Agenda item

Senior Officers from the People Directorate had been invited to the meeting to provide an update on residential and nursing care provision following on from a 2019 scrutiny task group on quality assurance and more recently, the Government’s requirement for all Councils to put in place a COVID Care Home Support Plan.

Officers went through the Agenda Report and the following main points were made:

·         The ‘Worcestershire Care Home Hub’ had been established in March 2020.  Made up of health, public health and social care partners, this pooled capacity and resource had provided a strategic lead to co-ordinate and facilitate action to support and advise providers with the aim of minimising outbreaks, cases and deaths in homes

·         Intensive work had taken place to support care homes to put in place effective infection prevention and control measures.  The pressure on providers across the County was immense, a picture replicated nationally

·         A large amount of data was being collected nationally on a regular basis, through the ‘national capacity tracker’, enabling comparisons to be made and for contingency planning to be undertaken nationally

·         This data would also help review and shape the care home market in Worcestershire, underpinning the proposed new model of care of ‘Home First’

·         Members were reminded that in Worcestershire the care home market was fragile, in part, with some providers at risk of financial difficulty.  In addition, there were gaps in the market, such as for patients with more complex needs or for high needs dementia care.  The longer term piece of work to develop the market would aim to mitigate the gaps   

·         Cases of COVID-19 in care homes was increasing, mainly amongst staff and there had been increasing quality concerns putting additional pressure on managers and providers.  In all cases, Officers were working closely with providers to assist and if necessary, compile action plans.

In the ensuing discussion, key points included:

·         When asked whether patients discharged from hospital to a care home were being tested for COVID-19, it was reported that systems were now in place to do so and central Government had recently published guidance to ensure that all patients being discharged back to a care home would need to be tested

·         The national capacity tracker was linked to infection control monies and providers had an incentive to complete the tracker.  Questions included areas such as vacancy rates and discharge.  Officers agreed to share the list of questions asked

·         A Member asked whether care homes were getting enough support with testing, to be informed that the situation had been challenging in part, however, was improved and care homes were deemed a priority.  It was clarified that an outbreak constituted 2 or more cases and as of 31 August 2020, 69 care homes, out of 179, in Worcestershire, had experienced outbreaks

·         In relation to a question about external quality assurance visits being undertaken, it was reported that the Care Quality Commission (CQC) had suspended visits.  Officers agreed to follow up with CQC as to when they envisaged restarting

·         The Council’s Quality Assurance team had restarted visits in the last two weeks, only if essential, and with Officers wearing full personal protective equipment (PPE).  Likewise, Social Workers were also permitted to enter care homes with full PPE

·         The Chairman referred to a recent event she remotely attended where it was mentioned that CQC had visited around 300 homes in August to look at best practice

·         In response to a query about any change to risk assessments, Officers reported that they would always refer to the latest advice from Public Health

·         A Member referred to the Agenda Report and asked for definitions of high risk and moderate risk referrals.  Quality Assurance Officers would use a risk matrix to identify areas of risk, however, as an example, Safeguarding was always a high risk.  Further information was requested from Officers

·         Concerns about providers could include concerns about management, which would result in an action plan being developed jointly between the provider and the Council to rectify the situation.  If no improvement, sanctions could include the Council stopping admissions to the home

·         A Member had understood that care homes with less than 3 beds were not subject to inspection.  Officers agreed to clarify the position

·         The current pandemic was proving challenging for providers.  Partnership working was important and shared intelligence was vital

·         On the advice from Public Health, all Worcestershire Care Homes were currently closed to visitors and a number were also closed to admissions as the number of cases was rising.  A Member asked if the County had enough bed capacity, to be informed that the situation was being closely monitored, however, there was enough capacity in the system at present as a large number of homes had vacancies at the current time

·         In response to a question as to whether any home was at risk of permanent closure, it was reported that financial risk was very real.  The Council was investigating the possibility of introducing block contract beds to ensure financial stability, however, there was also a need to ensure that the right type of care was available.  There was a piece of work being undertaken regionally to monitor the fragile situation

·         A Member referred to the reported 19 Care Homes with current outbreaks and asked whether the Staff were employed at other establishments. It was not information that was recorded; however, it was known that most cases were amongst the Staff, rather than residents.  The Infection Control Team would look at each setting and all homes were sent regular information and guidance.  A Member spoke personally and commended the information and guidance received and thanked Officers for the very good advice 

·         In usual circumstances, a Care Home would hope to operate at around 90% occupancy, with less than 80%, for a period of time, being a cause for concern.  The capacity tracker was extremely helpful as it was gathering intelligence on occupancy of the whole home, not just Council funded residents

·         In relation to decreasing supplies of PPE, there had been national issues and homes had reported inflated costs, however, the Council’s Commercial Team were praised for sourcing resources when individual homes struggled.  Officers reported that they were awaiting guidance on the recent Government announcement that care homes would receive free PPE

·         In response to a query as to whether Officers foresaw admissions to permanent care reducing, it was reported that it was a concern, however, regionally, early conclusions had suggested that the future market would look different as perceptions of care were already changing and alternative options was a growth opportunity, such as supported living or extra care.  It was felt that these possibilities would reduce the reliance on care beds and provide the drive to support people to live independent lives in their own homes: some modelling was being carried out in this area

·         The Agenda referred to an outline business case for high needs dementia beds, which Officers reported had been on hold due to the pandemic.  The Panel requested sight of it, something which Officers would check on its status and report back

·         The future of block purchasing would also likely change, with Officers reporting huge success in short term immediate placements.  In the medium and long term, the Council could proactively work with the market to ensure the right type of provision was available however there would need to be a lot of detailed negotiations.  The Panel also noted that a risk to the Council would always be that residents had the right to choose where they lived and that any setting where a block purchase was in place may not be where residents wished to live.

The Panel Chairman summed up the discussion and invited the Engagement Officer from Healthwatch to comment.  Healthwatch agreed with the Council’s actions taken to date and recognised the balance of risk in relation to visits to Care Homes, however, it was a worrying time for family and friends.  It would be helpful to be assured that if anyone had any concerns which needed to be escalated, that information could be shared appropriately with families.

During the discussion, the following information was requested:

·         The specific questions from the national activity tracker

·         Care Quality Commission steer as to when visits would recommence

·         Further detail from the Quality Assurance Team on risk matrix and definitions of high risk and moderation risk

·         Clarification on whether small homes are subject to inspection

·         A copy of the outline business case for high needs dementia beds.