The legal context for assessment and delivery of social care for older people is set out in the HPSSNI Order (1972).

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1 Trust Actions in relation to Dunmurry Manor Care Home Update for Trust Board: Wednesday 29 th August The Policy Context The arrangements setting out the current model of Care in the Community are described in the People First Care in the Community DHSS, This Policy paper describes the model for the provision of social care and establishes new roles for health and social care agencies in the context of the growth of a mixed economy of care. Key messages of the Policy direction are: - Choice and control over care arrangements - Involvement of service users and carers in decision making - New purchaser / provider arrangements - A new assessment framework - The promotion of a flourishing independent sector The Care Management process is described in the guidance document, ECCU 1/2010 (DHSSPSNI) Care Management, Provision of Services and Charging Guidance. This is the current guidance under which the HSC Trusts manage and implement the process of assessment and provision of services in the community. This document also refers to the promotion of a flourishing Independent sector alongside good quality public services. The legal context for assessment and delivery of social care for older people is set out in the HPSSNI Order (1972). The Adult Safeguarding Policy Prevention and Protection in Partnership was issued by DHSSPS in July 2015 with the procedural guidance issued in September The Joint Protocol for Adult Safe Guarding Investigations is an inter-agency working guidance document between 3 signatories PSNI, HSC Trusts and RQIA. 2.0 Roles and Responsibilities HSC Trust The role of the Trust is to assess the need of each individual and to agree a care plan suitable to meet the level of need identified. The Trust will either provide or commission the appropriate level of care for individuals according to the assessed needs and to ensure that the care provided can meet the needs identified. Care may be provided in a person s own home, Supported Housing, Residential or Nursing Home Care. The process for care management is: o Assessment and agree needs o Offer the person / family choices or options available o Give information about Nursing/Residential Homes and advise service users review the information on RQIA website 1

2 o People then choose how they want the care delivered and, in particular for permanent placements in residential or nursing home care, people choose which home they wish to live in o Following placement the first review takes place after 6 / 8 weeks o Subsequent to this there is an annual review o Where issues arise the Trust has a duty to intervene to seek resolution or to re-assess when needs change. RQIA The RQIA is the regulator. Established in 2003 the Regulation and Quality Improvement Authority is responsible for monitoring and inspecting the availability and quality of health and social care services in Northern Ireland. The role is to ensure that health and social care services are accessible, well managed and meet the required standards. The 2003 Order required the DHSSPS to develop standards against which the quality of care can be measured. The Quality, Improvement and Regulation Order NI 2005 created the legal framework for raising the quality of health and social care services. The RQIA has a program of inspections across all Regulated Facilities in NI and no service can be provided until a certificate of registration has been received. RQIA then conduct inspections against the DOH stipulated standards and where there are identified failings, Quality Improvement Plans are required and enforcement action can be taken. Independent Care Providers - The mixed economy of care was the direction promoted by People First and the promotion of a flourishing Independent Sector is supported by this and subsequent Policy documents, alongside the care provided within the public sector. All service providers must demonstrate achievement of the DOH stipulated standards to ensure they meet the registration requirements. Care Homes must have their certificate of registration from RQIA before they can accept residents to live in their Home. 3.0 Dunmurry Manor and Trust Actions during the period covered by the COPNI report Dunmurry Manor Care Home was registered by RQIA and opened to residents in July Residents from SET, Belfast, Northern and Southern Trust areas are resident in Dunmurry Manor. The attached chart shows: - the admissions over the timeline since opening in July the RQIA inspections and the periods of time when the facility was closed to admissions - the number of issues raised with SET - the interventions and actions by SET SET held a series of meetings with the Senior Management team of Dunmurry Manor to highlight the areas of concern and to request action plans to correct the issues and further meetings were held to review progress and any improvements made. As issues seemed to 2

3 escalate and improvements were not sustained, feedback was obtained from an RQIA care inspection on 17 & 18 th October As a result of that inspection there were 3 Failure to Comply notices issued by RQIA on 26 th October SET were also informed of an Adult Protection investigation under Joint Protocol by Belfast Trust involving a lady with severe pressure ulcers. On 21 st October 2016 SET convened a serious concerns meeting with the NI Director of Operations for Run wood Homes and the decision was taken by SET to formally suspend admissions to the home. The Senior Management team of Run wood were requested to provide action plans and work with the professional staff of SET, BHSCT, NHSCT and SHSCT to improve the quality of care and to demonstrate consistency and sustained improvement. A range of support was offered to Run wood by the SET to support them with the improvement of the quality of care. SET convened a further serious concerns meeting with the Executive team of Runwood Homes on 15 th November 2016 and assurances were given by the Runwood Senior Management team to improve leadership and management, and bring the care practices in the home up to the required standard. Over the period SET had a wide ranging and extensive number of actions and interventions with the home: - When the Trust identified concerns about quality of care issues these were communicated to RQIA as the regulator. Every issue raised with SET staff was acted upon. - As a trend emerged with increasing numbers of quality issues being raised and an increasing number of referrals under Adult Safeguarding process, SET commenced a broad review of quality monitoring, complaints and adult safeguarding referrals to ensure that all necessary actions had been taken. The review covered the period January to December SET conducted urgent care reviews with all residents to ensure that their specific needs were being met - SET commenced enhanced nursing input to Dunmurry Manor with Senior nurses visiting the home to ensure that the care plans of residents were being followed and to offer support to the home in attaining and sustaining the required standards of care - SET nursing team ensured that the Flu vaccination was given to all residents - Clinical Nurse Facilitators provided support and training in respect of tissue viability and pressure ulcer treatment 3

4 - SET Speech and Language and Dietetics services provided training and support to Dunmurry Manor - SET coordinated a series of audits undertaken across HSC Trusts by professional staff - SET worked collaboratively with other HSC Trusts and with RQIA to share information and to seek improvement in Dunmurry Manor. SET sought meetings with RQIA to share information in respect of concerns about the quality of care and to share specific outcomes of nursing audits - SET wrote to all families of the residents of Dunmurry Manor to notify them of the concerns, keep them informed and to ask them to contact the Trust if there were any issue of concern that they wished to bring to the Trust s attention - At a number of meetings both in SET and at Inter Trust meetings, the quality of care issues were discussed. The Runwood staff and managers who were there were seeking to provide as best they could for the resident s needs but were struggling with a lack of leadership in the care home, due to continuous management changes. There had been a number of reports of resident on resident issues and this was as a result of the disinhibited and sometimes unpredictable behaviour of people with a condition such as dementia. 4.0 Actions taken by the Trust as a result of the learning from Dunmurry Manor and since the publication of the COPNI report 4.1 Assurance The Trust has reviewed, documented and presented in graphical format (attached) the actions it took in relation to Dunmurry Manor and this information is being used to provide a holistic overview for interested parties. As reported at June 2018 Trust Board the Trust s Adult Safeguarding Committee (chaired by the Executive Director of Social Work) is overseeing the implementation of the Trust s Action Plan. This Action Plan includes: - Enhancing the governance arrangements through the establishment of a permanent placement team for Residential and Nursing Home care - Review of the incidents/ complaints / Adult Protection reporting systems with a monthly governance meeting to triangulate the information and to create an alert where trends / themes arise - Review of the information given to people and their relatives to discuss and prepare for a care home placement, including a leaflet Moving into a care home 4

5 - Highlighting of Contract mechanisms including the ability to withhold up to 20% in each month until remedies specified in a performance notice and/or remedial action plan have been implemented. This has not been applied by any Trust to date - The already planned Adult Protection Gateway Team being established - The SET Adult Protection Policy being reviewed and training in respect of the DoH policy has been rolled out across all areas - Development of an escalation protocol with time bound trigger points re: actions required when there are issues of concern with an Independent Sector Provider The Trust is scoping and benchmarking its current resource to support governance, quality monitoring arrangements and the contract review process. It is anticipated this will require significant enhancement. Any additional resource requirements will be brought to the attention of Trust Board and the HSCB as commissioner. The DOH is co-ordinating a response to the COPNI recommendations on behalf of all of the relevant authorities, an approach which has been welcomed by the COPNI. The Trust has submitted the information requested of them to inform this process. The DOH has commissioned an independent review into care failings at Dunmurry Manor Care Home, focussing on the actions of the Health and Social Care (HSC) system. The review will consider HSC responses to issues at Dunmurry Manor and identify lessons to be learned for the future. The Trust has provided feedback to the DOH as requested on the draft TOR and methodology for this review. 4.2 Communication On 5th July 2018, the Director of Nursing, Primary Care and Older People, along with the Assistant Director and the Lisburn Locality Manager visited Dunmurry Manor and met with family members of 15 current residents. All were happy with the quality of care currently provided to their relatives and many were distressed and concerned about the negative impact of the recent media attention on Dunmurry Manor. In July 2018, SET wrote to all next of kin of all residents living in residential or nursing home care to ask people to contact the Trust directly if they have any concerns about the quality of care. To date, there have been no issues raised regarding the quality of care in Dunmurry Manor. Lisburn & Castlereagh Council have requested a meeting with the Trust in relation to the report and this is currently being arranged. Briefings for Trade Unions and other political representatives have also been arranged for 30 th August There has been extensive local media coverage with regard to the report and, in particular from the Nolan Show, the Trust s role. On 29 th June 2018 the Chief Executive issued a statement to all staff explaining what the Trust had decided to do when challenged to appear on the show and why. 5

6 There have also been a number of Freedom of Information requests submitted to the Trust, some of which relate to issues raised in the media and these are being responded to through the usual well established information governance processes. Finally, in relation to communication with the regulator RQIA: As previously reported to Trust Board the Trust attended an RQIA facilitated workshop on 15 th June 2018 the focus of which was on building sustainable partnerships to improve working arrangements across agencies to keep people safe. The Trust awaits the report out from RQIA as a follow up to this workshop. 5.0 The Current position in Dunmurry Manor On 11 th June, the Department of Health presented a summary of a rapid review into the quality of care at Dunmurry Manor, undertaken by CPEA Independent Healthcare Consultants. This review found that there were no concerns about the quality of care currently provided to the residents in Dunmurry Manor. Of the 30 SET residents currently living in the Nursing Home, 2 people have been living there since 2014, 1 since 2015, and 10 since the early part of in One family member explained to us that she had been in the home when her Mother was very ill, night and day and she did not recognise any of the issues being quoted in the COPNI report or in the recent media. The family members we met were very anxious about the impact of the negative media attention both on them and on the staff and the implications for the home. We undertook to ensure that this information was shared with the Department of Health. 6.0 Next Steps The TOR for the CPEA Independent Review were published by the DoH on 20 th August 2108 and the Trust will be co-operating fully with the review process. All of the actions in the Trust s Action Plan outlined above will continue to be progressed overseen by the Adult Safe Guarding Committee. Opportunities will be taken through Transformation Bids and Demography funding to enhance governance, quality monitoring and the contract review process with the Independent Sector. 6