Transcript 19 Nov 2015 - Oxfordshire County Council

Oxfordshire Care Home Provider
Meeting
19 November 2015
Agenda
1
2
Time
09:30-09:45
09:45-10:25
3
4
5
10:25-11:00
11:00-11:15
11:15-12:10
6
12:10-12:40
7
12:40-13:00
Item
Welcome and Introductions
Rachel Lawrence, Workforce Development Programme Manager - Adult
Social Care Workforce Strategy
Dr Miles Carter, Locality Lead GP for West Locality
Break
Ross Burton, Prescribing Adviser Medicines Management Team, Oxfordshire
Clinical Commissioning Group
Hugh Ellis, Safeguarding Adults Team Manager - Serious Concerns/Standards
of care Framework
Information Sharing
Oxfordshire Adult Social Care
Workforce Strategy
Care Home Provider Workshops
November 2015
Workforce issues & challenges
Capacity gap
• If we don’t take action …
16000
Worker Numbers
15000
Worker supply
Worker demand
14000
13000
12000
Current
Y1
Y2
Y3
Turnover
• 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
Reducing Turnover
16000
15500
15000
Forecast demand
14500
Current supply
14000
Turnover 32%
13500
Turnover 26%
13000
Turnover 20%
12500
12000
Current
Year 1
Year 2
Year 3
Capability
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
What’s the plan?
15 point framework
for action
15 Support carers, volunteers and local communities
14 Support competence, qualifications and career pathways
13 Support core skills development
Five actions to
build capability
12 Support leadership and management development
11 Support workplace learning cultures
10 Support pre-employment programmes and Apprenticeships
9 Support effective use of technology
8 Develop partnerships in care
7 Support effective employment practices
Seven actions to
build capacity
6 Support recruitment & retention of care home nurses
5 Support recruitment across the county
4 Make the Social Care Commitment
3 Ensure commissioning addresses workforce issues
Three enabling
actions
2 Improve workforce data & intelligence
1 Develop Workforce Partnership Board, Council & communication strategy
Done so far …
• 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
Next steps
• 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
15 point framework
for action
15 Support carers, volunteers and local communities
14 Support competence, qualifications and career pathways
13 Support core skills development
Five actions to
build capability
12 Support leadership and management development
11 Support workplace learning cultures
10 Support pre-employment programmes and Apprenticeships
9 Support effective use of technology
8 Develop partnerships in care
7 Support effective employment practices
Seven actions to
build capacity
6 Support recruitment & retention of care home nurses
5 Support recruitment across the county
4 Make the Social Care Commitment
3 Ensure commissioning addresses workforce issues
Three enabling
actions
2 Improve workforce data & intelligence
1 Develop Workforce Partnership Board, Council & communication strategy
Any questions?
• Contact details:
– [email protected]
– 01865 323643 or 07919 298290
Oxfordshire
Clinical 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
Oxfordshire
Clinical 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)
Oxfordshire
Clinical 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
Oxfordshire
Clinical 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
Oxfordshire
Clinical Commissioning Group
Growth in number of care homes covered
by scheme
120
100
51
80
60
83
76
68
40
56
20
24
31
39
0
Apr-15
Jun-15
Participating Care Homes
Aug-15
Current (Nov 15)
Non-participating Care Homes
Oxfordshire
Clinical Commissioning Group
Coverage of scheme Nov 2015
60
56
46
50
51
40
30
31
20
10
0
Number of practices Number of practices Number of care
signed up to scheme
not in scheme
homes covered by
scheme
Number of care
homes not covered
by scheme
Oxfordshire
Clinical Commissioning Group
Cost and activity comparison of care homes’
emergency hospital admissions
20%
8%
10%
0%
10%
5%
11%
4%
1%
-10%
-10%
-20%
-20%
-30%
-28%
-36%
-40%
-37%
-50%
-50%
-60%
Apr-15
Participating Care Homes Cost
Participating Care Homes Activity
Jun-15
Aug-15
Non-participating Care Homes Cost
Non-participating Care Homes Activity
Oxfordshire
Clinical Commissioning Group
Advanced care plans and medication reviews
recorded by practices after 1st 6 months of
scheme
Computerised advance care plans (Digital Proactive Care Plan) being
introduced to improve capture of preferred place of care and resusc
status
1400
1220
1200
967
1000
876
787
800
588
600
566
400
200
0
Patients
covered by
scheme
Written
advanced care
plan
Not for
Preferred place Preferred place
resuscitation
of care
of care is care
recorded
home
Medication
reviews
Oxfordshire
Clinical Commissioning Group
Deaths and hospital admissions recorded by
practices in 1st 6 months of scheme
200
180
181
153
160
130
140
120
100
80
66
60
40
23
20
0
Deaths
Place of death
recorded
Died in care home
Died in hospital
Emergency
Hospital admission
Oxfordshire
Clinical 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
Oxfordshire
Clinical Commissioning Group
The future?
Emerging strategy across health care providers and
commissioners for out-of-hospital care
Promoting 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
Oxfordshire
Clinical Commissioning Group
Medicines Optimisation &
Care Homes
Ross Burton
Medicines Optimisation Team
Oxfordshire Clinical Commissioning Group
Oxfordshire
Clinical Commissioning Group
Outline
Role of the Medicines Optimisation
team at OCCG
Medication waste & homes
Best Practice Resources
Common issues in homes
Discussion
Oxfordshire
Clinical Commissioning Group
Medicines Optimisation Team
12 pharmacists
Support and advice to GPs
Development of medication formulary &
clinical guidance
Support OCCG projects
Overall aim is to ensure NHS funds are used
in the best possible way
Oxfordshire
Clinical 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
Oxfordshire
Clinical 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)
Oxfordshire
Clinical Commissioning Group
Waste Project
Several areas, one of which is the care &
nursing homes
Information sent to homes
OCCG pharmacist visiting homes to audit
waste
Advice to homes also given
Oxfordshire
Clinical Commissioning Group
So what has been identified??
Oxfordshire
Clinical Commissioning Group
Policy Confusion
PM contacted team
Home visited
Procedures investigated
Policies checked
Managerial meeting
Estimated saving
= £13,139 (71 beds)
Oxfordshire
Clinical Commissioning Group
Poor Organisation & Procedures
Home manager contacted team
Storage facilities investigated
Procedures examined
Excess medication stored inappropriately
Stock destroyed = £9,029
Procedures amended!
Oxfordshire
Clinical Commissioning Group
Practice
Home visited & stock levels satisfactory
Medication disposal record lengthy
Home receiving medication not ordered
Practice ‘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
Oxfordshire
Clinical Commissioning Group
Appliance Contractors
£51.32 per box (£615.84)
2 bags per week, 7 if bad
3 boxes received monthly
Home assume practice is
aware as they are issuing
scripts?!
Oxfordshire
Clinical Commissioning Group
Other issues…..
The ‘Complan Cupboard’
Oxfordshire
Clinical Commissioning Group
Insulin £41.50 per box
Oxfordshire
Clinical Commissioning Group
More diabetic issues…
Oxfordshire
Clinical Commissioning Group
Creams (barriers
and emollients)
Oxfordshire
Clinical Commissioning Group
Medication Best Practice
Managing Medicines in Care Homes – NICE March
2015
Oxfordshire CCG Internet Resources
Oxfordshire
Clinical 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
Oxfordshire
Clinical Commissioning Group
Questions?
[email protected]
07769 306970
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?
Changes in Safeguarding
Ethos of Safeguarding
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:
Empowerment … Protection … Prevention
Proportionality … Partnership … Accountability
Changes in Safeguarding
New 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
Changes in Safeguarding
National Changes in the Care Act
2.
1.
New
categories
Specific
mandatory
requirement to
investigate
(section 42 of
the Care Act)
3.
Making
safeguarding
personal
4.
Representation
and
advocacy
Changes in Safeguarding
Changes to categories
Acts of
omission &
neglect
Modern
slavery
Physical
abuse
Self-neglect
10
categories
Organisational
abuse
(2 added and
one amended
by the Care
Act)
Previously called
Institutional
Domestic
violence
Sexual abuse
Abuse
Discriminatory
abuse
Financial or
material
Psychological
abuse
Amended
category
3 New
categories
Exsisting
categories
Changes in Safeguarding
Section 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:
When things
started to go wrong,
people around me
noticed and acted
early.
The help I
received made
my situation
better
People asked what
I wanted to happen
and worked
together with me
to get it.
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)
At the end of the process a person should be able to say:
Professionals
helped me to plan
and manage the risks
that were important
to me
The people
I wanted
were
involved
People
understood me –
recognised and
respected what I could do
and what I needed
help with
I had good
quality care.
I felt
safe and
in control
Changes in Safeguarding
Representation and Advocacy
Must work within existing
Mental Capacity Act (2005)
Always involve the person consult their family, friends
and obtain advocacy where
necessary
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’
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 OSAB website to replace Safe
from Harm (www.osab.co.uk)
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
need
2. 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 Vaccination
Winter 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