal College of Physicians


Committee Clerk

Health and Social Care Committee

National Assembly for Wales,

Cardiff Bay

CF99 1NA



From The Registrar    

Patrick Cadigan MD FRCP



16 December 2011



Dear Sir or Madam

Re: Health and Social Care Committee: call for evidence on residential care for older people in Wales

The Royal College of Physicians (RCP) plays a leading role in the delivery of high quality patient care by setting standards of medical practice and promoting clinical excellence.  We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers.  As an independent body representing over 25,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.


The RCP wishes to raise the following points which are made from a clinical, professional perspective.


·         The interface between the NHS and residential care is very important for the health and wellbeing of the individual in care, and for the efficient operation of the NHS, particularly inpatient services.

·         Transfer from hospital to residential care is often a cause of delayed discharge from health care and there are times when the decision by the individual to move into residential care turns out to be inappropriate and regretted.  It is suggested that the Inquiry explores the possibility of making provision for trial periods of admission, perhaps accompanied by specialist medical management.

·         With current funding models there is a perverse incentive for residential homes to encourage dependency, yet systems that ensure closer collaboration with specialist input could be designed to avoid the spiral of disability that progresses into total dependency.

·         This would also require systems to ensure that residents are able to return to their own home where appropriate, and with adequate support.  This is particularly likely to occur if the illness that precipitated hospital admission continues to improve while the individual is in residential care. 


Yours faithfully

Dr Patrick Cadigan