cordis briefing extracts · brand b & m care 1,125 620 55% brand life style care plc 2,526 575...
TRANSCRIPT
Cordis Briefing Extracts
July 2016
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These are extracts from July 2016’s Cordis Briefing. Full versions of the slides are available for subscribers by
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Today’s Briefing
• Brexit
• Deprivation of Liberty Safeguards
• Care Home Managers
• CQC Annual Report and Strategy
• Health and Social Care Integration Update
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Deprivation of Liberty Safeguards
DoLS Report 2014/15 and the Law Commission’s proposals
for “Protective Care” scheme
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Introduction
• We are going to have our annual look at DoLS activity with a look at:
– CQC’s “Monitoring the Deprivation of Liberty Safeguards in 2014/15”
– HSCIC’s “Deprivation of Liberty Safeguards Annual Report 2014/15”
• We will then look at the Law Commission’s proposals for replacing the
DoLS, which the House of Lords describes as being “not fit for
purpose” with a new scheme
• Along the way, we will look back to where this all started, with “A”
having a difficult day in his day centre in 1997
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CQC’s Monitoring the DoLS
• We looked at the CQC’s report in January 2016 alongside annual
statistics on Safeguarding.
• This is the first full year of post-West Cheshire reporting on DoLS. As
we have noted previously, there has been a substantial increase in
DoLS referrals since West Cheshire:
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DoLS Applications
??
-
50,000
100,000
150,000
2009/10 2010/11 2011/12 2012/13 2013/14 2014/15
DoLS Applications
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DoLS – Detailed activity data from HSCIC
• The HSCIC report provides detailed data on DoLS activity by Local
Authority area and by CQC Registered Location.
• This level of data highlights issues that are not apparent from the CQC
report.
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DoLS Data by provider
• The HSCIC background data provides information on DoLS Referrals
and outcomes by CQC Location ID.
• Combining this with CQC’s published directory of service makes it
possible to analyse DoLS performance by provider.
• There may be data issues which affect the reliability of the figures, as
they rely on accurate reporting of DoLS by local authorities and correct
tagging by Location ID
• The following charts look at provider performance on DoLS in relation
to:
– The total number of referrals made as a percentage of Care Home Beds
– The number of authorised DoLS referrals as a percentage of total referrals
made
• Full datasets can be obtained from [email protected]
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DoLS Applications Made
Provider NameCare Home
BedsDoLS
Applications Application %
Handsale Limited 295 5 1.7%
BRAND Eldercare 573 10 1.7%
Central Bedfordshire Council 265 5 1.9%
Horizon Care Homes Limited 241 5 2.1%
Borough Care Ltd 466 10 2.1%
Mark Jonathan Gilbert and Luke William Gilbert 445 10 2.2%
Czajka Properties Limited 220 5 2.3%
BRAND Norwood 206 5 2.4%
Nazareth Care Charitable Trust 617 15 2.4%
Unity Homes Limited 324 10 3.1%
Care Homes UK Limited 162 5 3.1%
BRAND Metropolitan Housing Trust Limited 161 5 3.1%
Ms K A Rogers 157 5 3.2%
BRAND Viridian Housing 312 10 3.2%
Mrs Sally Roberts & Mr Jeremy Walsh 152 5 3.3%
Chadderton Total Care Limited 151 5 3.3%
Friends of the Elderly 438 15 3.4%
Mrs Wendy J Gilbert & Mr Mark J Gilbert 144 5 3.5%
Low levels of applications could be because of
low level care needs, an unsupportive LA or lack
of awareness of the regulations
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DoLS Applications Made
Provider NameCare Home
BedsDoLS
ApplicationsApplication
%
Mrs Barbara and Mr Andrew Watt 17 120 706%
Wirral Metropolitan Borough Council 20 100 500%
Mrs D J Brown 11 40 364%
Family Care Trust 7 25 357%
Penrose Residential Limited 6 20 333%
Dementia Care 5 15 300%
Independent Options (North West) 10 30 300%
Candour Care Services (Hillcrest) Limited 9 25 278%
Acorn Lodge (Bournemouth) Limited 16 40 250%
Mr & Mrs P Gilbert and Miss C Gilbert 17 40 235%
Medway Council 15 35 233%
Mrs P Hunter 9 20 222%
Garden House Rest Home Limited 14 30 214%
Key Healthcare (St Helens) Limited 44 90 205%
Solar Care Homes Limited 10 20 200%
Ranmore House 5 10 200%
High levels of referrals could indicate a high
turnover of residents over the 12 month period,
or people with multiple authorisations
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DoLS Applications Made
Provider NameCare Home
BedsDoLS
ApplicationsApplication
%
BRAND Barchester Healthcare 10,712 4,400 41%
BRAND BUPA Group 17,778 3,115 18%
BRAND Four Seasons Group 18,104 3,050 17%
BRAND Care UK 6,943 2,505 36%
BRAND Runwood 3,422 1,290 38%
BRAND HC-One Limited 7,926 1,105 14%
BRAND Quantum Care Limited 1,527 995 65%
BRAND Sanctuary Care Limited 3,418 880 26%
BRAND Priory Group 3,130 795 25%
BRAND Sunrise Senior Living 3,348 765 23%
BRAND Orchard Care Homes 4,971 655 13%
BRAND Cornwall Care Limited 661 630 95%
BRAND Anchor Trust 4,058 620 15%
BRAND B & M Care 1,125 620 55%
BRAND Life Style Care plc 2,526 575 23%
BRAND Care South 872 575 66%
BRAND Hampshire County Council 1,054 570 54%
There is a wide variance in the number of
applications as a percentage of beds – 95% for
Cornwall Care* at one end, and Orchard Care
Homes with 13% at the other. Personalisaton?
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DoLS Applications Granted
Provider Name Total Applications Granted%
BRAND Minster Care Group 280 100.00%
BRAND Meridian Healthcare 245 100.00%
BRAND Ideal Care Homes Limited 245 100.00%
BRAND Roseberry Care Centres 200 100.00%
BRAND Gold Care Homes 185 100.00%
Flightcare Limited 175 100.00%
BRAND Lancashire County Council 150 100.00%
BRAND Leonard Cheshire Disability 140 100.00%
BRAND Hill Care Group 135 100.00%
Island Health Care Limited 120 100.00%
County Care Homes Limited 115 100.00%
Restful Homes (Cannock) Limited 115 100.00%
BRAND Caretech Community Services 115 100.00%
BRAND Advinia Healthcare 105 100.00%
Nellsar Limited 105 100.00%
Most of these providers are national, suggesting
good practice on applications rather than LAs
rubber-stamping authorisations
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DoLS Applications Granted
Provider NameTotal
Applications Granted%
P S P Health Care Limited 195 0.00%
Brunelcare 160 0.00%
BRAND Abbeyfield Society 160 0.00%
N Notaro Homes Limited 130 0.00%
Mrs Barbara and Mr Andrew Watt 120 0.00%
Regal Care Trading Ltd 120 0.00%
Cornwallis Care Services Limited 115 0.00%
Oak Care Limited 115 0.00%
Stonehaven (Healthcare) Limited 115 0.00%
BRAND Norse Care (Services) Limited 115 0.00%
BRAND Somerset County Council (LD Services) 110 0.00%
BRAND Accord Housing Association Limited 110 0.00%
Dukeries Health Care Limited 110 0.00%
Hillcroft (Carnforth) Limited 105 0.00%
Wirral Metropolitan Borough Council 100 0.00%
These are applications that have been
processed and rejected. You would hope that
Somerset County Council could get it right – but
they only approve 13% of applications overall
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DoLS Applications Granted
Provider NameTotal
Applications Granted%
BRAND Barchester Healthcare 4,400 83%
BRAND BUPA Group 3,115 87%
BRAND Four Seasons Group 3,050 86%
BRAND Care UK 2,505 88%
BRAND Runwood 1,290 85%
BRAND HC-One Limited 1,105 90%
BRAND Quantum Care Limited 995 74%
BRAND Sanctuary Care Limited 880 89%
BRAND Priory Group 795 71%
BRAND Sunrise Senior Living 765 97%
BRAND Orchard Care Homes 655 71%
BRAND Cornwall Care Limited 630 14%
BRAND B & M Care 620 78%
BRAND Anchor Trust 620 94%
BRAND Care South 575 73%
BRAND Life Style Care plc 575 93%
Cornwall Care make lots of applications (95% of
total beds), but only 14% are authorised. Anchor
are the opposite.
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Local Authority Data
• The HSCIC data indicate a wide variation in performance across the
country, although there are some clear patterns
• The next few maps looks at DoLS applications in relation to:
– The total number of applications made per 10,000 of the population
– The percentage of applications that have not been completed (processed)
– The percentage of applications granted
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DoLS Applications per 10,000 population
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DoLS Applications not completed
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DoLS Applications Granted
Is a high level of applications granted a good
thing? It could suggest that councils are “rubber-
stamping” applications and not considering fully
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Reforms of the DoLS Framework
• The wide variance in DoLS performance between providers and local
authorities highlights why the House of Lords described the
Deprivation of Liberty Safeguards as “not fit for purpose”.
• The Law Commission was tasked with developing an alternative to
DoLS in 2014, and is currently working on draft legislation to be
pubished at the end of the year.
• Before looking at what the Law Commission is proposing, it is worth
looking at what got us to this point:
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The Commission Proposals
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Key Messages
• Even after 8 years, providers and local authorities are still having
problems with DoLS.
• Although the scope of DoLS has been increased by the West Cheshire
judgment, the data show that there are still fundamental problems in
care homes, where the regulations have applied for a long time
• The Law Commission proposals won’t narrow the scope of DoLS to
pre-West Cheshire levels, but they will shift some of the burden back
to LAs, to undertake alongside care planning
• There are still unanswered questions about changing capacity and
DoLS, and the role of providers in notifying the commissioner. You will
need to keep on top of the deprivation of liberty
• Care Home Managers will be key to the assessment and management
of mental capacity,
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Delayed Transfers of Care
Data Review
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Overview
In the last 5 years, as the population of older people in England has
grown, so too has the level of Delayed Transfer of Care
Sources: Office for National Statistics Population Estimates
DToC Time Series (Aug 2010 – Jul 2011, Apr 2015 – Mar 2016)
SIZE OF OLDER POPULATION (75+)
4.1 million 4.4 million
2010 2015
+7%
TOTAL DTOC DAYS
1.4million 1.8 million+22%
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The level of Delayed Transfer of care
varies significantly between Local
Authorities
DToC (November 2015 – April 2016)
1st Quartile (Lowest Levels)
2nd Quartile
3rd Quartile
4th Quartile (Highest Levels)
Source: DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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DToC (November 2015 – April 2016)
LOCAL AUTHORITIES WITH THE HIGHEST TRANSFER OF CARE RATE
LOCAL AUTHORITIES WITH THE LOWEST TRANSFER OF CARE RATE
Cumbria
East Sussex
Trafford
Cornwall
Oxfordshire
Northamptonshire
Dorset
North Somerset UA
Devon
Coventry
Oldham
Barnsley
Sunderland
Bradford
Wirral
Northumberland
Newham
Redbridge
Stockton
On Tees UA
Salford
Source: DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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DToC and the older population
Unsurprisingly, there is a strong
correlation between areas with a high
proportion of older people (75+) and a
high level of DToC
10 Local Authorities with the
highest DToC rate
Local Authorities with at least
10% of the population aged 75%
Local Authorities in both of
these categories
Sources: Office for National Statistics Population Estimates
DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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DToC and available beds
0
5000
10000
15000
20000
25000
30000
35000
40000
0 2000 4000 6000 8000 10000 12000 14000
DTo
C-
nu
mb
er o
f d
ays
(No
v 2
01
5 -
Ap
r 2
01
6)
Total residential beds for older people
Local Authorities with a
high number of older
people tend to provide a
higher number of beds.
0
20000
40000
60000
80000
100000
120000
140000
160000
0 2000 4000 6000 8000 10000 12000 14000N
um
ber
of
old
er p
eop
le (
75
+)
Total residential beds for older people
Yet, a high number of
beds correlates with a
high number of DToC
days, suggesting that
supply is failing to meet
demand in high need
Local Authorities.
Sources: Office for National Statistics Population Estimates
DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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What are the reasons for DToC?
0 40000 80000 120000 160000 200000
A) COMPLETION OF ASSESSMENT
B) PUBLIC FUNDING
C) WAITING FURTHER NHS NON-ACUTE CARE
DI) AWAITING RESIDENTIAL HOME PLACEMENT ORAVAILABILITY
DII) AWAITING NURSING HOME PLACEMENT ORAVAILABILITY
E) AWAITING CARE PACKAGE IN OWN HOME
F) AWAITING COMMUNITY EQUIPMENT ANDADAPTIONS
G) PATIENT OR FAMILY CHOICE
H) DISPUTES
I) HOUSING - PATIENTS NOT COVERED BY NHS ANDCOMMUNITY CARE ACT
Reasons for DToC - Nov 2015 - Apr 2016The cause of DToC can be
due the NHS, Social Services,
or other factors.
The most DToC days in the 6
months studied were:
• Awaiting a care package in
own home
• Awaiting further NHS Non-
Acute Care
• Completion of Assessment
Source: DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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What are the reasons for DToC?
0% 5% 10% 15% 20% 25% 30% 35%
A) COMPLETION OF ASSESSMENT
B) PUBLIC FUNDING
C) WAITING FURTHER NHS NON-ACUTE CARE
DI) AWAITING RESIDENTIAL HOME PLACEMENT ORAVAILABILITY
DII) AWAITING NURSING HOME PLACEMENT ORAVAILABILITY
E) AWAITING CARE PACKAGE IN OWN HOME
F) AWAITING COMMUNITY EQUIPMENT ANDADAPTIONS
G) PATIENT OR FAMILY CHOICE
H) DISPUTES
I) HOUSING - PATIENTS NOT COVERED BY NHS ANDCOMMUNITY CARE ACT
Reason for DToC (as % of total DToC days)
Lowest DToC Rate Highest DToC Rate
The reasons for DToC in the
10 local authorities with the
highest DToC rate and the 10
with the lowest vary.
In Local Authorities with high
rates of DTOC the patient is
more likely to be awaiting a
care package in their own
home or awaiting the
completion of an assessment.
In the 10 lowest, the reason
being the patients choice, or
awaiting is much more
common.
Source: DToC Total Delayed Days Local Authority (Nov 2015 – Mar 2016)
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The reasons for DToC are changing
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Parties Responsible for DToC 2010-2016
NHS Social Care Both
Across all local authorities,
the reasons for DToC have
been changing, particularly in
the last 18 months.
The proportion of DToC
caused by the NHS is
decreasing.
DToC caused by Social
Services is rising.
Source: Delayed Transfers of Care Statistics for England 2015/16
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How to save £1bn through better
integration approaches
• Focus efforts where the biggest difference can be made, e.g. transfers
of care from hospitals
• Put in place strong leadership, ownership and accountability
• Empower the front line – co-design solutions; raise awareness and
understanding of what needs to be done
• Measure outcomes
• Trial new approaches in manageable areas before rolling them out and
don’t be afraid to change course if something isn’t working
• Standardise approaches that are working and roll them out at scale
• If a new approach works, get rid of the old way of working instead of
treating the new one as a bolt on
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Your views on health and social care
integration
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Viewfinder 2016
Question Agree2016
Agree 2015
The closer integration of health and social care is a good thing 93% 95%
Health agencies are the main barrier to better integrated care 69% 63%
Local authorities are the main barrier to better integrated care 47% 37%Private and not-for-profit providers are the main barrier to better integrated care 10% 0%
CCGs are a positive step towards greater integration 41% 32%The complete integration of health and social care will happen in the next 5 years 12% 21%Increased integration of health and social care provision will save money 66% 74%The greater integration of health and social care will improve the quality of services on offer 74% 84%The greater integration of health and social care represents a growth opportunity for my organisation 84% 74%
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