Agenda item

10:30

The Committee will scrutinise the quality and availability of care in care homes (JHO7). Representatives from the Oxfordshire Clinical Commissioning Group and Oxfordshire County Council will attend to outline local arrangements for monitoring the quality of care provided and the work undertaken with care homes to ensure appropriate clinical and nursing support is available. A copy of the presentation slides is also attached at JHO7.

Prior to consideration of this item the Committee heard an address from Jean Warren of ‘Keep our NHS Public.’  She spoke in support of the argument to bring all care homes ‘in-house’, referring to an extract from ‘Private Eye’ which warned that a care crisis was coming. It referred to the high cost of care prices in the residential sector, which were being driven by Health business consultancies.

The Chairman welcomed Benedict Leigh, Deputy Director, Joint Commissioning, OCC and Helen Ward, Deputy Director of Quality, OCCG, both of whom gave a presentation on the quality of care in care homes across Oxfordshire. They were also joined by Patricia O’Leary, Manager of the Vale House Care Home, Littlemore, which had been rated as ‘Outstanding’ by the CQC in two categories ‘Caring’ and ‘Effective’.

Mr Leigh began the presentation in thanking HWO for citing the patient experience in relation to a particular care home and undertook to speak to the Quality Team, who would in turn talk to the care home in question. He stressed that the commissioners worked closely with the CQC, adding also that all homes were signed up to ‘enhanced’ GP cover in a liaison capacity.

Patricia O’Leary gave a presentation informing the Committee of the following:

·         The model by which the home had been set up was very unique and had proved to be a great success. Incorporated into it was specialised dementia care. The Home was a ‘Not for Profit’ organisation, with 9 trustees, none of whom received a salary or a stipend;

·         The Home was run by registered nurses on a day to day basis, which gave a consistency for residents and which also  assisted with retaining staff;

·         Family perception of the Home was the key factor, as they proved to be very discerning  as to whether their relative was well cared for or not;

·         A family support worker had been appointed 15 years ago which was the source of great importance to families, friends and staff. This was an element that had not been taken up by others;

·         The model also assisted the less wealthy and allowed OCC to address this;

·         The Home embraced psychology and emotional health as an important factor for the well-being of the residents and also used it as an audit tool;

·         The Home regularly adopted the lines of enquiry contained in the CQC inspection and had built up their documentation to ensure that it was giving safe, well –led, and effective care.

Questions for Patricia O’Leary from members of the Committee, together with responses received, included the following:

·         Some care homes were no longer accepting Social Services clients  following problems with negotiating payments. In response to follow up on this by members of the Committee, Benedict Leigh stated that whilst  some care homes did not accept OCC’s rates, OCC was not seeing a significant increase and was looking to negotiate block contracts to establish more long-term relationships;

·         With regard to referrals, there existed a care home support service (which was previously known as the Falls Service), which was commissioned by the OCCG and provided by OCC. It had proved to be very useful for prospective residents, as it included a number of experienced staff who were able to solve issues quickly. Where there were serious concerns, the Team would be involved almost immediately. It also worked with the Quality Management Team to provide general support to more troubled care homes, sharing learning and development;

·         With regard to the possible provision of Care Homes on an ‘in-house’ basis, Benedict Leigh explained that in the past OCC had provided care homes on this basis. Nowadays this was in partnership with the Orders of St. John (OSJ) who ran certain homes on OCC’s behalf. Currently OCC was exploring options for providing more home care. He added that both Vale House and OSJ had worked very effectively together, as has private home care. This would be an issue to be explored as part of the Oxfordshire Transformation Plan Consultation - Part 2. The Committee requested further data on the breakdown of care home placements provided by the Orders of St John, private providers and not for profit providers;

·         A member of the Committee pointed out that it may be feasible to use GP Federations to provide a surgery-based enhanced service as a multi – disciplinary team model encompassing pharmacy, advanced nurse practitioners etc. A good system of digitally active care plans could be available online, alongside the GP patient care plans. Helen Ward stated that GPs were investigating a number of  innovations as part of their case for the OTP Part 2;

·         In response to a question regarding the percentage of bed closures in each organisation it was stated that 180 beds had been purchased to support intermediate care. Of these, 131 were Hub beds purchased by the OCCG and operated by the Hub, and the remaining 49 were used as short stay beds for patients;

·         Benedict Leigh undertook to look into the number of people in Oxfordshire who funded their own care and the trends around the stage at which people enter care homes. He added that it was a matter of choice for the individual to enter a care home earlier, adding that improvements could be made to support this category of client to live in the community which they had lived in all their lives;

·         With regard to a question about the need to know more in the future about sustainability issues, Benedict stated that OCC had a statutory duty to publish the market position statement, which was due soon. He undertook to send it to members of the Committee when available;

·         In answer to a question to Patricia O’Leary about how it was ensured that staff remained motivated, she explained that measures included working with the trustees regarding good rates of pay, careful  recruitment of nurses and to honour speciality nursing training (for example, in caring for people suffering from dementia);

·         In response to a question, Patricia O’Leary confirmed that all bedrooms had en-suite bathrooms and community physiotherapy was accessed via the community Team.

All were thanked for their attendance.