ITEM 8 Care Home Support
North Lanarkshire Council · 21 February 2024
Back to IJB Performance, Finance and Audit Committee — 21 February 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 8 SUBJECT: Care Home Support TO: Integration Joint Board Performance, Finance & Audit Committee Lead Officer for Report: Trudi Marshall, Nurse Director, Health & Social Care North Lanarkshire Author(s) of Report Sharon Murray, Associate Nurse Director DATE: 21st February 2024 1. PURPOSE OF REPORT This paper is coming to the IJB PFA for: To update members on the progress on the support provided to care homes across Lanarkshire. For Approval: ☐ For Endorsement: ☐ To Note: ☒ 2. ROUTE TO THE BOARD This report was prepared by Sharon Murray, Associate Director of Nursing who is leading on the Care Home Support team across Lanarkshire. The report has been reviewed by North Lanarkshire HSCP CORE Management Team. This paper has been: Prepared By: ☐ Reviewed By: ☒ Endorsed By: ☐
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2 3. RECOMMENDATIONS It is recommended that the IJB PFA Committee: (1) Consider the professional oversight and clinical leadership that is provided to the care home sector. 4. VARIATIONS TO DIRECTIONS? This section outlines if the report requires a direction to be issued to the Local Authority, the Health Board, to both, or that no direction is required 5. BACKGROUND/SUMMARY OF KEY ISSUES Following communication from the Cabinet Secretary on 17th May 2020 there were additional requirements for the Executive Director of Nursing, Midwifery and Allied Health Professionals within NHS Lanarkshire (NMAHP) which included: Providing professional oversight and clinical leadership and support ensuring health needs of care home residents are met. Outbreak management Oversight of testing and review of test results, and supporting the development and implementation of a range of testing approaches for care homes. Conduct assurance visits and monitor information trends from safety huddle providing professional and clinical advice on provision of health care needs. Support compliance with IPC whilst monitoring trends and escalations via safety huddle. Support education and training in care homes in IPC measures. There are 86 care homes across Lanarkshire, 28 within North Lanarkshire and 58 within South Lanarkshire. There are approximately 3600 residents and 3200 staff working with in the care home sector. In 2021-22, My Health, My Care, My Home (Healthcare Framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for adults living in care homes across Scotland. The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes. Yes ☐ No ☒ N/A ☐
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3 The framework’s recommendations highlighted a need for a strong partnership approach, recognising the knowledge and experience of care home staff. This was reinforced by the letter received in March 2023 which outlined the new arrangements for Enhanced Clinical and Care Support for Care Homes describing the role of the Executive Nurse Director in supporting the implementation of the framework in alignment with Excellence of Care, HIS IPC standards/IPC national requirements and the National Care Home Contract. To ensure a collaborative approach with implementation of the Healthcare Framework an engagement session took place in April 23 with all key stakeholders including care home staff, care home managers, care home providers, Care Inspectorate, Scottish Care, Health, Social Work and Social Care Staff. 5.2 Objectives and Process Work collaboratively with care home sector to develop internal assurance processes in the context of Excellence in Care, including IPC standards and embedding the National Infection Prevention and Control Manual. Develop collaborative improvement models across sector. Review and develop support to care homes to improve health and wellbeing of adults living in care homes through implementation of My Health, My Care, My Home – healthcare framework for adults living in care homes and Health and Social Care Standards in Scotland. Support development and review of clinical protocols and pathway Work in Collaboration with other professionals & multi agencies to ensure optimum support & timely access to healthcare services.
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4 To achieve the objectives a Project Plan was developed and agreed with key stakeholders. Short Life Working Groups (SLWGs) were established covering all six core elements: o Nurturing Environment o Multi-Disciplinary Team (MDT) o Prevention o Anticipatory and Future Care Planning o Palliative and End of Life Care o Urgent and Emergency Care The Short Life Working Groups meet monthly and have undertaken a self-assessment to identify and prioritise actions that can be taken forward by all partners to support the implementation of the framework. These arrangements are in addition to the support and governance provided by the Chief Social Work Officer (CSWO), through the Adult Social Work team who lead on Adult Support and Protection and the Quality Assurance team, who oversee all aspects of contract monitoring in relation to the NCHC. Overall governance is provided by the Care Home Assurance & Support Board that meets quarterly. 5.3 Current Progress Lanarkshire HSCPs have already began evolving their arrangements in collaboration with care homes, focusing on improvement, sustainability and viability, considering the learning and experience of the pandemic and the strong, positive relationships built between our local partners and the care home staff, residents and their families. 5.3.2 Nurturing Environment Much progress has been made with recognising and valuing the important role care home staff have in improving the health and wellbeing of residents. The collaborative visit programme undertaken by the HSCP were seen by many care home staff as similar to an inspection and lacking the support it was designed to offer. Since its completion there has been a shift from “doing to” to “doing with” and new initiatives such as the MDT and Hand Hygiene Improvement projects have been built using a collaborative approach. There have been improvements in encouraging and listening to feedback. An example of this has been in working together to address the needs of care home staff training, which resulted in the development of the recently completed 6-month training programme. The newly appointed Practice Development Educator for care homes is currently engaging with staff to collaboratively develop the next programme based on the care homes identified needs and the HSCP’s priorities. This includes enabling routes for care home staff to access planned NHS training has begun.
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5 5.3.3 Multi- Disciplinary Team In February 2022, NHS Lanarkshire began a Care Home MDT pilot. Initially staff working in the care homes and GP practices identified patients new to living in the care home who were deteriorating or had complex needs. The care home liaison nurse and pharmacist reviewed the patient in collaboration with care home staff, completing a comprehensive geriatric assessment, accessing GP records and clinical portal with support as required from a Care of the Elderly Consultant. They also reviewed the individual’s assessments and care plans to produce a summary for the MDT to consider. As of September 2023, this has resulted in 40% of residents reviewed having one or more medications that are linked to increased falls risk stopped. In June 2023 the pilot began to roll out to all new residents admitted to care homes in three localities. The MDT has continued to work collaboratively with the care home staff, assisting with care planning and introducing ReSPECT (Recommended Summary Plan for Emergency Care and Treatment). The team have now joined up with Social Work to attend the residents’ 4–6-week review in the care home. The MDT work is currently working across 22 care homes in Lanarkshire, the current process will be evaluated and then further roll out as agreed with Social Work. General Practitioners are an important part of the MDT, and the framework highlighted the benefits of close relationships between individual GP practices and care homes. The framework highlighted that care home staff can encounter difficulties when working with several different GP practices, as they each have different ways for requesting advice, visits, and prescriptions. ‘Local enhanced services’ (LES) in relation to care homes provide additional funding to supplement services already offered within the core GP contract. In Lanarkshire where a LES has helped to align most care homes with a specific GP practice. 78% of care homes in Lanarkshire are currently linked with a single GP practice, providing care for all the people living in the care home; and only 11% of Lanarkshire care homes are required to engage with 3 or more different GP practices. This compares with the national figures of 45% and 36% respectively. 5.3. 4 Prevention There has been good uptake of COVID-19 and other vaccines by care homes; however, the SLWG identified that care home residents are often missed from public health screening programmes such as bowel and breast. Access to these programmes as appropriate to the individual must be available. Likewise, the group highlighted that routine hearing, sight and hearing reviews are not always being carried out the extent of this is not known. Social Work teams are now ensuring that these are being completed when carrying out reviews. The application of IPC standards in care homes is being well supported. The dedicated IPC team is available for advice, education and guidance. IPC are working with the
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6 care homes to promote and embed the NIPCM and have commenced on coproduced work to improve hand hygiene. Lack of care plan reviews were a recurrent theme highlighted by the collaborative visit programme and Care Inspectorate visits. There is ongoing training sessions for all Care home staff with Social Work Quality Assurance maintaining an overview as part of the NCHC monitoring arrangements. Care plans and risk assessment tools are not standardised with each home/ care home group choosing the care records that suit them best. The MDT approach will however support the contents of care plans to be reflective of the individuals care needs taking into account health needs, which is often a role that carers complete. The support from CHL will therefore ensure the best start for residents entering care homes ensuring a more comprehensive proactive, preventative approach. Progress is being made with ensuring proactive approaches in many other areas, for example continence with the relaunch of continence bundles, to promote continence and with promotion and training in the Swallowing Matters guidance by Speech and Language therapists4Prevention. 5.3.5 Anticipatory and Future Care Planning The framework advocates that all residents should have the opportunity to develop an ACP using a robust approach such as ReSPECT. The Collaborative visits, CI and audits completed by the team all highlighted that not all residents have meaningful ACPs in place, there is a lack of a standardised approach to documenting them and ACP information is not always shared with GPs to be added to eKIS. The SLWG group highlighted that care home staff are not equipped with appropriate ACP communication training to support having these often-difficult conversations nor made aware of their importance. There is therefore a need to raise awareness of ACP’s and to provide education and training for care home staff. A training package is currently being developed by palliative care consultants and the Care Home Practice Development Educator. 5.3.6 Palliative and End of Life Care This group found that care homes were not aware of nor were they using LPCAT or RELIC as tools to aid resident’s palliative/ end of life care needs. DNs provide the documents; however, there is a need to promote these tools and to provide training to support their use as recommended by the framework. Project ECHO has been endorsed as a means of working together to explore shared learning and peer support. A trial of the project is being planned for August 2023 involving 6 care homes across Lanarkshire.
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7 5.3.7 Urgent and Emergency Care Practice development have agreed to prioritise the deteriorating patient and the Practice Development Educator is to conduct a training needs assessment to establish the number of staff trained in vital sign observations. These tools are needed to support and empower care home staff as it is often carers who escalate concerns. The Flow Navigation Centre (FNC) appropriately refer care home residents to Hospital at Home from 09:00hrs- 17:00hrs. This approach has successfully supported care home residents to remain in the care homes. These hours will be extended over the next few months. To reduce hospital waiting times for residents requiring non-emergency radiology tests a Radiology pathway has been developed to allow direct access to care home residents. Poor discharge communication has led to DATIX regarding pressure ulcers, medication issues, lack of dressings and poor palliative care provisions. A transfer of care document has therefore been developed in collaboration with the care homes, hospital staff and CHL to address these issues. Discussions have taken place to scope the possibility of an electronic version however to date engagement with the document has been poor. 6. CONCLUSIONS This report provides an update to IJB committee members on work underway as part of the Care Home Support team in Lanarkshire. It highlights some of the complexities to the review and also some of the innovative approached being taken. Social Work staff and the Scottish Care Independent sector leads, commissioned by the HSCPs, continue to work closely with the Care Home Support team to ensure that there is a joined-up approach that promotes good outcomes for people. 7. IMPLICATIONS 7.1 NATIONAL OUTCOMES Link(s) to National Health and Wellbeing Outcomes People are able to look after and improve their own health and wellbeing and live in good health for longer ☒ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community ☒ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☒
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8 Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☒ Health and Social Care Services contribute to reducing health inequalities ☒ People who use Health and Social Care Services are safe from harm ☒ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide ☒ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 7.2 ASSOCIATED MEASURE(S) Associated measures include: ED attendances Emergency admissions Re-admissions Improved assessment/planning outcomes Co design evidence People dying in place of choice 7.3 FINANCIAL Any financial impact will be highlighted at the end of the review This paper has been reviewed by Finance: Yes No N/A 7.4 RISK ASSESSMENT/RISK MANAGEMENT Relevant Risk Register Details Current Risk Level Risk Owner Medium 7.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken.
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9 Objectives Further Details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes Ongoing engagement with sector. Further engagement session scheduled February 24 ☒ Provide stakeholders with information on how to get involved As above ☐ Ensure a diverse range of engagement and participation and opportunities are in place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Communication strategy will ensure regular feedback. ☐ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership 7.6 INEQUALITIES & FAIRER SCOTLAND DUTY EQIA Completed & Fairer Scotland Impact Assessment Form Completed and attached to report: Yes No N/A EQIA added to website: Yes No N/A
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10 8. BACKGROUND PAPERS None. 9. APPENDICES None. Please include a glossary of terms if not already included. CHIEF ACCOUNTABLE OFFICER (or Depute) Ross McGuffie Chief Officer Members seeking further information about any aspect of this report, please contact the following; Trudi Marshall, Nurse Director Trudi.Marshall@lanarkshire.scot.nhs.uk
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11 Direction from North Lanarkshire Integration Joint Board (IJB) 1 Reference Number 2 Report Title 3 Date direction issued by IJB 4 Date from which direction takes effect 5 Direction to: 6 Does this direction supersede, revise or revoke a previous direction – if yes, include reference number(s) 7 Functions covered by direction 8 Full text of direction 9 Budget allocated by Integration Joint Board to carry out direction 10 Performance Management / Governance arrangements 11 Date direction will be reviewed
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