oxfordshire care home provider meeting 17 november 2015
TRANSCRIPT
Oxfordshire Care Home Provider Meeting
17 November 2015
Agenda
Time Item1 09:30-09:45 Welcome and Introductions2 09:45-10:25 Rachel Lawrence, Workforce Development Programme Manager - Adult
Social Care Workforce Strategy3 10:25-11:00 Dr Julie Anderson, Clinical Director, South West Oxfordshire Locality and Lead
for End of Life Care, Nursing Homes, Dementia and Stroke - Oxfordshire Clinical Commissioning Group
4 11:00-11:15 Break5 11:15-12:10 Carol Schubert, Interim Inspection Manager Adult Social Care Inspection
Directorate - Care Quality Commission (Central Region)6 12:10-12:40 Hugh Ellis, Safeguarding Adults Team Manager - Serious Concerns/Standards
of care Framework7 12:40-13:00 Information Sharing
Oxfordshire Adult Social Care Workforce Strategy
Care Home Provider WorkshopsNovember 2015
Workforce issues & challenges
• If we don’t take action …
Capacity gap
Current Y1 Y2 Y312000
12500
13000
13500
14000
14500
15000
15500
16000
Worker supplyWorker demand
Worke
r Num
bers
• It’s high – 29.5% PVI sector average– 23.3% Care workers, home care– 38.0% Care workers, care homes– 53.1% Nurses, care homes
• 3,700 recruitments per year– 54% move jobs within the sector– 46% recruited from outside the sector
Turnover
Current Year 1 Year 2 Year 312000
12500
13000
13500
14000
14500
15000
15500
16000
Forecast demandCurrent supplyTurnover 32%Turnover 26%Turnover 20%
Reducing Turnover
Oxfordshire’s …
• Social care workers are poorly educated – Less educated than regional and national peers– 54% of care workers have no qualifications
• More reasons to leave than stay? – Few opportunities for career development– 8.5 care worker jobs for every 1 senior care worker job– Workers do not stay in their roles as long as regional and national peers
• Managers are older, less qualified and less experienced – 40% of registered managers are over 55– 23% don’t have a level 4 qualification
– Registered managers are older, less qualified and have been in post for less time than regional and national averages
Capability
What’s the plan?
15 point framework for action
Five actions to build capability
15 Support carers, volunteers and local communities
14 Support competence, qualifications and career pathways
13 Support core skills development
12 Support leadership and management development
11 Support workplace learning cultures
Three enabling actions
3 Ensure commissioning addresses workforce issues
2 Improve workforce data & intelligence
1 Develop Workforce Partnership Board, Council & communication strategy
10 Support pre-employment programmes and Apprenticeships
9 Support effective use of technology
8 Develop partnerships in care
7 Support effective employment practices
6 Support recruitment & retention of care home nurses
5 Support recruitment across the county
4 Make the Social Care Commitment
• Social care recruitment campaign, including:– Vacancy matching service, resources, information and advice,
job centre liaison• Values-based recruitment pilot• Programme of training & awareness on dementia and
assistive technology• Workforce planning tool, with Skills for Care• Help to Live at Home workforce specification & contract
induction • Workplace learning culture workshop• Workforce data & intelligence analysis
Done so far …
• Confirm delivery plan and priorities• Seek and secure funding• Actions for all
– No single organisation can fix the problem– Everyone can do something to help
Next steps
15 point framework for action
Five actions to build capability
15 Support carers, volunteers and local communities
14 Support competence, qualifications and career pathways
13 Support core skills development
12 Support leadership and management development
11 Support workplace learning cultures
Three enabling actions
3 Ensure commissioning addresses workforce issues
2 Improve workforce data & intelligence
1 Develop Workforce Partnership Board, Council & communication strategy
10 Support pre-employment programmes and Apprenticeships
9 Support effective use of technology
8 Develop partnerships in care
7 Support effective employment practices
6 Support recruitment & retention of care home nurses
5 Support recruitment across the county
4 Make the Social Care Commitment
Any questions?
• Contact details:– [email protected]– 01865 323643 or 07919 298290
OxfordshireClinical Commissioning Group
Proactive Medical Support to Care Homes 2015
New scheme introduced early 2015 to align care home with specific GP practice and provide scheduled weekly GP visit with the aim of providing more anticipatory care to improve quality of care and reduce inappropriate hospital admissions
OxfordshireClinical Commissioning Group
Features of anticipatory care
Documented advance care planning-what are wishes in the event of deterioration/end of life (preferred place of care, “ceiling” of care, resuscitation status ). Documentation needs to be readily accessible to care home staff and available for patient/next of kin
Reviewing medication regularly – drugs no longer required (eg antidepressants, BP medication), drugs where potential harmful side effects outweigh benefits , drugs which may improve patient quality of life
Identifying medical problems early to prevent escalations
Ensuring supportive measures for end-of-life care in place
(good communication with staff/family, anticipatory drugs etc)
OxfordshireClinical Commissioning Group
Challenges implementing scheme
• Considerable and growing pressure on GP practices – eg ageing population and increasing complexity of patient problems
• Some are experiencing recruitment difficulties• Historical or current difficulties in managing care home
patients• Perceived workload problems with providing the care
required under this scheme• Some consider payments under the scheme insufficient• Some concern residents will no longer be able to stay with
existing GP where patient preference is for this to happen
OxfordshireClinical Commissioning Group
How is it going?• Slow but steady take-up of the scheme among GP
practices• Initial data on emergency hospital admissions
show encouraging reductions• First 6 month data collection from practices in the
scheme appears to show good compliance with scheme
• Survey underway to collect feedback from care homes, GPs and Care Home Support Service to inform any adjustments at formal review early 2016
OxfordshireClinical Commissioning Group
Growth in number of care homes covered by scheme
Apr-15 Jun-15 Aug-15 Current (Nov 15)0
20
40
60
80
100
120
2431
39
56
8376
68
51
Participating Care Homes Non-participating Care Homes
OxfordshireClinical Commissioning Group
Coverage of scheme Nov 2015
0
10
20
30
40
50
6031
4656 51
OxfordshireClinical Commissioning Group
Cost and activity comparison of care homes’ emergency hospital admissions
Apr-15 Jun-15 Aug-15-60%
-50%
-40%
-30%
-20%
-10%
0%
10%
20%
-20%
-37%
-50%
8% 10% 11%
-10%
-28%
-36%
1%5% 4%
Participating Care Homes Cost Non-participating Care Homes Cost
Participating Care Homes Activity Non-participating Care Homes Activity
OxfordshireClinical Commissioning Group
Advanced care plans and medication reviews recorded by practices after 1st 6 months of scheme
0
200
400
600
800
1000
1200
1400
1220
967
787
588 566
876
Computerised advance care plans (Digital Proactive Care Plan) being introduced to improve capture of preferred place of care and resusc status
OxfordshireClinical Commissioning Group
Deaths and hospital admissions recorded by practices in 1st 6 months of scheme
Death
s
Plac
e of
dea
th re
cord
ed
Died
in car
e ho
me
Died
in h
ospi
tal
Emer
genc
y Hos
pita
l adm
issio
n 0
20406080
100120140160180200 181
153 130
23
66
OxfordshireClinical Commissioning Group
What can care homes do to be “taken on” by practices (if this is wanted) ?
• Use support provided by Care Home Support Service to ensure organisational aspects of scheme are in place
• Obtaining good background medical information on each new resident at time of admission including accurate and up-to-date medication
• CHSS may also be able to help with aspects of optimising patient care to reduce GP time doing so
• Assisting with advance care planning • Discuss with practices their concerns and anything that might
help
OxfordshireClinical Commissioning Group
The future?Emerging strategy across health care providers and commissioners for out-of-hospital carePromoting ambulatory care (ie specialist input
but without a hospital admission)Preventing patients medically fit for discharge
staying in hospital by providing more rehabilitation support and care in their home setting
Possibly expanding “intermediate care” beds in nursing homes ie patients transitioning from hospital to home
Break
1
Ensuring good care in residential and nursing homes
Carol Schubert, Inspection Manager, Adult Social Care17 November 2015
The Mum (or anyone you love) Test
Is it good enough for my Mum?
Is it safe?
Is it caring?
Is iteffective?
Is it responsive to people’s needs?
Is itwell-led?
28
Focusing on quality
Providing better information
Encouraging innovation
Becoming a more efficient regulator
Working with partners to encourage improvement
Our new strategy for 2016-2021 will help us to achieve these goals
3
What is CQC’s role?
30
Regulation to inspire improvement
What we do:
Set clear expectations
Monitor and inspect
Publish and rate
Celebrate success
Tackle failure
Signpost help
Influence debate
Work in partnership
31
Our new approach
32
Pre
viou
s R
egul
atio
ns
Care and welfare of service usersAssessing and monitoring the quality of service provision Safeguarding service users from abuse Cleanliness and infection control Management of medicines Meeting nutritional needs Safety and suitability of premises Safety and suitability of equipment Respecting and involving service users Consent to care and treatment Complaints Records Requirements relating to workersStaffing Supporting workers Cooperating with other providers
New
Reg
ulat
ions
Person-centred careDignity and respectNeed for consentSafe care and treatmentSafeguarding service users from abuseMeeting nutritional needsCleanliness, safety and suitability of premises and equipmentReceiving and acting on complaintsGood governanceStaffingFit and proper persons employed and Fit and proper persons requirement for directorsDuty of candour
Fundamental standards
33
Fit and proper person requirement
PurposeEnsure directors or equivalents are held accountable for the delivery of care and
They are fit and proper to carry out this role
Actions for providersEnsure recruitment of ‘directors’ tests whether candidates meet the requirement
CQCRegistration
Respond to concerns raised
34
Special measures
PurposeEnsure failing services improve or close
Actions for providersUse time available to improve service
CQCServices rated as inadequate will go into special measures
Time limited period to improve
Improvements made – out of special measures
No improvement – move to cancel registration
35
Scores on the doors
PurposePublic able to see rating of service quickly and easily
Actions for providersDisplay ratings in service and website
Suggest accompany with additional information
CQCWill provide template
Inspection – check that rating is displayed
36
Example of poster showing Good rating
Scores on the doors
37
What will market oversight do?
6
PurposeProtect people in vulnerable circumstances by spotting if a provider may fail – and make sure right action is taken
CQC will: Monitor finances of ‘difficult to replace’ providers – 40-50Provide early warning to local authoritiesAssist with system response if failure occurs
It will not:Either ‘bail out’ struggling providers, or pre-empt failure through inappropriate disclosure of information
38
Our enforcement powers
• Requirements (formerly known as compliance actions)
• Warning notices• S.28 warning notices
Protect people who use services by
requiring improvement
Civil enforcement powers• Impose, vary or remove
conditions of registration • Suspension of registration • Cancellation of registration • Urgent procedures
Failing services • Immediate action to protect
from harm • Time-limited ‘final chance’• Coordination with other
oversight bodies
Criminal powers • Penalty notices • Simple cautions • Prosecutions
Holding individuals to account • Fit and proper
person requirement • Prosecution of
individuals
Hold providers to account for failure
Sev
erit
y
Protect people who use services by requiring
improvement
A challenging environment
13
Most organisations are good or outstanding, but some people get poor care:
7% of services rated were inadequate
Current ratings overall and by key question
40Source: Ratings data extracted 11/09/2015
9122 services rated at October
2015
Ratings by service type
41Source: Ratings data extracted 11/09/2015
Themes from Well-led:Outstanding
42CQC Published reports – sampled for data on well-led in mid June. Sample size 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted).
Themes common to Outstanding services
43
• People who use services, relatives and staff speak highly of the service
• Effective monitoring, quality assurance and audit systems
• Open culture - people who use services/staff/relatives given the opportunity to share views and any issues are addressed
• 75 per cent of services had a registered manager in post consistently, and that manager is supportive of their staff
• Good leadership extends beyond the manager and includes the provider
CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.
Themes from Well-led:Outstanding sample only
44
• Effective systems in place for managing and developing staff
• Safe care actively promoted – effective oversight of care and staff communication
• A can do, will do, attitude
• Effective partnership working
• Culture of continuous development of the service/manager/staff with best practice being followed
• Service and/or staff being recognised through national or local awards
• Strong links with the local community in just under half of the services
“This place is brilliant, management care so much as do the staff,
everybody knows their role and the
atmosphere is amazing.”, “I’m made to feel important, I’m encouraged to better
myself”
CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.
Safety is a fundamental expectation …but it is our biggest concern
Not learning from mistakes Not planning for the future
19
Safety
Safety is our biggest concern
Staffing requirements, safeguarding and medicines management are key factors
20
Adult social care
Themes from Well-led: Inadequate sample only
47CQC Published reports – sampled for data on well-led. In mid June. Sample size 127 services with inadequate ratings for well-led.
Themes common to Inadequate services
48
• People who use services and their relatives speak of continuous management churn and change
• Poor care planning resulting in lack of personalised care
• Closed culture - people who use services/staff/relatives feeling unable to raise issues or their views not listened to or acted upon
• No registered manager or, if in post, unable to lead and support staff effectively and consistently
• Poor oversight of care with care plans not up to date, reviewed or followed
CQC Published.
Themes common to Inadequate services
49
• Ineffective systems to identify and manage risks and learn from mistakes
• Lack of supervision and training opportunities to develop staff skills
• Poor working relationship between the manager and the provider
• Under developed partnership working and community links
• Unawareness of best practice• Notifications to CQC not being made
CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.
Good leadership is important to delivering safe, good quality care
24
Leadership
Continue to provide information about individual services
Set expectations for services to work with others
Undertake thematic reviews – Cracks in the Pathway
Look at experience of people in localities
What can regulation do to help?
Person-centred co-ordinated care not organisational focus
Work with vanguard sites
‘Walk the talk’ – work in partnership with others – through co-production and addressing duplication
25
Where we see poor care, we challenge providers to improveWhere we see excellence, we celebrate it
26
Encouraging improvement
An outstanding care home
‘Relatives and friends visiting the home told us they only had positive experiences and praise for this service’
‘Staff told us that they would not like to work anywhere else’
Vida Hall, Harrogate
53
An outstanding care home
"We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of
their life with as much happiness, love and security as we can give them."
Suzanne, Prince of Wales House, Ipswich
54
29
The future
Putting quality of care at the centre of
change and Innovation
Some thoughts to consider………
Do I have a trusted critical friend, someone independent who will tell me the truth abut my service?
Do I really know what care users think about the care and attention they receive?
Are my staff really clear about our visions and values?
Do I have ways in which to encourage and support my staff to try out innovative ideas?
How do I value and support my staff?
Adult Safeguarding
The Way Ahead
What we are doing today ?
1. Changes in adult safeguarding
Ethos and language National and local
changes
2. What does this mean for you? Implementing
making safeguarding personal
Representation & advocacy
3. How we are hoping to help
New web site Updated
procedures On-line referral Threshold of
Needs Matrix
3. Any questions?
1. Work is person centered and makes safeguarding personal
2. Needs and interests of adults at risk always respected and upheld
3. The human rights of adults at risk are respected and upheld
4. Response is proportionate, timely, professional and ethical
5. Decisions and actions in line with The Mental Capacity Act 2005
6. Key words:
Changes in SafeguardingEthos of Safeguarding
Empowerment … Protection … PreventionProportionality … Partnership … Accountability
Changes in SafeguardingNew language of Safeguarding
Enquiries not investigations or assessments
• Establish facts• Ascertain adult’s views and wishes• Assess need for protection, support and redress. How might
they be met?• Protect from the abuse and neglect, in accordance with
wishes of adult where possible• Decide follow-up action for those responsible for the
abuse/neglect• Enable the adult to achieve resolution and recovery
1.New
categories
2.Specific
mandatory requirement
to investigate (section 42 of the Care
Act)
3. Making
safeguarding personal
4. Representati
on and advocacy
Changes in SafeguardingNational Changes in the Care Act
Changes in SafeguardingChanges to categories
10 categor
ies(2 added and one
amended by the
Care Act)
Acts of omission & neglect
Physical abuse
Domestic violence
Sexual abuse
Psychological abuse
Financial or material
Self-neglect
Modern slavery
Amended category
3 New categories
Exsisting categories
Changes in SafeguardingSection 42
Duty to make enquiries
Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult who meets the criteria is, or is at risk of, being abused or neglected.
This duty continues until it decides what action is necessary to protect the adult and by whom and ensures itself that this action has been taken.
Changes in Safeguarding Making safeguarding personal? (1)
At the start of the process a person should be able to say:
The help I received made my situation
better
People asked what I wanted to happen
and worked together with me
to get it.
When things started to go wrong, people around me noticed and acted
early.
I got the help I needed by those in the best placed to
give it.
I understood the reasons when
decisions were made that I didn’t agree
with.
People will learn from my experience and use it to help others
Changes in Safeguarding Making safeguarding personal? (2)
I felt safe and in control
People understood me – recognised and
respected what I could do and what I needed
help with
Professionals helped me to plan
and manage the risks that were important
to me
I had good quality care.
I had the
information
I needed, in
the way that
I needed it
The people I wanted were
involved
People worked
together redu
cing
risk to my safety
and wellbeing
At the end of the process a person should be able to say:
Changes in SafeguardingRepresentation and Advocacy
Must work within existing
Mental Capacity Act (2005)
Always presume capacity - take
reasonable steps to establish a person’s
capacity
If a person lacks capacity decisions
must be in their best interest and ‘least restrictive option’
Always involve the person - consult
their family, friends and obtain advocacy
where necessary
Changes in Safeguarding
The safeguarding duties apply to an adult who:• has needs for care and support (whether or not
the local authority is meeting any of those needs) and;
• is experiencing, or at risk of, abuse or neglect; and
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.
New OSAB website to replace Safe from Harm (www.osab.co.uk)
New online Safeguarding Form (7th December)
New OSAB Threshold of Needs Matrix
What does it mean for you?1. What outcomes do you want to achieve?
• Prevention: take action before harm occurs• Protection: support and represent those in greatest
need2. How are you going to achieve these outcomes?
• Empowerment: person led decision-making and informed consent
• Partnership: working with others and the local community
• Proportionality: least intrusive appropriate response to the risk
3. How will you know?• Accountability: safeguarding practice and
arrangements should be accountable and transparent
Questions
Information Sharing
The Flu VaccinationWinter 2015/16
The following groups are recommended by the NHS to receive the flu vaccine:
• Everyone aged 65 and over• Everyone living in a residential or nursing home• Everyone who cares for an older or disabled person• All frontline health and social care workers• For advice and information about the flu vaccination, speak to
your GP or practice nurse. • Further information is available on the NHS Choices website: http://www.nhs.uk/Livewell/winterhealth/Pages/Fluandthefluvaccine.aspx