Oxfordshire Care Home Provider Meeting 17 November 2015

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

mailto:[email protected]

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


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)


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


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


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


Coverage of scheme Nov 2015

0

10

20

30

40

50

6031

4656 51


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


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


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


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


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”


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


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?

[email protected]

@CareQualityComm

Carol SchubertInspection Manager, Adult Social Care

Thank you

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)

http://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

http://www.nhs.uk/Livewell/winterhealth/Pages/Fluandthefluvaccine.aspx

http://www.nhs.uk/Livewell/winterhealth/Pages/Fluandthefluvaccine.aspx

Documents

Oxfordshire Care Home Provider Meeting 17 November 2015