CARE HOME/PROVIDER GOVERNANCE: UPDATE REPORT

Transcription

1 QUALITY & SAFETY COMMITTEE 09 OCTOBER 2014 AGENDA ITEM 3.2 CARE HOME/PROVIDER GOVERNANCE: UPDATE REPORT Report of Paper prepared by Purpose of Paper Action/Decision required To update the on the outcomes of the Care Home Governance Summit and the forward plan To discuss and note Link to Doing Well, Doing Better: Standards for Health Services in Wales : Link to Health Board s Annual Plan Acronyms and abbreviations 1. Governance and accountability framework Improving Health and Wellbeing Ensuring the Right Access Striving for Excellence Involving the People of Powys Making every pound count CSSIW - Care and Social Services Inspectorate for Wales Page 1 of 6

2 Introduction CARE HOME/PROVIDER GOVERNANCE: UPDATE REPORT This report provides a further update to that received by the Quality and Safety Committee in May An annual Care Home Governance Summit was held in May, bringing together key leads across the organisation and built upon those held in previous years. This report outlines the key areas of focus for the Summit and the strategic direction in relation to continually improving the safety, care and experience of people in receipt of either residential care and/or independent sector provided care within people s own homes. Background There are a number of key drivers in relation to care home/provider governance, which have shaped and will continue to shape the approach, including: - The teaching Health Board development work on this area, starting from a low base in During 2011/12 a Care Home Governance Framework was developed within the teaching Health Board which has shaped the development work for the organisation in relation to this sector of care. - Internal Audit review indicated significant areas for improvement, noting on follow-up review that good progress had been made. - Older People s Commissioners Review of the experiences of people living in Residential care, with a particular focus on quality of life. Powys teaching Health Board has participated in the Review which is scheduled to be published in November Impending independent report into the learning from Operation Jasmine (the largest UK investigation into a series of serious allegations of care failures in care homes in South East Wales). This review is due to be published in Autumn 2014 and has been led by Margaret Flynn. Key themes from Care Home/Provider Summit There were a number of key themes that emerged through the discussion which have informed the forward work programme, including: 1. The Framework - the organisation has made good progress over the last 3 years using the existing framework, however there is consensus that this now needs revising. Whilst it has been extremely helpful in guiding the improvements to date a greater focus on areas such as clear demand and capacity modelling, well developed commissioning plans, improved planning engagement with the sector and an integrated commissioning approach with the Local Authority are all aspects for consideration in the revised Framework. 2. The Relationship with the Sector- Given the particular challenges facing the sector, and their importance to the NHS in relation to care provision, consideration needs to be given to a different relationship and provision arrangements. This may include a strategic partner approach or the exploration of the social enterprise/care cooperative model. Page 2 of 6

3 3. The Scope - Whilst the initial focus of the work to date has been on residential nursing homes given the assessed risk at the time, progress is such that work must now broaden to include a greater level of emphasis on care provided in people s own homes by the independent sector in particular. This is work that will be critical to carry out on a joint basis with the Local Authority. 4. The Focus - Care home governance to date has focused on the fundamental safety and quality of patients care. It has been appropriate to ensure that as commissioners, the safety of people has been paramount and the monitoring mechanisms have reflected that. As good progress has been made, a consensus was agreed that understanding the experience of care requires focussed attention. This should enable people to have their voices heard in order that improvements can be made. Furthermore, there is opportunity to work more closely with CSSIW to align review processes. The Care Home Governance Summit also specifically focused on the monitoring reports of all Care Homes in Powys. The detail of specific reports and the general themes are also discussed as the Joint Intelligence Monitoring Panel, a multiagency forum including CSSIW. Where concerns exist a care home is placed into the provider performance mechanisms where additional support and scrutiny is put in place. Some Powys Care Homes have been subject to these procedures during this year for issues such as record keeping and management. Further detail can be provided. Forward work programme 14/16 There are 5 high level areas within the draft work programme. It is anticipated that the Local Authority and the teaching Health Board work together on the majority, if not all, of the plan. Priority 1: Revise the Care Home/Provider Governance Framework This is in light of the experience of the last 3 years; the Operation Jasmine Independent Review; and the Older People s Commissioners report. Priority 2: Develop a proposal for establishing a Joint Commissioning Team for Health and Adult Social Care This could include understanding the demand and capacity of the sector; developing opportunities for engaging with the market; understanding the potential of other models of provision; commissioning Continuing NHS Healthcare; contract review policies/procedures and mechanisms; the involvement of the Community Health Council and appropriate others. There is potential for Powys to be used as a pilot site for a project aimed at enhancing patient/resident/client outcomes and quality of care monitoring. Priority 3: Establish as a matter or urgency improved contracts and contract monitoring processes for care providers. This includes domiciliary care contracted by the teaching Health Board directly, and out of county placements. Page 3 of 6

4 Priority 4: Develop a proposal for proactively seeking feedback on care services from clients, their relatives and staff. There is significant potential to learn from success elsewhere in this regard. One project in Aneurin Bevan Health Board enabled retired nurses to undertake visits to care homes to chat with residents and relatives both as a friend and as an informal advocate. Priority 5: Develop a proposal for establishing a Care Development Partnership with the Care Sector in Powys. This could include the development of a Care Partnership Forum where the sharing of learning, support and expertise across the different areas of Powys; a potential buddy scheme where a ward sister or team leader buddies with a matron or care Home Manager; the development of a joint Development Programme for learning; and specific focus on supporting professional developments such as revalidation. Risks There remain a number of key risks for the Committee to be aware of in effectively managing this area of the thbs business: - Resourcing: Previously the resourcing of Care Home Governance has been identified as a risk. Although an investment in a dedicated senior nurse post to establish and coordinate activity in this areas has been made, the scale of the work is significant and a reassessment is taking place to identify the resources required to effectively manage care home/provider governance and provide assurance. This reassessment is likely to lead to a review of the current model of practice. - Out of county placements although this links to resourcing, there is significant challenge in maintaining constant scrutiny of placements that may be some considerable distance away. Further steps will be taken on reducing the numbers of distant placements being made by the thb in order to reduce risk, and further enhancements to local connections for soft intelligence will be identified. - Increasing expectations meeting increasing expectation of agencies such as Public Service Ombudsman and Older People s Commissioner is likely to require further developmental work. This may require additional expertise, workforce and new practices to be adopted. Although increasing expectations are to be welcomed, delivering at pace these changes may require additional focus, prioritisation and investment. Working more closely with people who use services, their relatives and other agencies such as the Community Health Council may provide valuable support in further enhancing our approach to this sector. - Care Provider governance the focus so far of the work has been on care Homes where the risk and impact of poor care is potentially higher. The issue of care provider governance (i.e. home care) is also significant and there is a possibility that the risk has been under-estimated. Specific safeguarding work is underway in relation to this area. Page 4 of 6

5 Conclusion There has been significant progress over the last 3 years or so in the area of Care Home Governance. The Care Home/Provider Governance Summit provided a good opportunity to take stock and to develop a work programme for the coming 2 years. This will be finalised over the coming weeks, in conjunction ideally with the Local Authority. An assessment of any financial implications will also be undertaken prior to the programme being signed off by the Executive Team, where implementation will also be monitored. Recommendation The Quality and Safety Committee is asked to discuss/note the report. Report prepared by: Carol Shillabeer Presented By: Carol Shillabeer Background Papers Financial Consequences Other Resource Implications Consultees none None identified at this time however the reassessment of capacity to effectively manage the totality of this sector will be undertaken None identified at this time Summit attendees Page 5 of 6

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