Agenda item

Future residential and nursing care for older people

Purpose of the Report

 

To enable the Committee to scrutinise matters relating to future residential and nursing care provision for older people in West Northamptonshire.

Decision:

RESOLVED: That the People Overview and Scrutiny Committee:

 

a)    Noted the report.

 

b)    Requested to receive a further report on residential and nursing care for older people in West Northamptonshire to the Committee meeting on 16th November 2021 providing information on the following matters:

·         How the breakdown of Care Quality Commission ratings for care homes in the area compares with the position in other similar local authorities.

·         The latest position concerning occupancy in care homes in the area.

·         The number of care homes in the area currently rated ‘good’ where the Council may still have concerns about performance.

·         The number of contracts with care home providers in the area that have been cancelled in the past three years.

·         The latest position and direction of travel regarding staffing in care homes in the area.

·         The potential future direction of the care home market.

 

c)    Requested that an opportunity be arranged for Committee members to observe the operation of the Council’s processes for monitoring the performance of care homes.

 

d)    Recommended that West Northamptonshire Councillors be informed in advance in the event that a care home located in their ward is due to be closed. 

 

Minutes:

The Executive Director – Adults, Communities and Wellbeing and Assistant Directors presented the report, which provided an overview of current internal and external care provision in West Northamptonshire, key issues and priorities, assurance and risk and the potential direction of future development. They highlighted particular points as follows:

·         Both internal and external care homes had faced an unprecedented amount of attention during the pandemic and had experienced challenges resulting from rapid changes in government guidance and expectations.

·         Occupancy levels had reduced as a result of the pandemic and now needed to be built up again.

·         The care homes in West Northamptonshire included a significant cluster in Northampton. There was quite a high number of individual homes overall.

·         The 117 external care homes in West Northamptonshire included 26 rated as requiring improvement by the Care Quality Commission (CQC) and 2 rated as inadequate. WNC operated an internal team that provided support for improvement work, although this had been more challenging during the pandemic. The total number of external care homes included 71 rated good and 11 rated outstanding.

 

Members discussed the points raised and asked the following questions:

·         Around one-third of care homes rated as requiring improvement seemed a high proportion. How did this compare with other areas?

·         The current situation was a particularly challenging one for care homes and involved potential tension between the need to address low occupancy and to maintain service quality. It was acknowledged that all care home staff had been under huge pressure during the pandemic. 

·         What would be done for the 26 homes requiring improvement?   Would they be mentored?  How would improvements be measured?  What action could WNC take if a home required improvement but the provider did not act to achieve this?

·         Would an underperforming provider be paid at the same rate as an effective one?

·         Was it known that all 71 homes currently rated good were in fact performing at this level and were not falling back?

·         How many contracts with care home providers had been terminated in recent years due to concerns about performance?

·         When would changes be made to the 26 homes rated as requiring improvement?  The results were not good enough and did not provide value for money. Improvement was needed.

·         Were homes losing money because of reduced occupancy?

 

The Executive Director – Adults, Communities and Wellbeing and Assistant Directors provided additional information in response to questions from members as follows:

·         Most other local authorities were in a similar or worse position to WNC in terms of the percentage of residential care homes rated by the CQC as requiring improvement. The CQC ratings were helpful but did not give the whole picture. In future WNC would seek to define some key performance indicators as part of the service planning process that would give a clearer picture of providers’ performance within the overall CQC ratings. Benchmarking data about CQC ratings could be shared with the Committee.

·         The current situation for care homes was difficult due to factors such as increased mortality and reduced demand for residential care resulting from the pandemic.  Under-occupied providers would face challenges.  WNC’s approach to managing the market needed to reflect the importance of retaining those providers rated good or outstanding.

·         WNC had a set process for providing assurance on service quality, risk and contractual compliance in relation to residential care. This was intelligence-based and involved working with providers on plans for improvement where necessary. Lead officers in the Safeguarding and Commissioning teams provided a specific point of contact for individual homes.

·         A care home would need to complete specific steps to improve its CQC rating. It was not possible for a home to go directly from being rated as requiring improvement to an outstanding rating.  A sustained improvement over time needed to be shown.

·         Reducing the fees paid to under-performing care homes would lead to a reduction in quality, so a supportive but firm approach was taken to addressing questions of performance.

·         The support provided to self-funders was an another key question relating to future models of care. At present the care market nationally was effectively being subsidised by self-funders. Further consideration could be given to the issue of how WNC could best work with self-funders.

·         Care homes that were rated as good were subject to the same WNC monitoring process as those performing less well. The number of care homes rated as good where performance issues were being considered could be confirmed.

·         Details of residential care contracts terminated due to performance concerns in recent years could be provided.

·         Care homes needed to be safe, caring, responsive to needs, effective and well-led.  The CQC carried out a process to determine whether these requirements were met.  WNC worked with each home that needed to improve its performance.  However, progress up through the ratings depended on when the CQC carried out an inspection, which was not within WNC’s control.  It was also very challenging for a home to achieve an outstanding rating. 

·         The interim commissioning intentions agreed by the Cabinet in June 2021 required providers to be rated good or outstanding for WNC to commission them. Previous providers that were not at this level would not be successful if they reapplied.

·         Care home beds were not block purchased, but acquired on an individual basis.  Needs had become more complex during the pandemic and costs had therefore increased.

·         WNC was developing a strategy regarding the use of assistive health technology. This was a massive growth area. The strengths-based approach to care provision taken by WNC reflected the same principles of offering alternative options and tailoring care to individuals’ needs in order to support independence. 

 

Members made additional points during discussion as follows:

·         WNC should think in terms of how it could provide hybrid support to self-funders in partnership with the family.

·         It was important for care homes to have the right environment for residents.  The needs of current residents were different from those of the previous generation.

·         It was requested that the topic of future residential and nursing care be revisited at the People Overview and Scrutiny committee in November 2021, with an update on particular matters raised at the current meeting.

·         It was emphasised that the local councillors should be advised beforehand if a care home in their ward was due to be closed.

·         Members requested the opportunity to observe the process used by WNC to review a care home’s performance. 

 

RESOLVED: That the People Overview and Scrutiny Committee:

a)    Noted the report.

b)    Requested to receive a further report on residential and nursing care for older people in West Northamptonshire to the Committee meeting on 16th November 2021 providing information on the following matters:

·         How the breakdown of Care Quality Commission ratings for care homes in the area compares with the position in other similar local authorities.

·         The latest position concerning occupancy in care homes in the area.

·         The number of care homes in the area currently rated ‘good’ where the Council may still have concerns about performance.

·         The number of contracts with care home providers in the area that have been cancelled in the past three years.

·         The latest position and direction of travel regarding staffing in care homes in the area.

·         The potential future direction of the care home market.

c)    Requested that an opportunity be arranged for Committee members to observe the operation of the Council’s processes for monitoring the performance of care homes.

d)      Recommended that West Northamptonshire Councillors be informed in advance in the event that a care home located in their ward is due to be closed. 

Supporting documents: