Cornwall Partners in Care News

Residential Forum

Held at Crossroads Care Home 29^th August 2018

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

Mary chaired the meeting.

The next Partnership meeting (according to https://www.cornwall.gov.uk/health-and-social-care/adult-commissioning-and-transformation/partnership-boards/care-home-and-home-care-provider-partnership-boards/) is 13^th September 2018, 10:00 to 12:30, venue to be confirmed.

Mary circulated a Council document regarding the Council inspectors having access to all Service Users during inspections. It was raised at the last Partnership meeting that a number of sources of legal advice obtained by various Providers indicated that this should not be the case and that for the purposes of inspections, commissioners should only be granted access to the records for the Service Users that they are funding. The Council will take this information back to their legal team.

Providers that deal with other Local Authorities noted that in other areas Councils are happy to comply with such restrictions.

It was also noted that sometimes the inspectors themselves do not appear to be aware of who they are funding.

Mary raised an ongoing issue where inspectors are still telling Providers that they should be shredding some documents that Providers have to retain by law by Government departments such as HMRC and the Home Office.

Action: Richard to raise with CQC the issue of being told by inspectors to shred documents which must be kept by law, and to circulate to the sector both the communication to the CQC and their response.

From the 3^rd September, flu vaccinations will be free for social care staff.

It was noted that Providers have still not seen any revised draft contract.

Richard circulated a draft document outlining some of the issues identified by Providers in implementing the Foundation Living Wage rate. This will form the basis of an Impact Assessment which will be presented to the Council. Other issues raised include;

• Staff working around the tax threshold of £11,850 and not wanting to exceed this.
• Can people afford any increase to existing top ups?
• The impact on Providers with only a few Council funded residents. Some will be giving them back rather than signing a contract.
• Providers cannot split wages.
• Providers that work with other local authorities cannot pay staff differently depending on which local authority is providing the funding.
• One Provider works with 15 local authorities. Following Cornwall Council’s decision to implement the Foundation Living Wage, the Provider has started negotiations with all 15 local authorities. The only one still yet to agree anything is Cornwall Council.
• Non-care staff such as cleaners, maintenance staff, etc will be paid considerably more than the market rate once the FLW is implemented. How will Providers manage their career progression?
• How will the FLW impact on NHS recruitment?

It was reported that the Trusted Assessor, who have had issues appointing assessors previously now have a full team. Providers indicated that they would rather do their own assessments.

Mary noted that the Trusted Assessor scheme in Lincoln is working well, where assessors are used as an extra deputy, to be called upon by Providers if they cannot get to do the assessment themselves.

Action: Richard to request examples of poor discharge from Providers.

At the Partnership meeting on the 22^nd August, Rab McEwen, Chief Operating Officer at RCHT stated that he wants a 7 day service from Providers and accept hospital discharges over the weekend, however the services that underpin Providers are still strictly working week only. One example was given of the loans service that were not able to respond to a Provider when an air mattress failed on a Friday evening. The Provider was told it would be at least a week before a replacement would be available. Despite the best efforts of the Provider, the Service User in question (an extremely frail older lady) developed pressure sores over the weekend. It took the intervention of the District Nurses before the loans department would make a replacement air mattress available.

Providers are generally willing to offer a 7 day service, however this can only be achieved if the support services are also available 7 days too.

Mary reported that the Red Bag scheme has a task and finish group setup to help drive it forward, however it is still not clear how it will operate and who will buy the bags (ie who will return the bags to a Provider should a Service User pass in hospital?). Mary has been invited onto the group and will report back.

One Provider reported that they have already developed a Red Folder system for the Service User’s paperwork. The Provider had 17 admissions to Derriford hospital. All 17 were admitted with their red folders. Not a single red folder has been returned to the Provider.

The sector is represented on the Safeguarding Adults Board; Peni represents the Home Care and Supported Living sector and Mary represents the Residential sector.

The End of Life strategy board will be launching Co-ordinate My Care, a software program that will allow centralised care plans with access available for all relevant parties, so that they have access to useful information.

Gross payments were discussed as the Council are indicating that they would like to manage the payments and fees on behalf of private clients. Providers feel that this creates risks that the Council could use their position to start offering to help source alternative, cheaper placements for residents and could compromise any impartiality.

The meeting also discussed the meaning of the comment “gross payments from day 1, backdated following assessment” which has been mentioned by Cornwall Council. The feeling is that this is not good enough. Providers need the income from day 1, not back dated following an assessment which might take 3 months. Providers are happy to accept backdated amendments following assessment.

Mary shared a document regarding patient transport service. The comment was made that if people are being treated as if they are in their own home, the Council should be paying for resident’s transportation to hospital appointments etc. Currently this cost falls on the Provider with taxi’s costing up to £60 per visit, plus the costs of sending a member of staff if residents have dementia, for example. This can sometimes be several times per week. For people in their own homes, a number of qualifying benefits and schemes exist to enable them to claim for some of these costs, however resident’s do not have the same access.

The meeting closed at 12:00.