OLDER PEOPLE IN HAMMERSMITH AND FULHAM - FUTURE NURSING HOME PROVISION

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1 AGENDA ITEM NO. 5 HEALTH AND ADULT SOCIAL CARE SCRUTINY COMMITTEE 16 November 2006 SUBJECT OLDER PEOPLE IN HAMMERSMITH AND FULHAM - FUTURE NURSING HOME PROVISION WARD/S ALL CONTRIBUTORS PCT SYNOPSIS This report sets out the current nursing home provision and future capacity as determined by factors such as patient choice to receive care in the home. It also provides details of strategies being proposed to address the changing patterns in care provision. RECOMMENDATIONS 1. That the Committee considers the report and make recommendations as appropriate to the Cabinet Member for Community and Children s Services. 2. That the Committee note the report. CONTACT OFFICER: Sarah Arkle Director of Commissioning & Partnerships H&F Primary Care Trust 32

2 1. INTRODUCTION 1.1 In April 2006, LBHF Health and Social Care Scrutiny Panel were informed that the PCT in partnership with LBHF and key local stakeholders were considering plans for the future of NHS continuing care in the borough. In 2000 Ealing, Hammersmith and Hounslow Health Authority developed a strategy for Older People with high care needs in partnership with the London Borough of Hammersmith and Fulham. It included NHS continuing care services, rehabilitation services, and long-term residential care for older people. The strategy has seen the development of Extra Care Sheltered Accommodation and three new care homes, Acton Care Centre which opened in April 2003, Farm Lane which opened in September 2005 and St Vincent s which opened in April When these plans were first made, approximately 120 continuing care and rehabilitation beds were being provided. The Health Authorities plan was to reprovide this number of beds, in modern, cost-effective facilities within borough which vastly reduced the need for people to move homes if their needs changed. 1.3 However, changing patterns in where people choose to receive long term care has lead to more older people opting to remain in their own homes for longer and to support this we have invested in a range of community based services which provide support and rehabilitation to people to remain well at home. Consequently the demand for beds in nursing homes has dropped significantly. 1.4 The following graph shows the numbers of people requiring NHS continuing care since April

3 H&F PCT Continuing Care Totals for Older People April Aug 2006l Total Number of Placements Apr-04 May Jun-04 Jul-04 Aug-04 Sep-04 Oct-04 Nov-04 Dec-04 Jan-05 Feb-05 Mar-05 Apr-05 May Month and Year Jun-05 Jul-05 Aug-05 Sep-05 Oct-05 Nov-05 Dec-05 Jan-06 Feb-06 Mar-06 Apr-06 May-06 Jun-06 Jul-06 Aug The PCT are faced with a large number of empty beds in the three new care homes. A number of these have beds have been sold on to the London Borough of Hammersmith and Fulham (LBHF) and some to neighboring PCTs. However at any one time there are approximately beds not being used by PCT clients. This is not a good use of scare NHS resources and the PCT needs to ensure that we provide the right number of beds for people requiring NHS continuing care and ensure that we spend public money in the best way possible. 2. CURRENT SERVICES 2.1 The PCT currently has contracts with Vintage Care for Acton Care Centre, and in partnership with LBHF with Care UK for Farm Lane and St Vincent s Care s for the provision of - NHS continuing care beds. This is long term care for frail older people or older people with dementia who meet NHS continuing care criteria (see attached) - Intermediate care beds, to provide step care to facilitate early discharge from hospital prior to returning home - Rehabilitation beds to provide short term intensive rehabilitation - All services are provided in newly built, single room with en suite accommodation 2.2 Acton Care Centre is located outside of borough, St Vincent s and Farm Lane are in borough (see map attached). 54 Total 34

4 Table 1 Older Peoples Bed Configuration as at October 2006 Site Dementia Frail Elderly Interim Rehab Care Acton Care Farm Lane Care St Vincent s Care Total beds (122) In addition to this we are currently spot purchasing 5 continuing care beds outside of borough and are supporting 14 people with continuing care at home. 2.4 The contract with Care UK for St Vincent s and Farm Lane is a 25 year contract with no opportunity to withdraw without significant penalties. 2.5 The contract with Vintage Care for Acton Care Centre is a 10 year agreement and there is an opportunity to terminate the agreement 5 years from the date of opening. 3. THE NEED FOR CHANGE 3.1 Over half of the contracted nursing homes beds are not being used by PCT clients. Table 2 Beds being used by PCT clients as of 1 September 2006 Site Dementia Frail Elderly Interim Rehab Care Acton Care Farm Lane Care St Vincent s Care Total beds (57) The PCT cannot continue to pay for beds that are not being used. This is a poor use of scare NHS resources that could be redeployed. 3.3 We have talked to key local stakeholders about options for using the vacant capacity in the nursing homes. Some of the areas we have explored are: 35

5 - Developing local services for younger physically disabled people - Developing palliative care services - Developing more rehabilitation services - Selling vacant capacity to neighbouring PCTs 3.4 However, none of the options above have proven to be robust in terms of demand, service provision and costs. 3.5 We are currently selling 30 beds to other local authorities and PCTs, these are generally on spot basis, so long term funding is not secure. 36 In 2005/6 we had an agreement with the Hammersmith Hospital NHS Trust to contribute to the funding of rehabilitation beds to facilitate discharge from hospital. We have been unable to secure commitment to ongoing funding from the Hospital in 2006/ We are confident that we are fully meeting the local need for NHS continuing care both now and in the future because: There are no delays in discharging people from hospital to NHS continuing care. The population of people over 70 year of age is projected to remain stable up to The demand for NHS continuing care for older people has remained stable for the last 3 years 4. FUTURE NURSING HOME PROVISION 4.1 The PCT needs to reduce the numbers of beds that we are paying for that are not being used. In doing this the PCT will continue to: - Ensure that high quality services are provided for older people requiring NHS continuing care - Provide sufficient services to meet local demand - Ensure that any change has minimal disruption to existing patients - Retain services in borough - Provide choice - Provide rehabilitation and interim care(subject to agreement on funding with HHNT) - Make spot placements out of borough in exceptional circumstances (e.g. to meet specific faith requirements etc.) - Support continuing care at home where this does not exceed the cost of a nursing home bed. 4.2 In order to reduce bed numbers the PCT has given 18 months notice to terminate the contract with Acton Care Centre as of April 2008 and relocate 36

6 these services to Farm Lane and St Vincent s. This will also mean that any commissioners sub contract PCT beds e.g. LBHF, will need to make their own arrangements with the care providers for these beds in the future. The PCT will retain an agreement with Care UK for 62 beds, which we believe will meet the demand for NHS continuing care and continuation for rehabilitation and a number of interim care beds. 4.3 In consultation with other local service providers we have determined that the best configuration for these services is to move Dementia Care from Acton to St Vincent s, move Frail Elderly from Acton to St Vincent s and Farm Lane. Table 3 Future service configuration Site Dementia Frail Elderly Interim Rehab Care Acton Care Farm Lane Care St Vincent s Care Total beds (62) This service configuration moves dementia care in borough to a facility that will also have a dementia day hospital and where the Community Mental Health Team for older people is located. This will address concerns raised in complaints over the last three years that dementia care is not available in borough. 4.5 Frail elderly care will be provided in both homes. There will be some flexibility in the designation of the beds across the sites, which will ensure that we can meet fluctuations in demand. Rehabilitation will continue to be provided at Farm Lane. 4.6 The services currently provided at Acton Care Centre can then be transferred to Farm Lane and St Vincent s during the 18 month notice period. We would need to cease admissions to Acton as soon as possible to ensure that the minimum number of residents remain in Acton once the contract terminates. We would wish to offer a choice to remaining residents as to whether they would like to continue to live at Acton or move to one of the other homes. No one will be required to move if they do not wish to do so. 4. FINANCE (AT 2006/7 PRICES) Cost of current services million Current income (from selling on beds - insecure) million 37

7 Cost of future option estimated 3.2 million (this does not include any costs of continuing to purchase beds for individual who wish to remain at Acton) 5. CONSULTATION 5.1 Discussions over the future use of the nursing homes beds and the proposed changes have taken place over the past 18 months with Hammersmith Hospitals NHS Trust, LBHF Social Services, Care UK and Vintage Care, the Whole Systems Steering Group which is a multi agency commissioning group which includes representatives of older people, cares and voluntary sector, Better Government for Older People and the Patient and Public Involvement forum. The options in the paper build on the regular updates that have been provide to the PCT board, the last one agreeing the development of rehabilitation in July CONCLUSION 6.1 We have explored the potential for using the spare capacity in our nursing home provision. In order to reduce the financial risk to the PCT and poor utilisation of scare NHS resources we are terminating our contract with Acton Care Centre and providing dementia care, frail elderly NHS continuing care and rehabilitation at Farm Lane and St Vincent s nursing homes. The PCT will work closely with LBHF Social Services and Care UK to ensure that good quality NHS continuing care service are provided to meet the needs of older people in Hammersmith and Fulham, in local facilities that are of a high standard. 38