oxfordshire care home provider meeting 19 november 2015
TRANSCRIPT
Oxfordshire Care Home Provider Meeting
19 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 Miles Carter, Locality Lead GP for West Locality 4 11:00-11:15 Break5 11:15-12:10 Ross Burton, Prescribing Adviser Medicines Management Team, Oxfordshire
Clinical Commissioning Group6 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
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
OxfordshireClinical Commissioning Group
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)
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
Coverage of scheme Nov 2015
0
10
20
30
40
50
6031
4656 51
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
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
OxfordshireClinical Commissioning Group
Medicines Optimisation & Care Homes
Ross BurtonMedicines Optimisation Team
Oxfordshire Clinical Commissioning Group
OxfordshireClinical Commissioning Group
Outline
Role of the Medicines Optimisation team at OCCG
Medication waste & homes Best Practice ResourcesCommon issues in homesDiscussion
OxfordshireClinical Commissioning Group
Medicines Optimisation Team
12 pharmacistsSupport and advice to GPsDevelopment of medication formulary
& clinical guidanceSupport OCCG projects
Overall aim is to ensure NHS funds are used in the best possible way
OxfordshireClinical Commissioning Group
The Medication Waste Challenge£300million (10% of medicines) of
prescribed medication wasted in England annually
Half of this is ‘avoidable’Avoidable waste could fund 6557
extra nurses in the NHS (£22,875/nurse)…..
……Or 28,735 hip replacements
OxfordshireClinical Commissioning Group
Waste In Oxfordshire
Care Home sector may account for around £50million of this
Oxfordshire Drug Budget 2015/16 = ~£80million
Estimated £8million drug wastage this year within Oxfordshire (£1.3million in homes)
OxfordshireClinical Commissioning Group
Waste Project
Several areas, one of which is the care & nursing homes
Information sent to homesOCCG pharmacist visiting homes to
audit wasteAdvice to homes also given
OxfordshireClinical Commissioning Group
So what has been identified??
OxfordshireClinical Commissioning Group
Policy Confusion
PM contacted teamHome visitedProcedures investigatedPolicies checkedManagerial meetingEstimated saving = £13,139 (71 beds)
OxfordshireClinical Commissioning Group
Poor Organisation & Procedures Home manager contacted teamStorage facilities investigatedProcedures examinedExcess medication stored
inappropriately
Stock destroyed = £9,029Procedures amended!
OxfordshireClinical Commissioning Group
Practice
Home visited & stock levels satisfactory
Medication disposal record lengthyHome receiving medication not
orderedPractice ‘too busy’ to check what is
being ordered & repeats last month’s order
Home discarding stock as no room to store
Excess stock = £3,264 (60 beds) per year
OxfordshireClinical Commissioning Group
Appliance Contractors
£51.32 per box (£615.84)2 bags per week, 7 if bad3 boxes received monthlyHome assume practice is aware as they are issuing scripts?!
OxfordshireClinical Commissioning Group
Other issues…..
The ‘Complan Cupboard’
OxfordshireClinical Commissioning Group
Insulin £41.50 per box
OxfordshireClinical Commissioning Group
More diabetic issues…
OxfordshireClinical Commissioning Group
Creams (barriers and emollients)
OxfordshireClinical Commissioning Group
Medication Best PracticeManaging Medicines in Care Homes – NICE
March 2015Oxfordshire CCG Internet Resources
OxfordshireClinical Commissioning Group
Other issues for discussion?? Homely remedies PRN protocols Sip feeds Community pharmacies EPS prescriptions Barrier protectants Controlled drugs Full directions on medications CQC inspections
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. Representation
and advocacy
Changes in SafeguardingNational Changes in the Care Act
Changes in SafeguardingChanges to categories
10 categories(2 added and one amended
by the Care Act)
Acts of omission & neglect Physical
abuse
Domestic violence
Sexual abuse
Psychological abuse
Financial or material
Discriminatory abuse
Organisational abuse
Previously called Institutional
Abuse
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 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