Constructive Conversations - Birmingham - 16 October · in care would need to increase by around 2.6% per year until 2035 to meet increased demand. However, the annual growth in the

Constructive Conversations

Welcome!LGA,TLAP, NCAG, ADASS, UKHCA,

RNHA, NCF

16th October 2018 www.local.gov.uk

• Please turn all mobile phones onto silent

during the conference.

• There is no scheduled fire alarm test today, if

the alarm sounds please evacuate by the

nearest exit and the meeting point is at the

rear of the building.

• Men's, women's and disabled toilets are all

located on the ground floor.

www.local.gov.uk

Morning Timetable10.00am Introduction and welcome Brigid Day, Care and Health Improvement Programme

Tim Parkin, Think Local Act Personal10.10am The importance of

constructive

conversations - different

perspectives

Isaac Samuels – TLAP, National Co-Production Advisory Group

Ian Turner - Chair, Registered Nursing Home Association

David Watts - Director of Adult Services, City of Wolverhampton Council

10.45am Table discussions 1 Pre-selected Groups

What’s working and what’s not? Main challenges you face? What does good look like?

How would a more constructive conversation help achieve it? How could tools such as

Market Position Statements help? What will the future hold for care homes and housing

and care? 11.15am Coffee Break

11.30am Table discussions 2 Agree main challenge and possible ways forward

11.50am The future of the care

home market in the West

Midlands

Elaine Carolan - Worcestershire County Council

Christine Lewington - IEWM Associate and West Midlands Lead for the Future of Care

Homes

12.20pm Lunch and Networking

Purpose of the event

• Challenging circumstances for adult social

care

• More important than ever for partners to work

more closely together

• So this is why LGA and TLAP have come

together to put on a series of events -

• Constructive Conversations

Isaac Samuels

TLAP National Co-Production

Advisory Group

Perspective of someone

currently using services


Ian Turner

Chair, Registered Nursing

Home Association

Current issues and the care

home provider perspective



A provider view

Ian Turner, Executive Chair, RNHA

Personal background

Always been around a health environment

Father was psychiatric nurse

Wife was a nurse

Owned nursing homes for over 34 years

Currently operate 300 beds in East Anglia

Chair Registered Nursing Home Association

Produced Care Act guidance and various market

initiatives

What is the provider view?

Providers must take a long term view, at least for any

residential care.

We typically finance projects over twenty years.

We cannot move buildings, only find alternative uses.

Just as importantly labour markets shift.

We cannot affect those markets; only work with our

current staff.

It frequently feels very lonely, especially for RM’s.

What service?

In the 1980’s we were caring for people with a single

health condition, could have been stroke or multiple

sclerosis.

How that has changed.

We are now seeing people living with multiple diagnosis (

more than 10 is not uncommon) and also caring for

many more people who can demonstrate a degree of

physical independence.

There will be a need for more episodic care in future.

What shape in the future?

Learn from the past; how did we miss / continue to miss

the growing demand for dementia care.

How do we communicate market movement?

Provider view is that we take all the risk; long term

liabilities and short term contracts / placements.

Why is intermediate care not available more generally?

How do you communicate?

In short, we don’t.

Registered Managers do not have the authority to commit

resources and change markets.

Might not even be the responsible individual.

Providers take supply side decisions, in the main, without

a dialogue with commissioners.

What topics should we address?

Start with labour markets since there are common

objectives.

Accept that whilst we can agree on most costings, we

work in different ways when it comes to capital.

How do we create that dialogue?

Providers do not employ professional meeting attenders.

Continually adding new contract clauses and “telling”

providers they must do X or Y, does not go down well.

We always have a queue of people at the door who are

all specialists in their own right and know what we

should be doing, but have never haad to make the trade

offs to determine what is appropriate for that group of

people.

Constructive Conversation

What is the objective?

Then we can determine the who and the how.

A recommended read!

David Watts

Commissioner perspective

Director of Adult Services,

City of Wolverhampton Council


Table Discussions - 1• Brief introductions

• Appoint a scribe to record key points only

• Agree on your table the common (or different) top issues

you are facing

• If time move to what they might be able to do to address the

issues - not necessarily solutions but starting points

• Please identify the agreed top three issues on the flipchart

in priority order with possible ways forward

• This information will be recorded for later

Table Discussions 1 - QuestionsPre-selected Groups

• What’s working and what’s not?

• Main challenges you face?

• What does good look like?

• How would a more constructive conversation help achieve it?

• How could tools such as Market Position Statements help?

• What will the future hold for care homes and housing and

care?

Please idebtify the agreed top three issues on the flipchart in

priority order with possible ways forward

Coffee Break

Please return to your table by

11.30am

Table Discussions - 2

• Agree your main challenge out of the top

three and any possible ways forward

• Please record this main challenge on your

group flipchart

The future of the care home

market in the West Midlands

Elaine Carolan and Christine

Lewington


Elaine Carolan Head of Commissioning Worcestershire County CouncilAndChristine LewingtonIEWM Associate and Programme Lead

Redefining the Future of Residential and Nursing Care in the West Midlands

23

Our Regional Position

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• 14 Local Authorities

• Mixed economy of Residential Care

• Maintain people in the community

• Manage expectations

• Strategic view of cost v price

• Quality

• Sustainability

The Challenges

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• Demographics

• Increasing need and complexity

• Workforce – Where have all the nurses gone ?

• Cross-subsidy from self-funders

• Affordability/Sustainability

• Short term funding

• Market Management

• DOL’s

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• Urgent Care Systems - DTOC

• CHC

• FNC

• Trusted Assessments

• Do the NHS understand what residential care is ?

• Support to Care Homes

Joint working

Redefining the future of Residential and Nursing Care in the West Midlands

27

Project Outline

The purpose of this commission is to stand back and ‘take the long view’ (10/20+

years) at the preferred direction for the development of the care home market.

And consider the increasing complexity of needs, the workforce issues, the array

of fee structures and its impact on the markets stability and sustainability and

the interface with other professionals and stakeholders.


28

Key ambitions for this work are:• To have at its heart careful consideration of the experience

and outcomes for older people and their families when moving into a care home

• Jointly driven by health and social care in partnership• Incorporates strong involvement from the sector itself


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The Output

An analysis of relevant data and evidence relating to the delivery of care in the West Midlands Care Home market

Identification of the issues and areas for development that need to be addressed to enable a responsive, sustainable, high quality care home market for the future and to make associated recommendations as to how this should be achieved.

A report and presentation which can be shared regionally to inform regional developments.

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36 This includes expenditure on social services for people below 65 and for older people not in care homes.

Gross current expenditure excludes capital charges and expenses offset by other income (except for client

contributions).

• The NAO has estimated that central government

has reduced its funding to local authorities by 37%

in real terms between 2010/11 and 2015/16. And

experienced a real terms reduction in spending

power of 23% over the same period.

• The King’s Fund reported that 81% of local

authorities cut their spending in real terms on social

care for older people since 2010. In more than half

of LAs the reduction was at least 10%. However,

the picture is not uniform –18% maintained or

increased spending (Kings Fund, September

2016).

• The Association of Directors of Adult Social

Services (ADASS) (2017) showed that for adult

social care LAs in England have a reported £366

million overspend in 2016/17 and planned £824

million of further savings in 2017/18 bringing

cumulative savings to £6 billion since 2010.

Source: CMA Report 2017.

LAs expenditure on adult social care has declined since 2009/10.

Further pressure is expected.


31

It is estimated that LAs in England spent around £4.7 billion on social care for older people in residential and nursing care settings in 15/16.

And in England, LA funded residents contribute around £1.6 billion to

their cost of care.

NHS Digital, Personal, Social Services: Expenditure and Unit Costs, England - 2015-16,

In 2015-16, almost 160,000 people received, or were assessed as

eligible for, CHC funding in the year, at a cost of £3.1bn

nao.org.uk

http://nao.org.uk/

32

Source: CQC State of Adult Social Care 2014 - 2017

Quality of Provision

Workforce

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Growth in the number of jobs has fallen behind growth in demand for care.The Department commissioned modelling based on 2014 data that suggested the number of full-time equivalent jobs in care would need to increase by around 2.6% per year until 2035 to meet increased demand. However, the annual growth in the number of jobs since 2013 has been 2% or lower.

Source: NAO Report The adult social care workforce in England 2018

6.6%was the vacancy rate for jobs across the care sector in 2016-17.

Residential & Nursing Markets

34

During 2016, ADASS West Midlands undertook an exercise to map the residential and nursing care markets funded by the 14 authorities in the region. This work looked at Adult Social Care funded placements only and excluded Health Funding – we learnt that

• The market was large and diverse – at the time of the snapshot collection exercise the councils in the region were buying around 34% of the 42,000 registered residential and nursing beds in the region

• Over 900 different provider companies were providing services funded by a council in the company – but there were homes and/or companies that councils did not purchase from at all

• But despite this diverse market, around a third of total expenditure was with one of the ‘big brand’ provider companies in the region

• The regions councils – based on the snapshot data – were spending over £400m a year on bed based care for older people

Residential & Nursing Markets

35

During 2018 we have been asking CCG’s for their data on spend in the older persons residential and nursing care sector. Whilst this is an incomplete data set at present we know that –

• CCG’s are funding FNC and CHC placements in largely the same provider market locally

• That the market concentration for ‘big brand’ providers is similar in the health system as it is in the social care system

• Based on the snap shot data – which as noted above is incomplete – around another £150m per annum is being funded from CCG’s (true figure is likely higher)

We continue to work with Health and Social Care colleagues to better understand our local ‘bed based’ care market – this helps inform our market oversight responsibilities under the Care Act, but also conversations around the future shape of the local market.

We are undertaking a similar exercise in Learning Disabilities shortly.

36

Forecasting the care needs of the older population in England

over the next 20 years: estimates from the Population Ageing

and Care Simulation (PACSim) modelling study

Article The Lancet Sept 2018

37


What people have to say - from those over the age of 60 years…

Weekly GP sessions

Themed Rooms/cinemas

Daily menus

Small village/neighbourhood model

Authentic

Don’t take choice away, give control back

Bring community in - children into homes

Working environment -chickens/gardening

Having control over your own life

Able to take your own pets

Induction programmeFor residents and relatives

Properly trained staff

Lifestory book(know me!!- who am I?)

Personal Daily Plan

Let people do their own jobs

To live independently within the home

38


What Providers have to say….

1. What does the Care Home market need to look like in 10/20 years time?

2. What do you think the Challenges will be to meet growing demand?

3. What would you need to support you to make any changes?

4. What role does technology play in any redesign of residential and nursing care?

5. How does commissioning need to change?

6. Given the complexity of needs, what are the thoughts on the role of other professionals?

7. Views on the community having a stronger role in care homes.


What do you think the Challenges will be to meet growing

demand?

Finance/Funding – LA funding unrealistic and

families struggling to cope with top-ups.

Not enough homes/capacity within homes for growing

ageing population.

Lack of Quality Staff due to wages on offer (minimum

wage).

Lack of Skilled/Specialist Staff to cope with growing

complexity of needs.

Staff Retention.

Relationship with the NHS

Regulations.

39

What does the Care Home market need to look like in

10/20 years time?

More diversity to meet the growing cultural

changes.

More specialised dementia units.

Allow Carers time to care not pressured by funding

and regulations.

Make care more person centred.

Closer Integrated working relationships with other

professionals (NHS, Social Workers).

Professional bodies to spend time in Care Home to

witness daily pressures.

More staff (higher ratio) and better quality staff.

Better and more realistic funding.

Better environments possibly some Male only units.


What would you need to support you to make any

changes?

Realistic Fees.

One system across the West Midlands?!!! Is

this feasible?

Practical support from Local Authorities.

Better communications and working

relationships with professional bodies (NHS,

social workers).

More support for Care Homes to cope with

people with challenging behaviour.

Better training not just minimum standard.

Diversification of business model - future has to

be an offer of multiple services that are community led

40

What role does technology play in any

redesign of residential and nursing care?

More use of Social Media

Next generation would want Wi-Fi in

every room

Possible use of tablets for Day Books

etc.

Better relationship with stakeholders.

How does commissioning need to change?

More Industry awareness (people who know what

Care Homes actually do).

Quality/skills of commissioners/procurement

More honesty, openness and information.

How will health and social care commissioners

organise themselves? One Spec/Contract for the WM?

A new model for paying invoices to providers! - awful!!

Longer contracts.

Consider ‘grey’ areas as not always black and white –

one size does not fit all.

Pathways need to be clearer.

Stop unnecessary form filling exercises and respond to

calls for support and help.

Work with the Care Homes not against them.

Something around the quality and skills of

commissioners/procurement - commissioners need to

keep up with innovation.

41

Given the complexity of needs, what are the thoughts on

the role of other professionals?

GP’s reluctant to attend.

CPN’s/GP’s who take responsibility?

Told to call before certain times of day is

unacceptable.

Queue system for booking appointments is frustrating.

Telephones constantly engaged at GP’s surgeries.

Receptionist asking personal and confidential details

and do not accept that Care Workers know their

patients.

Prescriptions – EPS

How do we share information?in a more coherent

and consistent way?


42


Views on the community having a stronger role in care homes

Provide more information in Local Libraries.

Possible use of more volunteers.

Utilise community assets and build community networks eg; Local pubs

43

Aligned to Acute Hospitals SMART Villages Extensions of Care Home role to

include Community Support

Future residential and nursing care

homes directly linked to hospitals to

avoid admissions and to speed up

discharge home. Links to Intermediate

Care.

NHS and Local Authorities to work

together to invest in capital strategy for

creating smaller res and nursing care

homes.

Create a planned and organised model

for the individual and the family and

widen the funnel to include staff

providing personal care in a persons

own home/day care.

Providers need to have a direct

relationship with the hospital. The

conversation needs to begin at the point

of admission - needs a clearer

route/pathway and relationship.

Build SMART neighbourhoods and be

more preventative/early interventions.

Build/create care homes built close to

medical centres - incorporating bistro

cafes/transport/touch points to avoid

calling 999.

Local authority and smaller providers to

work together with investment firms to

find a way to model flows of customers

with care needs

Strength based model. Creating a

bundle of care in a community - led by

the community, with the community.

Use the assets within the community

eg; local pub

Redefining the Future of Residential and Nursing Care in the West MidlandsEmerging Perspectives so far…

44


Next Steps

More listening (frontline staff/regulators/commissioners…. and I am interested in your views.

Enhanced Health Care in Care Homes

The Data…

Thank You for Listening to me!

www.local.gov.uk

World Café session choices1. Involving people in design and delivery of the care home/housing with care of the future,

Isaac Samuels and Tim Parkin TLAP/National Co-Production Advisory Group MAIN

CONFERENCE ROOM NEAR SCREEN PINK TABLE

2. NHS and support to the sector, Grace Abel, Adviser, LGA ROOM 2

3. Working together and joint planning on the care home/housing with care workforce, Clare

McKenzie, Locality Manager, Skills for Care MAIN CONFERENCE ROOM PURPLE TABLE

4. Understanding the business of providing care in care homes, Ian Turner, RNHA MAIN

CONFERENCE ROOM ORANGE TABLE

5. Bringing commissioning and procurement together to innovate for the care home/housing

with care sector of the future, Brigid Day, LGA and Elaine Carolan, Worcestershire County

Council ROOM 7 UPSTAIRS

6. New models - housing and care, Clare Skidmore Strategic Lead, Influencing and Networks,

Housing Learning and Improvement Network ROOM 6

Lunch

Please sign up to your first world

café session choice.

‘World Café’ session

• Facilitators will be hosting the conversation on

their topic

• Participants can rotate group after 20 minutes

• Facilitators - please keep a flipchart record of

the themes and main points so people joining

can see what’s been discussed - and so we

and you, can use the insights to inform work in

the future


Involving people in the design and

delivery of services

Isaac Samuels, National Co-production Advisory Group

Tim Parkin, Think Local Act Personal

16 October 2018

The Ladder of Participation

Ten top tips for co-production

Coalition for Collaborative Care:

A co-production model

• What is co-production?Co-production is a way of working that involves people who use health & care services, carers & communities in equal partnership; & which engages groups of people at the earliest stages of service design, development and evaluation.

Co-production: Five values

Seven practical steps to make co-production happen in reality

Stronger partnerships

for better outcomes

The afternoon table session

Discuss and scribes please record

• Any insights gained over the day

• Achievable priorities for constructive

conversations - for the next three months?

• Agree a ‘takeaway’ action from each person

preferably on what people could commit to

working together on and how

Feedback from

the Day

Knowledge Hub.

Thanks for coming!

We will be sending a feedback survey via email

to you shortly with the powerpoints

Documents

Constructive Conversations - Birmingham - 16 October · in care would need to increase by around 2.6% per year until 2035 to meet increased demand. However, the annual growth in the