Western Counselling Services Ltd v North Somerset District Council

DECISION : 367 REGISTERED HOMES TRIBUNAL This decision may be freely reproduced and distributed. It should be drawn to the attention of inspection staff and legal advisers ___________________________________________________________________________ Western Counselling Services Ltd Appellant V North Somerset District Council Respondent Tribunal sitting on 24th and 25th November 1998 at Weston College, Weston-super-Mare. Before:Michael KellyJames ChurchillDavid Stanley Representation The Appellant:- Mr Hart (Solicitor) The Respondent:- Mrs Stevenson (Solicitor) ___________________________________________________________________________ DECISION The tribunal confirms the decision of the Registration Authority – but directs that the condition 'the exemption shall be removed if the business of Western Counselling Services or any part thereof is sold or sub-contracted or in any way ceases to be under the control of the present owner', shall cease to have effect; and varies the condition, 'no residents in the primary stages of treatment shall be admitted to a residential which does not have staff permanently present on the premises' to, '24 hour staff cover will not be required for residents who are in the second or extended treatment stage'. ___________________________________________________________________________ Introduction This is an appeal under Section 15 of the Registered Homes Act 1984 against the decision of the Social Services Registration and Inspection Sub-Committee of North Somerset District Council on 11th March 1998 and 11th June 1998 which imposed additional conditions in respect of the homes run by Western Counselling Services Limited. These conditions were :-

1. That Western Counselling Services be granted an exemption in respect of the Authority's policy standards for shared rooms, but may have no more than two residents sharing a room at any one time.

2. That the exemption shall be removed if the business of Western Counselling Services or any part thereof is sold or sub-contracted or it in any way ceases to be under the control of the present owner.

3. That no residents in the primary stage of treatment shall be admitted to a residential home which does not have staff permanently present on the premises.

4. That any existing residents shall benefit from arrangements currently made for their care, but the standards and exceptions above shall apply to all new residents. It was agreed at the beginning of the hearing that the only condition which was in dispute was that relating to the use of triple bedded rooms. So far as condition 2 was concerned it was agreed by the parties that it was not permissible for the Registration Authority to impose a condition that the number of residents might vary on the happening of a specified contingency, (Avon County Council v Lang [1990] C.O.D. 365) So far as condition 3 was concerned the Authority accepted that the requirement for 24 hour cover did not need to apply to residents in the secondary stage of treatment. We were invited by the parties to delete or vary these conditions as appropriate. Condition 4 was contingent upon our decision on the issue of triple bedded rooms. It followed that the only issue before us was the issue of triple bedded rooms. We heard evidence from the following witnesses : For the Respondent:- Mrs Maureen Hayter, The Chair of North Somerset District Council Social Services Committee. Mr David Finney, Head of Registration, Inspection and Consumer Services in the Housing and Social Services Department of North Somerset District Council. For the Appellant:- Mr David Eric Evans, Director and principal shareholder of Western Counselling Services Limited. Mr David Colin Wilkes, A Director and the company secretary of Western Counselling Services Ltd. Mr Simon Shepherd, A Psychologist, an employee of Telos (which provides research, training and constancy in the fields of substance misuse and offending behaviour); recently appointed as acting Chief Executive of The European Association for the Treatment of Addiction and an expert witness. We also read the affidavit of John Andrew Teller, The Chief Executive of ACAD (Advice Counselling on Drugs and Alcohol) which is a specialist organisation involved with those with alcohol and drug related problems. Background On 11th March 1998 North Somerset District Council adopted new Policy Guidelines for Residential Homes caring for people recovering from Drug and Alcohol addictions. These guidelines were contained in a publication entitled 'Improving Standards' . The Registration Authority resolved that the registration of Western Counselling Services Limited, (who are registered in respect of 5 such residential homes in North Somerset), should, with certain exemptions, become subject to these guidelines in the form of conditions. There was extensive and appropriate consultation before 'Improving Standards' was adopted and it was as a result of those consultations that Western Counselling Services Ltd appealed. The Appellants and the Respondents agreed that the only issue in contention related to three bedded rooms. Western Counselling Services provides residential care for persons suffering from drug and alcohol dependency and has done so in Weston-super-Mare since 1983. The method of treatment is the 'Minnesota 12 step treatment'. The 5 homes have a total of 7 single rooms, 23 double rooms and 6 triple rooms. The Issue The Case for the Respondent Mrs Hayter set out the reasons for introducing this new policy. The Council was concerned that North Somerset had a large number of residential units and this caused some problems for the local community. Indeed it had become a recent recommendation of the Registration Sub-Committee that no more such units should be registered. Mr Finney said that each application for registration and each decision to impose conditions would be considered on its merits. Concern about the problems caused to the local community was one of the factors which led to 'Improving Standards' but it was contended that the Local Authority were making a genuine effort to improve standards. The document itself suggests that the initiative was undertaken to help protect the interests of vulnerable people entering these units. Mr Finney insisted that the general principles of residential care needed to be observed; dignity, privacy, independence, fulfilment and rights. The Respondent at first wished to ensure that everyone entering a residential home should have a choice of a single or double room. However it was accepted that people recovering from drug and alcohol addiction need some limits on choice and independence and this may involve the close support of other residents and the need to share a room. Treatment under the 'Minnesota Method' is provided in a number of ways without the need to rely upon the experience of sharing a room. A regime which required clients to spend a greater part of their time in their bedrooms would have little hope of success. Mutual support can be provided within communal areas and by using the 'mini group system'. Secondary or extended care offers a 6-9 month stay and this allows time for a person to personalise their environment and to feel 'at home'. This promotes the dignity of the individual. The need for latitude referred to in Local Authority Circular 86(6) was well recognised by the Respondent. It seemed to the Respondent that this particular method of treatment could be carried on successfully in double rooms as well as triple rooms. The expert evidence suggested that it made no difference to treatment outcome whether clients were accommodated in double or triple rooms. The evidence also suggested that there was no significant difference in clients' perceptions of treatment or psychological well-being between those sharing a triple room and those housed on their own or with only one other. Mr Finney argued that there was a distinction between residential care homes and nursing homes because appropriate provision has to be made for medical treatment in a nursing home. His responsibility was for residential care homes. The Respondent contended that the objectives of the 'Minnesota method' could be achieved where no more than 2 people shared a room and privacy and dignity were reduced in proportion to the number of people sharing a room. The case for the Appellant The Appellant argued, 'If it ain't broke don't fix it'. Western Counselling Services had been operating a successful treatment scheme for 15 years. There had never been any problems with the treatment and they provided a valuable local and national resource for those who wanted to tackle their drug or alcohol addiction. The Respondents had contrived a distinction between double and triple rooms when none existed. If sharing with one other person is acceptable where is the evil in sharing with two others? The need for mutual support within the programme outweighs privacy and dignity for those recovering from drug or alcohol addiction. The Respondent's policy will reduce the overall number of beds available for treatment and it is not in the public interest. Concern has been expressed at a national level by Mr Trace, the Deputy UK Anti-Drugs Co-ordinator who suggested that the decision might have an effect on Government Policy. Mr Evans gave evidence of a caring and altruistic regime aimed at helping desperate people to overcome their drug and alcohol problems. The 'Minnesota Method' was widely recognised and respected as a successful treatment. People who came to take advantage of it had often lost everything; they had been living on the streets or had been in prison. Privacy and dignity were not uppermost in their mind. He said that costs had to be covered but that no one was discharged before they completed their treatment, even if they could not pay. He agreed that he would like to see three or more people sharing a room. He felt that 'the more people you can ask for help the more help you are going to get' and that 'addicts need to realise what it is like living with someone who has yet to respond to treatment'. He also felt that addicts had often tried to recover on their own and failed; triple rooms allow them to accept that they need help from others and this is the thrust of treatment all the way through. They gain strength by working at changing themselves and by sharing they can agree to disagree. Clients develop a closeness with one another which helps them to overcome their problems. Mr Evans thought that it would be impossible to achieve care objectives if all clients were in single rooms but Western Counselling Services had been operating with double rooms so care objectives could be achieved with double rooms – treatment under the 'Minnesota Method' could be delivered, but it would be better with triple rooms. There had been no problems with compatibility; there was a no smoking policy in the bedrooms and all clients were encouraged to keep themselves clean and behave properly. Finally he felt that there was no difference between a Registered Care Home and a Nursing Home operating the same treatment regime Nursing Homes have to have a quota of medical staff on the premises and they are often more expensive. Mr Shepherd gave an interesting insight into the statistics of the treatment and gave us a picture of the facilities provided in other Homes, mostly Nursing Homes. He was unable to offer any conclusive evidence of the relative merits of double and triple rooms. At most he was able to suggest that sharing triple rooms had no negative effects upon the clients undergoing the 12 step treatment. During the week beginning 11th October 1998 a study was carried out to test if sharing a triple room had any effect upon the clients' psychological well being or their perceptions of treatment. The study involved the 3 secondary houses in use at the time. St Davids housed 13 female residents with 6 sharing with 2 others, 6 sharing with 1 other and 1 resident on her own. Clarence House had 12 male residents. All of them shared with 2 others. Larkhill had 9 residents. 8 shared with 1 other and 1 was on his own. The study found no significant differences in any of the houses. Perceptions of treatment seemed most positive in Clarence House, in which all residents shared triple rooms, and least positive in Larkhill. No significant difference was found between those sharing a triple room and those housed on their own or with one other. Perceptions of treatment and psychological well-being were found to be more positive amongst those in triple rooms. The findings suggested that neither sharing triple rooms nor being in a house with no single rooms had any impact on either the residents perceptions of treatment or on their psychological well-being. Our Conclusions We were impressed by the degree of co-operation between the parties and we are sure that our decision will not affect that co-operation. Western Counselling Services are offering a valuable service to the community and we were impressed by the genuine commitment and dedication of Mr Evans and his colleagues to the Minnesota 12 step treatment and to the addicts who were in need of that treatment. We accepted that The Minnesota 12 step treatment method could be applied successfully to clients in two bedded rooms. There was no significant evidence before us which demonstrated that the treatment was more successful or the completion rate was improved if clients shared three bedded rooms. There was evidence that the Respondent Local Authority was concerned about the impact of Drug and Alcohol Rehabilitation Units upon the local community but there was no evidence that this concern was reflected in the decisions and policies of the Registration Unit or in 'Improving Standards'. In particular there was no evidence that this policy had any effect upon decisions concerning the Registration of Western Counselling Services Ltd. We accepted that there were differences between Nursing Homes and Registered Care Homes specialising in the treatment of drug and alcohol abuse. Medical help is more necessary and available in Nursing Homes and medical staff are available to treat those who have been damaged as a result of addiction. It is the responsibility of the Local Authority to set standards and it is axiomatic that those standards should aim to improve the care of all those who use the services of Residential Homes. Provided that the special circumstances of those who need treatment for addiction are recognised, it is the duty of the Authority to enhance the privacy and dignity of residents and to set standards which are consistent with the treatment provided for drug and alcohol addicts. In allowing 2 residents to share a room the Authority has accepted that the 'Minnesota Method' is effective and has modified its standards to provide a reasonable balance between the requirements of the method of treatment and the needs of residents for privacy and dignity. We feel that the consultation process was a model of good practice. We think that our decision is unlikely to have a significant effect upon the number of places available for the treatment of drug and alcohol addiction. On balance we think that the decision of the Local Authority that there must be no more than 2 people sharing a room is right. Michael Kelly James Churchill David Stanley