Overview
Working jointly with our partners in the NHS and the provider market, we intend to deliver our strategic objectives for care homes (Improving the quality of care homes in Staffordshire, ensuring timely access to care home placements when required, and ensuring affordability of care home placements). In addition, we also aim to strengthen our collaborative approaches to the care workforce, clinical support to care homes, digital and technology, and strength based and outcomes based commissioning.
Quality
We will measure this primarily by the proportion of care homes rated as ‘Good’ or ‘Outstanding’ by CQC with a target to reach the England average within the next 3-5 years.
Whilst progress has been made in shaping and supporting the quality of marketplace, there are areas still for further improvement.
- The Council will maintain an ongoing and enhanced focus on quality assurance and quality improvement. The Council is developing a Quality Assurance Framework and the new care home contract will align with this enabling the Council to effectively manage the risks and quality improvement work with the market
- The Council and its partners will continue to build on their experience during the pandemic to continually refine their support to care homes for quality improvement.
- Where care homes are repeatedly identified by CQC as requiring improvement, and unable to demonstrate a capacity for sustained improvement despite advice and assistance, the Council will consider whether it can continue to make new placements and also consider supporting a move of residents, where this is in their interests on a balance of risks.
Accessibility and sufficiency
We aim to ensure timely access to care home placements that meet people’s needs. This will be measured by the proportion of placements sourced to target timescale (Priority, Urgent or Standard) with a target of 85% achieved to time.
- It will remain important for the Council to continue to track occupancy and staffing levels at a home-by-home level, and to remain engaged with care homes to understand their individual positions. We will gain this information through any national tools that are provided, rather than duplicate information requests from care homes. If no national system is put in place, then we will seek to collect this information locally and share it across the Council, the NHS and other commissioners
- The Council is intending to increase the percentage of block booked beds that it commissions from the market, while continually reviewing the level of block booked beds to ensure that unoccupied beds are kept at a low level. Timescales for assessments and acceptances by homes with block booked beds will be robustly managed
- To further improve the timeliness of assessments we will review our approach to trusted assessments, and the Council is therefore interested in discussions with providers who wish to help us shape this.
- The nursing care market is the market with the greatest percentage of care homes that have not reached a ‘Good’ CQC rating. The Council is keen to improve access to good quality, affordable nursing home provision and is interested in discussions with innovative providers who want to diversify or any residential homes who wish to develop nursing with dementia care.
- The Council may also develop additional nursing capacity with trusted partners in areas of the county where there is a long-term insufficiency in nursing care of a suitable quality and price, subject to business case for any such developments.
- The Council are interested in working with partners to develop services to support young adults transitioning from children’s services, including those from the age of 16.
Price
As a commissioner of care, the Council seeks to pay a fair price, with cost effective placements, and overall expenditure within budget. This is measured by the tracking the average price of placements against the modelled average price, and by seeking to reduce unwarranted variation in price within lots.
As part of the national implementation of social care reforms, the Council has carried out a cost of care exercise.
Person centred care and support
The Council aims to improve current practice by working with care home providers to ensure the delivery of care is driven by what is important to the individual’s being supported.
For every person supported in a care home the following statements from the Think Local, Act Personal Making it Real campaign need to underpin the delivery of care;
- I am treated with respect and dignity.
- I feel safe and am supported to understand and manage any risks.
- I am supported to manage my health in a way that makes sense to me.
- I have people in my life who care about me – family, friends, and people in my community.
- I have a place I can call home, not just a ‘bed’ or somewhere that provides me with care.
- I can get information and advice that helps me think about and plan my life.
- I can get information and advice about my health and how I can be as well as possible – physically, mentally, and emotionally.
- I can get information and advice that is accurate, up to date and provided in a way that I can understand.
- I can keep in touch and meet up with people who are important to me, including family, friends and people who share my interests, identity, and culture
- I have a co-produced personal plan that sets out how I can be as active and involved in my community as possible.
- If my medication has to change, I know why and am involved in the decision.
- I am supported by people who see me as a unique person with strengths, abilities, and aspirations.
- I am supported by people who listen carefully, so they know what matters to me and how to support me to live the life I want.
- I am supported to make decisions by people who see things from my point of view, with concern for what matters to me, my wellbeing and health.
- I have considerate support delivered by competent people.
Capacity
In all circumstances where possible the Council supports people in our community to live independently in their own homes. In the cases when a person can no longer live independently care home placements are considered. Due to advances in technology and support to manage people safely at home the Council has a greater need for new capacity to deliver nursing care rather than residential only provision.
Staffordshire has relatively fewer total care home beds (residential and nursing) compared to similar local authorities and the England average, but a relatively higher number of nursing beds, as shown below. However, the availability of affordable nursing care to meet the needs of people placed by the Council is reducing.
Residential and nursing capacity per 100,000 population over 65
Residential care beds per LA population (age 65+)
| | Local Authority | Comparators | England |
|---|
| Weighted number of beds |
3336 |
4761 |
4308 |
Nursing care beds per LA population (age 65+)
| | Local Authority | Comparators | England |
|---|
| Weighted number of beds |
4430 |
3755 |
4106 |
Over the last few years there has been a reduction in nursing home capacity in Staffordshire.
Planning consent for new build care homes is managed through the district and borough councils. The planning regulations do not require that an application identifies whether the care home will be for nursing or residential care. Planning consent is awarded for three years; if a development has not started in that time the applicant has to reapply. Staffordshire County Council and the Staffordshire Integrated Care Board would welcome discussions with Providers considering developments for affordable nursing care provision.
Workforce
The Council will continue to support the care home workforce through:
• Providing information and support for providers regarding recruitment and retention, training and events and signposting to local and national resources.
• Working with the NHS to develop apprenticeship and Care Reserve models
• Advocating for the sector, for example through our Dignity in Care Awards
• Supporting opportunities for innovation and technology within the sector and associated skills
• Working with the NHS to develop more resilient support and advice for nursing staff
• Developing and implementing a sector wide Workforce Strategy with partners
Digital and technology enabled care
The Council is committed to addressing digital exclusion and has a digital strategy, acting as a catalyst to enable more supported and connected communities. The Council intends for digital to underpin a transformed health and social care system that focuses on self- care, early intervention and prevention and has improved healthy life expectancy.
We have a number of current schemes and initiatives in place relevant to care home sector, including the deployment of Reminiscence Interactive Therapy Activities (RITA) in up to 51dementia care homes. We also support care homes in accessing secure information exchange with the NHS and other partners, including through support available to the marketplace through the Staffordshire Association of Registered Care Providers (SARCP). The completion of the digital toolkit to support access to secure information exchange will be an expectation in future contracts.
By 2024 we expect that there will be increased digital information sharing as appropriate of care records, and we will support the sector in developing the skills and capabilities to do this.
Strength based/outcomes based
The Council will review our processes for sourcing care home placements to emphasise the personal outcomes and strengths of people placed in care homes by the Council, alongside the needs and risks that care homes must be able to safely manage. Our Quality Assurance Team will place a stronger emphasis on gaining evidence of how care homes implement person-centred, responsive care for residents, and incorporate the voice of residents in their own continual improvement plans.
Clinical support
The Council and our NHS partners will work together to provide advice and support to care homes where necessary. This includes the Enhanced Health in Care Homes support provided by the NHS to support access to primary and community care for residents. We will also build on the role of the Provider Improvement Response Team and the Care Homes Intensive Support Team to enable good quality clinical advice to the sector, and access to specialist services such as Infection Prevention and Control (IPC), Speech and Language Therapy (SALT) and Tissue Viability Nurse (TVNs). As part of their own quality improvement, we do expect care homes to make best use of this advice and support.
Where appropriate, we will incorporate the expectation of close and consistent working with the NHS into our future contracts – for example, utilising the Deteriorating Patients Network tool to identify and intervene proactively where residents’ needs are escalating.