Cordis Briefing Extracts · BRAND B & M Care 1,125 620 55% BRAND Life Style Care plc 2,526 575 23% BRAND Care South 872 575 66% BRAND Hampshire County Council 1,054 570 54% There

Cordis Briefing Extracts

July 2016

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Today’s Briefing

• Brexit

• Deprivation of Liberty Safeguards

• Care Home Managers

• CQC Annual Report and Strategy

• Health and Social Care Integration Update

Extract


Deprivation of Liberty Safeguards

DoLS Report 2014/15 and the Law Commission’s proposals

for “Protective Care” scheme

Extract


Introduction

• We are going to have our annual look at DoLS activity with a look at:

– CQC’s “Monitoring the Deprivation of Liberty Safeguards in 2014/15”

– HSCIC’s “Deprivation of Liberty Safeguards Annual Report 2014/15”

• We will then look at the Law Commission’s proposals for replacing the

DoLS, which the House of Lords describes as being “not fit for

purpose” with a new scheme

• Along the way, we will look back to where this all started, with “A”

having a difficult day in his day centre in 1997

Extract


CQC’s Monitoring the DoLS

• We looked at the CQC’s report in January 2016 alongside annual

statistics on Safeguarding.

• This is the first full year of post-West Cheshire reporting on DoLS. As

we have noted previously, there has been a substantial increase in

DoLS referrals since West Cheshire:

Extract


DoLS Applications

??

-

50,000

100,000

150,000

2009/10 2010/11 2011/12 2012/13 2013/14 2014/15

DoLS Applications

Extract


DoLS – Detailed activity data from HSCIC

• The HSCIC report provides detailed data on DoLS activity by Local

Authority area and by CQC Registered Location.

• This level of data highlights issues that are not apparent from the CQC

report.

Extract


DoLS Data by provider

• The HSCIC background data provides information on DoLS Referrals

and outcomes by CQC Location ID.

• Combining this with CQC’s published directory of service makes it

possible to analyse DoLS performance by provider.

• There may be data issues which affect the reliability of the figures, as

they rely on accurate reporting of DoLS by local authorities and correct

tagging by Location ID

• The following charts look at provider performance on DoLS in relation

to:

– The total number of referrals made as a percentage of Care Home Beds

– The number of authorised DoLS referrals as a percentage of total referrals

made

• Full datasets can be obtained from [email protected]

Extract


mailto:[email protected]

DoLS Applications Made

Provider NameCare Home

BedsDoLS

Applications Application %

Handsale Limited 295 5 1.7%

BRAND Eldercare 573 10 1.7%

Central Bedfordshire Council 265 5 1.9%

Horizon Care Homes Limited 241 5 2.1%

Borough Care Ltd 466 10 2.1%

Mark Jonathan Gilbert and Luke William Gilbert 445 10 2.2%

Czajka Properties Limited 220 5 2.3%

BRAND Norwood 206 5 2.4%

Nazareth Care Charitable Trust 617 15 2.4%

Unity Homes Limited 324 10 3.1%

Care Homes UK Limited 162 5 3.1%

BRAND Metropolitan Housing Trust Limited 161 5 3.1%

Ms K A Rogers 157 5 3.2%

BRAND Viridian Housing 312 10 3.2%

Mrs Sally Roberts & Mr Jeremy Walsh 152 5 3.3%

Chadderton Total Care Limited 151 5 3.3%

Friends of the Elderly 438 15 3.4%

Mrs Wendy J Gilbert & Mr Mark J Gilbert 144 5 3.5%

Low levels of applications could be because of

low level care needs, an unsupportive LA or lack

of awareness of the regulations

Extract




BedsDoLS

ApplicationsApplication

%

Mrs Barbara and Mr Andrew Watt 17 120 706%

Wirral Metropolitan Borough Council 20 100 500%

Mrs D J Brown 11 40 364%

Family Care Trust 7 25 357%

Penrose Residential Limited 6 20 333%

Dementia Care 5 15 300%

Independent Options (North West) 10 30 300%

Candour Care Services (Hillcrest) Limited 9 25 278%

Acorn Lodge (Bournemouth) Limited 16 40 250%

Mr & Mrs P Gilbert and Miss C Gilbert 17 40 235%

Medway Council 15 35 233%

Mrs P Hunter 9 20 222%

Garden House Rest Home Limited 14 30 214%

Key Healthcare (St Helens) Limited 44 90 205%

Solar Care Homes Limited 10 20 200%

Ranmore House 5 10 200%

High levels of referrals could indicate a high

turnover of residents over the 12 month period,

or people with multiple authorisations

Extract




BedsDoLS

ApplicationsApplication

%

BRAND Barchester Healthcare 10,712 4,400 41%

BRAND BUPA Group 17,778 3,115 18%

BRAND Four Seasons Group 18,104 3,050 17%

BRAND Care UK 6,943 2,505 36%

BRAND Runwood 3,422 1,290 38%

BRAND HC-One Limited 7,926 1,105 14%

BRAND Quantum Care Limited 1,527 995 65%

BRAND Sanctuary Care Limited 3,418 880 26%

BRAND Priory Group 3,130 795 25%

BRAND Sunrise Senior Living 3,348 765 23%

BRAND Orchard Care Homes 4,971 655 13%

BRAND Cornwall Care Limited 661 630 95%

BRAND Anchor Trust 4,058 620 15%

BRAND B & M Care 1,125 620 55%

BRAND Life Style Care plc 2,526 575 23%

BRAND Care South 872 575 66%

BRAND Hampshire County Council 1,054 570 54%

There is a wide variance in the number of

applications as a percentage of beds – 95% for

Cornwall Care* at one end, and Orchard Care

Homes with 13% at the other. Personalisaton?

Extract


DoLS Applications Granted

Provider Name Total Applications Granted%

BRAND Minster Care Group 280 100.00%

BRAND Meridian Healthcare 245 100.00%

BRAND Ideal Care Homes Limited 245 100.00%

BRAND Roseberry Care Centres 200 100.00%

BRAND Gold Care Homes 185 100.00%

Flightcare Limited 175 100.00%

BRAND Lancashire County Council 150 100.00%

BRAND Leonard Cheshire Disability 140 100.00%

BRAND Hill Care Group 135 100.00%

Island Health Care Limited 120 100.00%

County Care Homes Limited 115 100.00%

Restful Homes (Cannock) Limited 115 100.00%

BRAND Caretech Community Services 115 100.00%

BRAND Advinia Healthcare 105 100.00%

Nellsar Limited 105 100.00%

Most of these providers are national, suggesting

good practice on applications rather than LAs

rubber-stamping authorisations

Extract



Provider NameTotal

Applications Granted%

P S P Health Care Limited 195 0.00%

Brunelcare 160 0.00%

BRAND Abbeyfield Society 160 0.00%

N Notaro Homes Limited 130 0.00%

Mrs Barbara and Mr Andrew Watt 120 0.00%

Regal Care Trading Ltd 120 0.00%

Cornwallis Care Services Limited 115 0.00%

Oak Care Limited 115 0.00%

Stonehaven (Healthcare) Limited 115 0.00%

BRAND Norse Care (Services) Limited 115 0.00%

BRAND Somerset County Council (LD Services) 110 0.00%

BRAND Accord Housing Association Limited 110 0.00%

Dukeries Health Care Limited 110 0.00%

Hillcroft (Carnforth) Limited 105 0.00%

Wirral Metropolitan Borough Council 100 0.00%

These are applications that have been

processed and rejected. You would hope that

Somerset County Council could get it right – but

they only approve 13% of applications overall

Extract



Provider NameTotal

Applications Granted%

BRAND Barchester Healthcare 4,400 83%

BRAND BUPA Group 3,115 87%

BRAND Four Seasons Group 3,050 86%

BRAND Care UK 2,505 88%

BRAND Runwood 1,290 85%

BRAND HC-One Limited 1,105 90%

BRAND Quantum Care Limited 995 74%

BRAND Sanctuary Care Limited 880 89%

BRAND Priory Group 795 71%

BRAND Sunrise Senior Living 765 97%

BRAND Orchard Care Homes 655 71%

BRAND Cornwall Care Limited 630 14%

BRAND B & M Care 620 78%

BRAND Anchor Trust 620 94%

BRAND Care South 575 73%

BRAND Life Style Care plc 575 93%

Cornwall Care make lots of applications (95% of

total beds), but only 14% are authorised. Anchor

are the opposite.

Extract


Local Authority Data

• The HSCIC data indicate a wide variation in performance across the

country, although there are some clear patterns

• The next few maps looks at DoLS applications in relation to:

– The total number of applications made per 10,000 of the population

– The percentage of applications that have not been completed (processed)

– The percentage of applications granted

Extract


DoLS Applications per 10,000 population

Extract


DoLS Applications not completed

Extract



Is a high level of applications granted a good

thing? It could suggest that councils are “rubber-

stamping” applications and not considering fully

Extract


Reforms of the DoLS Framework

• The wide variance in DoLS performance between providers and local

authorities highlights why the House of Lords described the

Deprivation of Liberty Safeguards as “not fit for purpose”.

• The Law Commission was tasked with developing an alternative to

DoLS in 2014, and is currently working on draft legislation to be

pubished at the end of the year.

• Before looking at what the Law Commission is proposing, it is worth

looking at what got us to this point:

Extract


Extract


The Commission Proposals

Extract


Key Messages

• Even after 8 years, providers and local authorities are still having

problems with DoLS.

• Although the scope of DoLS has been increased by the West Cheshire

judgment, the data show that there are still fundamental problems in

care homes, where the regulations have applied for a long time

• The Law Commission proposals won’t narrow the scope of DoLS to

pre-West Cheshire levels, but they will shift some of the burden back

to LAs, to undertake alongside care planning

• There are still unanswered questions about changing capacity and

DoLS, and the role of providers in notifying the commissioner. You will

need to keep on top of the deprivation of liberty

• Care Home Managers will be key to the assessment and management

of mental capacity,

Extract


Delayed Transfers of Care

Data Review

Extract


Overview

In the last 5 years, as the population of older people in England has

grown, so too has the level of Delayed Transfer of Care

Sources: Office for National Statistics Population Estimates

DToC Time Series (Aug 2010 – Jul 2011, Apr 2015 – Mar 2016)

SIZE OF OLDER POPULATION (75+)

4.1 million 4.4 million

2010 2015

+7%

TOTAL DTOC DAYS

1.4million 1.8 million+22%

Extract


The level of Delayed Transfer of care

varies significantly between Local

Authorities

DToC (November 2015 – April 2016)

1st Quartile (Lowest Levels)

2nd Quartile

3rd Quartile

4th Quartile (Highest Levels)

Source: DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)

Extract


DToC (November 2015 – April 2016)

LOCAL AUTHORITIES WITH THE HIGHEST TRANSFER OF CARE RATE

LOCAL AUTHORITIES WITH THE LOWEST TRANSFER OF CARE RATE

Cumbria

East Sussex

Trafford

Cornwall

Oxfordshire

Northamptonshire

Dorset

North Somerset UA

Devon

Coventry

Oldham

Barnsley

Sunderland

Bradford

Wirral

Northumberland

Newham

Redbridge

Stockton

On Tees UA

Salford


Extract


DToC and the older population

Unsurprisingly, there is a strong

correlation between areas with a high

proportion of older people (75+) and a

high level of DToC

10 Local Authorities with the

highest DToC rate

Local Authorities with at least

10% of the population aged 75%

Local Authorities in both of

these categories


DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)

Extract


DToC and available beds

0

5000

10000

15000

20000

25000

30000

35000

40000

0 2000 4000 6000 8000 10000 12000 14000

DTo

C-

nu

mb

er o

f d

ays

(No

v 2

01

5 -

Ap

r 2

01

6)

Total residential beds for older people

Local Authorities with a

high number of older

people tend to provide a

higher number of beds.

0

20000

40000

60000

80000

100000

120000

140000

160000

0 2000 4000 6000 8000 10000 12000 14000N

um

ber

of

old

er p

eop

le (

75

+)

Total residential beds for older people

Yet, a high number of

beds correlates with a

high number of DToC

days, suggesting that

supply is failing to meet

demand in high need

Local Authorities.


DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)

Extract


What are the reasons for DToC?

0 40000 80000 120000 160000 200000

A) COMPLETION OF ASSESSMENT

B) PUBLIC FUNDING

C) WAITING FURTHER NHS NON-ACUTE CARE

DI) AWAITING RESIDENTIAL HOME PLACEMENT ORAVAILABILITY

DII) AWAITING NURSING HOME PLACEMENT ORAVAILABILITY

E) AWAITING CARE PACKAGE IN OWN HOME

F) AWAITING COMMUNITY EQUIPMENT ANDADAPTIONS

G) PATIENT OR FAMILY CHOICE

H) DISPUTES

I) HOUSING - PATIENTS NOT COVERED BY NHS ANDCOMMUNITY CARE ACT

Reasons for DToC - Nov 2015 - Apr 2016The cause of DToC can be

due the NHS, Social Services,

or other factors.

The most DToC days in the 6

months studied were:

• Awaiting a care package in

own home

• Awaiting further NHS Non-

Acute Care

• Completion of Assessment


Extract


What are the reasons for DToC?

0% 5% 10% 15% 20% 25% 30% 35%

A) COMPLETION OF ASSESSMENT

B) PUBLIC FUNDING

C) WAITING FURTHER NHS NON-ACUTE CARE

DI) AWAITING RESIDENTIAL HOME PLACEMENT ORAVAILABILITY

DII) AWAITING NURSING HOME PLACEMENT ORAVAILABILITY

E) AWAITING CARE PACKAGE IN OWN HOME

F) AWAITING COMMUNITY EQUIPMENT ANDADAPTIONS

G) PATIENT OR FAMILY CHOICE

H) DISPUTES

I) HOUSING - PATIENTS NOT COVERED BY NHS ANDCOMMUNITY CARE ACT

Reason for DToC (as % of total DToC days)

Lowest DToC Rate Highest DToC Rate

The reasons for DToC in the

10 local authorities with the

highest DToC rate and the 10

with the lowest vary.

In Local Authorities with high

rates of DTOC the patient is

more likely to be awaiting a

care package in their own

home or awaiting the

completion of an assessment.

In the 10 lowest, the reason

being the patients choice, or

awaiting is much more

common.


Extract


The reasons for DToC are changing

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Parties Responsible for DToC 2010-2016

NHS Social Care Both

Across all local authorities,

the reasons for DToC have

been changing, particularly in

the last 18 months.

The proportion of DToC

caused by the NHS is

decreasing.

DToC caused by Social

Services is rising.

Source: Delayed Transfers of Care Statistics for England 2015/16

Extract


How to save £1bn through better

integration approaches

• Focus efforts where the biggest difference can be made, e.g. transfers

of care from hospitals

• Put in place strong leadership, ownership and accountability

• Empower the front line – co-design solutions; raise awareness and

understanding of what needs to be done

• Measure outcomes

• Trial new approaches in manageable areas before rolling them out and

don’t be afraid to change course if something isn’t working

• Standardise approaches that are working and roll them out at scale

• If a new approach works, get rid of the old way of working instead of

treating the new one as a bolt on

Extract


Your views on health and social care

integration

Extract


Viewfinder 2016

Question Agree2016

Agree 2015

The closer integration of health and social care is a good thing 93% 95%

Health agencies are the main barrier to better integrated care 69% 63%

Local authorities are the main barrier to better integrated care 47% 37%Private and not-for-profit providers are the main barrier to better integrated care 10% 0%

CCGs are a positive step towards greater integration 41% 32%The complete integration of health and social care will happen in the next 5 years 12% 21%Increased integration of health and social care provision will save money 66% 74%The greater integration of health and social care will improve the quality of services on offer 74% 84%The greater integration of health and social care represents a growth opportunity for my organisation 84% 74%

Extract



Documents

Cordis Briefing Extracts · BRAND B & M Care 1,125 620 55% BRAND Life Style Care plc 2,526 575 23% BRAND Care South 872 575 66% BRAND Hampshire County Council 1,054 570 54% There