2.45
The Director of Social and Community Services will give the Committee a verbal update on current issues and answer questions. The Cabinet Member for Adult Services will also be present to respond to questions from the Committee.
Minutes:
The Director of Social and Community Services gave an update on current key issues for Adult Services.
Local issues:
The Director gave the following update on local issues:
Winterbourne View Hospital
There is a police investigation so there are limits on what we can say.
Winterbourne View is a specialist hospital for people with learning disabilities and mental health issues, run by a large national provider, Castlebeck. OCC has responsibility for specialist hospital placements for LD, on behalf of the PCT, through the pooled budget and lead commissioning arrangements. Hospitals are regulated and monitored by the Care Quality Commission.
The hospital supports people experiencing a period of serious mental illness. This often manifests itself in challenging behaviour that poses serious risk to the person and others. People are either detained under the mental health act following assessment by 2 approved doctors and an Approved Mental Health Professional, or they may agree to voluntary admission. The hospitals provide assessment and treatment and employ therapists including psychiatrists and psychologists. No placement should be permanent, though the length of time taken for people to recover enough for a safe discharge varies considerably
Oxfordshire commissions 9 inpatient beds in Oxford from Ridgeway Partnership. These are procured and closely monitored by the Council.
OCC’s policy is to minimise the use of out of area hospital placements, and they are only used for temporary placements when no local bed is available that can meet the needs. In the last 18 months Oxfordshire has made 3 placements at Winterbourne View. No patients are there now. Oxfordshire currently has 3 placements at other Castlebeck hospitals,
The Learning Disability Teams are part commissioned/part provided by the Council. Admissions to specialist hospitals are often urgent, may be out of hours. The psychiatrist in the Learning Disability Team normally seeks an available bed to meet the clinical needs identified, close to Oxfordshire if possible. A limited number of large national providers are used, of whom we have previous experience. Poor reports from the Care Quality Commission would exclude a provider. There was no evidence provided to us before 13th May that there were concerns about Castlebeck as a company or about Winterbourne View as a hospital.
Patients and families are involved in decisions. The Council funds the placement through the pooled budget. Once placed, the care manager, (often with a nurse and psychiatrist in the LD Team) monitors the placement, progress towards recovery, and plans for discharge or a move back to an inpatient bed in Oxfordshire. Regular contact is made and reviews held to ensure the person’s needs are met and they are happy.
Questions we are looking at:
· We cannot replicate the role of the regulator, but what are the key indicators that we could check in out of area placements?
· Should we work with other PCTs to establish an approved provider list?
· Can we do more to enable service users and families to identify concerns and raise them with us?
Southern Cross
My summary of the situation is based on an answer that Councillor Fatemian will give to a question from Councillor Larry Sanders at Council tomorrow.
Southern Cross is one of the largest care home providers in the country. They are responsible for 31,000 beds across the country. Their financial problems appear to come from a business decision taken several years ago where they disposed of their property assets.
There are six Southern Cross homes in Oxfordshire with a total of nearly 230 beds. This council supports 136 residents in these homes with there being a further 38 private residents: a total of 174. We have been following the situation in a number of ways: firstly at a national level through the Association of Directors for Adult Social Services, and secondly at a local level through contact with Southern Cross' Area Manager for Oxfordshire.
There has also been the usual media speculation that naturally follows a situation such as this. The President of ADASS (Peter Hay) has appealed for calm in the media coverage of this issue. It is important to stress that there are thousands of residents and their families who will be worrying about what might happen to them.
John Dixon, Deputy Director for Adult Social Care last met Southern Cross' Area Manager for Oxfordshire on 20th May and will again meet him on 28th June. Councillor Fatemian also spoke to their Area Manager at the Directorate’s Annual Commissioning Conference on 20th May. Both NHS Oxfordshire and AgeUK are aware of the situation and the County Council’s Media & Communications Team has liaised on press enquiries. Our understanding is that all parties are working on the basis of continuity of care for the residents.
At this moment there is no indication that homes may close and Southern Cross continue to work on their business restructuring. We will continue to monitor the situation during the coming months and will update you should there be any changes. Despite the above we are looking at Contingency Plans for the 'what if' scenario. Those plans include:
· Looking at vacancies within other care homes in Oxfordshire. There does appear to be a number of available beds in the system to help meet demand.
· We are aware of a number of new beds that will come onto the market in the coming months.
· We are looking at the dependency of those people in Southern Cross homes to see how they might match up to the vacant beds.
· We will continue to put the needs of residents and their families as our first priority and if changes are needed going forward, we will use the information we have to plan in the best possible way.
· Should any home close, and I would like to reiterate that on the information currently available to us that we do not expect this to happen, then we have a duty to assist ALL clients who needed support in obtaining alternative sources of care that best meets their needs.
People in placements are regularly monitored in terms of their health and social care needs but it is not for the local authority to replicate the regulator’s(the Care Quality Commission) role to monitor the quality of service provision.
In a response to a question from the Chairman it was confirmed that the decision to send a person to the treatment hospital is made by a psychiatrist and an approved mental health social worker and would have involved the families and carers of the person concerned as appropriate.
Councillor Hannaby commented that good monitoring is especially important if we are relying on large companies to deliver services and also the importance of supporting families to voice concerns if need be. The Director confirmed that we have very good monitoring procedures for local services and that although we have good contact with out of area placements it is inevitably much harder to monitor services that are further away or spot purchased.
The programme raised a lot of issues and it was suggested that two areas of focus might be whether we should be working with the PCT to agree an approved provider list and what further support we put in place for service user, their families and carers to raise concerns.
There were concerns voiced about the reliability of the CQC following their failure in this case and it was questioned how much we should rely on their assessments of quality both in current service provision and commissioning plans going forward.
2.
Councillor Skolar supported the view that it was not justifiable for the Council to duplicate work that is already the responsibility of the CQC. John Jackson agreed to provide a more detailed response to Councillor Skolar in reply to his question about patients needing a longer period of stay at the hospital.
It was agreed that Sarah Carter would circulate to the Committee a statement made by Paul Burstow, Minister of State for Health, on the matter which describes the CQC’s reponse, including an acknowledgement that they should have acted sooner and the actions that are being taken to look at processes, and inspections on other Castlebeck services.
The Director of Social and Community Services gave an update on current key issues for Adult Services.
Local issues:
The Director gave the following update on local issues:
Winterbourne View Hospital
There is a police investigation so there are limits on what we can say.
Winterbourne View is a specialist hospital for people with learning disabilities and mental health issues, run by a large national provider, Castlebeck. OCC has responsibility for specialist hospital placements for LD, on behalf of the PCT, through the pooled budget and lead commissioning arrangements. Hospitals are regulated and monitored by the Care Quality Commission.
The hospital supports people experiencing a period of serious mental illness. This often manifests itself in challenging behaviour that poses serious risk to the person and others. People are either detained under the mental health act following assessment by 2 approved doctors and an Approved Mental Health Professional, or they may agree to voluntary admission. The hospitals provide assessment and treatment and employ therapists including psychiatrists and psychologists. No placement should be permanent, though the length of time taken for people to recover enough for a safe discharge varies considerably
Oxfordshire commissions 9 inpatient beds in Oxford from Ridgeway Partnership. These are procured and closely monitored by the Council.
OCC’s policy is to minimise the use of out of county hospital placements, and they are only used for temporary placements when no local bed is available that can meet the needs. In the last 18 months Oxfordshire has made 3 placements at Winterbourne View. No patients are there now. At the date of the meeting, Oxfordshire currently has 3 placements at other Castlebeck hospitals.
The Learning Disability Teams are part commissioned/part provided by the Council. Admissions to specialist hospitals are often urgent and may be out of hours. The psychiatrist in the Learning Disability Team normally seeks an available bed to meet the clinical needs identified, close to Oxfordshire if possible. A limited number of large national providers are used, of whom we have previous experience. Poor reports from the Care Quality Commission would exclude a provider. There was no evidence provided to us before 13th May that there were concerns about Castlebeck as a company or about Winterbourne View as a hospital.
Patients and families are involved in decisions. The Council funds the placement through the pooled budget. Once placed, the care manager, (often with a nurse and psychiatrist in the LD Team) monitors the placement, progress towards recovery, and plans for discharge or a move back to an inpatient bed in Oxfordshire. Regular contact is made and reviews held to ensure the person’s needs are met and they are happy.
Questions we are looking at:
· We cannot replicate the role of the regulator, but what are the key indicators that we could check in out of area placements?
· Should we work with other PCTs to establish an approved provider list?
· Can we do more to enable service users and families to identify concerns and raise them with us?
Southern Cross
My summary of the situation is based on an answer that Councillor Fatemian will give to a question from Councillor Larry Sanders at Council tomorrow.
Southern Cross is one of the largest care home providers in the country. They are responsible for 31,000 beds across the country. Their financial problems appear to come from a business decision taken several years ago where they disposed of their property assets.
There are six Southern Cross homes in Oxfordshire with a total of nearly 230 beds. This council supports 136 residents in these homes with there being a further 38 private residents: a total of 174. We have been following the situation in a number of ways: firstly at a national level through the Association of Directors for Adult Social Services (ADASS), and secondly at a local level through contact with Southern Cross' Area Manager for Oxfordshire.
There has also been the usual media speculation that naturally follows a situation such as this. The President of ADASS (Peter Hay) has appealed for calm in the media coverage of this issue. It is important to stress that there are thousands of residents and their families who will be worrying about what might happen to them.
John Dixon, Deputy Director for Adult Social Care last met Southern Cross' Area Manager for Oxfordshire on 20th May and will again meet him on 28th June. Councillor Fatemian also spoke to their Area Manager at the Directorate’s Annual Commissioning Conference on 20th May. Both NHS Oxfordshire and AgeUK are aware of the situation and the County Council’s Media & Communications Team has liaised on press enquiries. Our understanding is that all parties are working on the basis of continuity of care for the residents.
At this moment there is no indication that homes may close and Southern Cross continue to work on their business restructuring. We will continue to monitor the situation during the coming months and will update you should there be any changes. Despite the above we are looking at Contingency Plans for the 'what if' scenario. Those plans include:
· Looking at vacancies within other care homes in Oxfordshire. There does appear to be a number of available beds in the system to help meet demand.
· We are aware of a number of new beds that will come onto the market in the coming months.
· We are looking at the dependency of those people in Southern Cross homes to see how they might match up to the vacant beds.
· We will continue to put the needs of residents and their families as our first priority and if changes are needed going forward, we will use the information we have to plan in the best possible way.
· Should any home close, and I would like to reiterate that on the information currently available to us that we do not expect this to happen, then we have a duty to assist ALL clients who needed support in obtaining alternative sources of care that best meets their needs.
People in placements are regularly monitored in terms of their health and social care needs but it is not for the local authority to replicate the regulator’s(the Care Quality Commission) role to monitor the quality of service provision.
In a response to a question from the Chairman it was confirmed that the decision to send a person to the treatment hospital is made by a psychiatrist and another authorised doctor (which could be an appropriate GP or another psychiatrist) and an approved mental health social worker and would have involved the families and carers of the person concerned as appropriate.
Councillor Hannaby commented that good monitoring is especially important if we are relying on large companies to deliver services and also the importance of supporting families to voice concerns if need be. The Director confirmed that we have good monitoring procedures for local services and that although we have good contact with out of area placements it is inevitably much harder to monitor services that are further away or spot purchased.
The programme raised a lot of issues and it was suggested that two areas of focus might be whether we should be working with the PCT to agree an approved provider list and what further support we put in place for service user, their families and carers to raise concerns.
There were concerns voiced about the reliability of the CQC following their failure in this case and it was questioned how much we should rely on their assessments of quality both in current service provision and commissioning plans going forward.
Councillor Skolar supported the view that it was not justifiable for the Council to duplicate work that is already the responsibility of the CQC. John Jackson agreed to provide a more detailed response to Councillor Skolar in reply to his question about patients needing a longer period of stay at the hospital.
It was agreed that Sarah Carter would circulate to the Committee a statement made by Paul Burstow, Minister of State for Health, on the matter which describes the CQC’s reponse, including an acknowledgement that they should have acted sooner and the actions that are being taken to look at processes, and inspections on other Castlebeck services.