Cornwall Partners in Care News

Residential Forum

Held at Crossroads Care Home 31^st October 2018

These are notes (not minutes) and reflect the opinions and understandings of those present

Download Karen's presentation on Winter Pressures planning (Powerpoint, 11mb)

Mary chaired the meeting.

Karen Kay (Urgent and Emergency Care Executive Lead for Cornwall and the Isles of Scilly) attended the meeting to discuss Winter Pressures planning.

The meeting was expected Kate Alcock and Nicola Redfearn to attend from Cornwall Council to talk about the Fair Cost of Care and the Red Bag scheme respectively, however both had to cancel at the last minute.

Karen started by agreeing to discuss what she knew about the situation with the contract for Residential and Nursing Care and invited questions from Providers.

It was noted that Providers had given some very detailed feedback on the contract originally proposed back in January 2018, however only received very minimal communication since then, with no information at all since the 3^rd July working group. No-one knows what is happening.

Karen did accept that part of the delays might be due to the NHS whilst they assure themselves that everything is acceptable and that they have not yet signed off on the contract.

Other points made include;

• Providers have had 2 uplifts in wages and pension increases, but no uplift in fees.
• The impact that the delays are having with Provider’s ability to plan and budget.
• The delays are starting to damage relationships and trust, which had previously been improving.
• Delayed payments are still a very big issue (every Provider in the room agreed, although one did report a recent improvement over the last couple of months).
• The current Health contract is working brilliantly; why would Health need to have a joint contract with the Council when it is clearly a backward step.
• Still no detail on what “gross payments” actually means.
• Current NHS processes are considerably more straightforward that Council processes.

A discussion took place around the hospital’s tendency to over medicalise patients, trying to address issues that don’t need addressing and that they have happily lived with for years.

Karen reported on daily calls, a system which she has implemented to improve communication. Karen extended an invite to social care providers when they have a patient admitted to a ward to improve communication flow.

Karen also reported that since the Trusted Assessor scheme has started, Providers’ residents average stays have been reduced. From 8 to 4 days.

Karen asked how Providers were involved in the process for setting up and running Trusted Assessors. Other than one member being on some of the interview panels, the sector has not been involved. It was noted that Cornwall Partners in Care have offered several times to facilitate a meeting with the successful Trusted Assessor scheme operating in Lincoln, but this has not yet been taken up.

Karen indicated that the Trusted Assessors are supposed to operate peripatetically, acting as an extra deputy for residential and nursing homes. Providers in the room all reported that none of the Trusted Assessors have visited their premises and have no knowledge of care homes to enable them to act as extra deputies.

The meeting discussed some of the difficulties Trusted Assessors are experiencing in discharging patients into homes. It was noted that there is no financial incentive for Providers to refuse a patient from hospital as an empty bed is losing that business money. The only time a patient is refused is where it is right for that patient, the staff, and the other residents already in the home.

The point was made that social care is the poorer cousin in Healthcare. Even in the recent budget, the NHS got a pension boost, however social care didn’t.

Karen highlighted the free flu vaccines available for all social care staff and encourage Providers to urge their staff to get vaccinated. It was noted that it can be hard to get staff to go see a GP or pharmacists and Karen is happy to send teams into Providers if they can get a group of staff together to make it worthwhile.

The meeting moved onto the Winter Pressure plan and Karen is looking for more involvement from the wider care community.

The six main aims of the plan are;

1. Help people stay safe, well & independent at home
2. Provide rapid assessment & advice or treatment of urgent care needs
3. Make Ambulatory Care our default, with bed based care only when clinically indicated
4. Get people back home quickly if they are admitted to hospital
5. Maintain planned levels of access to elective care
6. Maintain safety & standards & people’s experience of care - 24/7 within available resources

A discussion took place around upskilling care home staff to do things such as plasters, giving insulin etc as this would reduce the need for District Nurse visits, freeing them up to do higher level work (eg care at home team). It was noted that District Nurses have historically not been keen on shared care due to concerns over who would be accountable.

Karen is keen for a Care Home sections within the winter plan, outlining what care homes can do to help and what support care home need from partners in achieve this.

Currently there are 97 patients in hospital whose care has ended and are waiting for care packages or care home beds. 40 of theses are waiting for beds, eg waiting for a dementia bed in a specific area, or waiting for a ground floor room due to limited mobility.

Karen is looking for Providers to stop saying “no we cannot take the patient” and start saying “we could take the patient if we had …. (eg District Nurse visits, the right equipment, training, etc)”. There are no guarantees of a better response, but it will certainly help change the culture.

There was a discussion around 111 sending a paramedic when all the Provider had asked for was a GP or District Nurse visit. 111 needs to trust Providers more, as they know their residents better than anyone and are sometimes just looking for reassurance. Paramedics are more likely to admit a resident, even when a Provider doesn’t feel that admission is necessary.

Provides broadly agreed with everything the winter plan proposes, although Providers are aware that other services are stretched or do not offer a 24-hour service.

It was highlighted than a single week admission typically leads to a financial loss for a home, and that a 2 week admission is around the breakeven point.

Providers present mentioned that they are aware that the risks of taking admissions over the weekend are greater as everyone is happy to blame the Providers for any problems.

There was a discussion around getting the right paperwork to Providers when discharging to them from hospital. Time should be allowed for Providers to review the paperwork when they are assessing a patient in hospital. This seems to happen in some places, but not everywhere.

Karen highlighted that they are looking for a prompt response when Providers have beds and can take admissions.

It was noted that better access to the mental health team would be useful as they can be hard to access at times. Karen acknowledged this and indicated that they are already working on a solution.

The meeting closed at 13:00.