Wolverhampton Clinical Commissioning Group - Care Home Document

Transcription

1 Wolverhampton Clinical Commissioning Group - Care Home Document 1

2 Contents Page 1. Purpose 2. Workstreams Completed /15 Workstreams 4. Future Workstreams 2

3 1. Purpose 1.1. Introduction This chapter describes what Wolverhampton Clinical Commissioning Group (WCCG), is aiming to achieve through the WCCG Care Home Plan in partnership with Wolverhampton Local Authority The chapter comprises of the following elements: A vision statement A set of guiding principles Roles and Responsibilities within WCCG In devising this document, WCCG is reinforcing its commitment to Care Homes across the city, with the aim of interpreting national and local guidance to formulate a plan to address the issues facing the WCCG now and in the future WCCG recognises the key role that care homes have in the health and social care, and their importance in the care of the Wolverhampton City population WCCG has identified that one of our main goals is to reduce avoidable admissions to hospital. Some of the most vulnerable people in Wolverhampton live in care homes and these residents are more likely to be admitted to hospital than people living in the community. WCCG is aware that there is more that can be done to help residents of care homes manage their health and to support staff who care for people within the homes. The projects outlined in this plan aim to contribute to improving the services provided to care homes and their residents and to reduce the number of hospital admissions for this group Wolverhampton City has 20 Nursing Homes and 65 Residential Care Homes as at 1 st July (Appendix one) 1.2. Vision WCCG vision is to provide the right care in the right place at the right time for all of our population. Our patients will experience seamless care, integrated around their needs and they will live longer with an improved quality of life" The Aim of WCCG is: To improve the health of the population of Wolverhampton by focussing on those patients who currently endure inequity in health outcomes To ensure that service delivery is focussed on patients and their needs To ensure that the services are delivered to the right standards and to ensure quality remains at the heart of all commissioning decisions. We will learn from national reviews and inquiries WCCG have three main strategic objectives which underpin this document:: Transforming and integrating services to maximize the quality of care Development of services and capacity outside of hospital Assurance, monitoring and development to ensure quality and access to services The overall WCCG Plan for Care homes is reflected in appendix Two - Four. 3

4 1.3. Guiding Principles Clinical guidelines aim to help health care professionals and patients/residents make the best decisions about treatment or care by improving communication and providing recommendations for the care of individuals with specific conditions, needs and/or circumstances. Clinical guidelines also form the basis for education and training and can be used to develop standards to assess the clinical practice and competence of individual health professionals WCCG Clinical Guidelines - WCCG 1 Pressure Ulcer Prevention - WCCG 2 Enteral Feeding - WCCG 3 Prevention and Management of Malnutrition - WCCG 4 Infection Prevention - WCCG 5 Management of Urinary Catheters - WCCG 6 Aseptic Technique in Nursing Homes - WCCG 7 Observations / VTE Detection and Prevention - WCCG 8 Management and Prevention of Falls and Resulting Harm 1.4. Roles and Responsibilities WCCG Responsibilities The functions that the WCCG are responsible for exercising are largely set out in the 2006 Act, as amended by the 2012 Act. An outline of these appears in the Department of Health s Functions of clinical commissioning groups: a working document. They relate to: a) Commissioning certain health services (where NHS England is not under a duty to do so) that meet the reasonable needs of: i) All people registered with our member practices, and ii) People who are usually resident within our area and are not registered with a member of any clinical commissioning group; b) Commissioning emergency care for anyone present in our area; c) Meeting the costs of prescriptions written by our member practices; d) Paying our employees remuneration, fees and allowances in accordance with the determinations made by the governing body and determining any other terms and conditions of service of the group s employees; e) Determining the remuneration and travelling or other allowances of members of our governing body. WCCG take a partnership approach to safety and quality, working with Wolverhampton Local Authority, providers and the Care Quality Commission (CQC) to develop and implement a rigorous inspection regime, both announced and unannounced. WCCG will hold failing providers to account and a range of remedial actions and penalties will be imposed where appropriate. Further details are reflected in appendix five and 6 4

5 1.4.2 Medicines Optimisation Medicines optimisation involves using evidence to make informed decision about medicines, involving effective patient engagement and professional collaboration to provide an individual person centered approach to medicines use, within the available resources. Medicines offer benefits to patients but can also do harm if not used appropriately. How to treat patients with the prescribing of medications is important as patient s age and multimorbidity becomes more prevalent. The service involves commission of prescribing advice to primary care clinicians. The Medicines Optimisation Lead and Deputy are members of the Quality Team Strategy and Solutions The team supports healthcare service redesign in partnership with NHS colleagues and external stakeholders. Taking into account local and regional variations and recognised best practice, the team facilitates the critical appraisal process and subsequent improvement of systems and pathways. As part of the teams portfolios there are a number of projects aligned to care homes, this includes: - Training and Education - Clinical Support - Step Down Management - Community Services Review Quality The Quality team s priority is to prevent harm and improve the quality of commissioned services for all who use those services. This includes ensuring that as far as reasonably possible the services commissioned by WCCG are safe, effective and provide a positive experience for service users. The patient's experience of care and treatment is sought and heard to improve services. The approach is to work in partnership with patients, public and all service providers whilst ensuring that evidence-based, safe, high quality services are delivered. The CCG s quality team interlinks with many teams within the CCG and with many external areas, the team contributes to Wolverhampton Adult & Children s safeguarding. The Quality Nurse team interconnects with every care home within the city; and act as the main point of contact for the CCG with the care homes. The Team is made up of a Director of Nursing and Quality; WCCG Head of Quality and Risk; Quality nurse Manager; Care Home Quality Nurse Advisors; Quality and Patient Safety Manager; Quality and Risk coordinators and Safeguarding Leads Individual Care Team The Individual Care Team delivers all of NHS Funded care for people who are registered with a Wolverhampton GP. The team has a number of functions and these are delivered by either our in house nurse assessors or our administration team. The team is led by a Lead Nurse with five nurses all trained in using the National Framework for NHS Continuing Healthcare and Funded Nursing Care. They visit individuals to undertake assessments and reviews of their health care needs in a variety of settings, these assessments 5

6 usually involve a multidisciplinary team, the person being assessed and a family member or carer. The nurses also liaise with providers around quality issues and contact other services to refer individuals if needed. They also work with social care colleagues to deliver personal health budgets. The administrative team includes the commissioner and deals with the whole process for NHS Funded Care. This starts with a notification of admission to a nursing home or other referral, arranging an assessment, logging all details on the database, sending multiple letters and informing all involved of the outcomes of assessments. There are a number of other functions such as appeals, equipment, finance processes and individual cases work that the team also completes as part of their service Wolverhampton Local Authority The overarching aim of Wolverhampton Local Authority Community Directorate is to enable all communities, families and individuals to thrive with a specific goal of investing in early intervention, reablement and prevention to reduce the need for intensive support. Wolverhampton Local Authority older people strategy Living Well in Later Life notes that some 20% of older people living in Wolverhampton (approximately 8000 people) are identified as more likely to lose their independence. These people include older people that live alone and/or have: - dementia or dementia like symptoms - a small social network - suffered a fall - experienced crime - a low income - suffered a bereavement - unpaid caring responsibilities Preventative services have a key role to play in reducing the need for longer term intensive support by minimising the risk of older people entering and/or progressing through the downward spiral of care. The downward spiral of care can be described as follows: Illness, disability, loss, caring responsibilities, social isolation Depression, anxiety & negative well-being Functional decline, increased disability & illness Increased depression & anxiety further deterioration of well-being Increased risk of loss of independence / increased risk of needing formal social care interventions including residential 6 care

7 Wolverhampton Local Authority are committed to reducing care home admissions by working closely with WCCG by commissioning high quality services that target those at risk of losing their independence, promote healthy lifestyles and reduce health inequalities. Where a care home placement is assessed as the best option to meet an individual s need we will work together to ensure residential and nursing homes offer a quality service through the development of an overarch WLA/WCCG joint contract and robust contract monitoring. Wolverhampton Local Authority Public Health Team is developing a Prevention Strategy, due to be completed by December This will demonstrate the evidence of effectiveness for solutions aimed at preventing ill-health Financial Spend 2013/14 Area WCCG Step down 1,087,288 WCCG Funded Nursing Care 2,100,000 WCCG Continuing Health Care 9,000,000 WCCG Mental Health Individual Cases 3,000,000 WCCG Learning Disabilities / CHC 1,200,000 WCCG Care Home Training 25,000 Local Authority Care Home Gross Spend 19,800,000 Local Authority Public Health (infection prevention 107,000 services in care homes) Total 36,212,288 7

8 2. Workstreams to Date 2.1 Priority Areas of Commissioning Home in Reach Pilot The Home In-reach Team pilot started January 2014 and provided a rapid response service to residents of the nursing homes when their health showed signs of deterioration. An assessment was completed to determine if it was safe for the resident to be treated in the home with support from the team. The pilot has achieved the following benefits: Fewer ambulances called Fewer trips to A&E Fewer residents admitted to hospital Improved care for residents in times of crisis Training In 2012/13 WCCG funded a training programme to educate Wolverhampton nursing and residential homes staff in courses to improve their knowledge and skills. The programme curriculum was identified from admission data from emergency portals and feedback from delegates. The programme was delivered as 12 class room training courses, The training courses covered were: Falls; Tissue Viability; Catheter Care; Fluids and Nutrition; Stoma Care; Diabetes; Infection Prevention; Deteriorating patients; Dementia; Medicines management; Continence; Lymphoedma. The most popular courses were: Falls; Tissue Viability and Fluids and Nutrition. In total 29 care homes attended one or more training courses; of which 7 were Nursing Homes, 56 people attended the training Pressure Ulcer Prevention Training (Nursing Homes only) In 2013/14 WCCG funded pressure ulcer prevention training for Nursing homes staff. 11 Nursing homes attended pressure ulcer prevention training across 13 dates (120 staff attended). 1 training session was held for a residential care home. The Love Great Skin campaign was produced and launched by Wounds UK on behalf of Midlands and East NHS to raise awareness of pressure ulcers in the care home and nursing home setting, online access to the resource was sent to all care homes to use Care Home Managers Induction Training Care Home Managers were invited to attend development events scheduled throughout the year hosted by WCCG. The aim of the events is to support care home managers with compliance with quality standards and implementation of harm free care which will underpin contracts in the future. The inaugural event held in April 2014 was well attended, during the event WCCG re-launched the benefits of the care homes participating in the safety thermometer and quality indicators, and thus achieving harm free care across Wolverhampton. Subsequent events are planned in July 2014 and October

9 2.1.5 Managing Patients More Effectively and Care Planning Through quality visits and root cause analysis investigations the Quality Nurse Advisors (QNA) have identified areas for improvement particularly the need for clinical guidelines and care planning, training of care staff and access to specialist advice and support. The training programme for care home staff includes topics that enable patients and residents to be managed more effectively. The lessons learned derived from Root Cause Analysis (RCA) investigations are being shared and action plans are being developed with care home managers to ensure targeted areas for improvement. The introduction of a standard care plan template, amalgamation of elements of care, and improving documentation has proven beneficial in streamlining and managing the patient with multiple care needs. Review of these care plans and audit is in place to enable robust evaluation of care. During 2013/14 39 pressure ulcer RCA investigations were completed by the QNAs. The lessons learnt from these investigations were that there was a need for more rigorous care planning. The QNAs have subsequently supported the respective care homes to make improvements by introducing better care planning arrangements based on best practice and clinical evidence Local Authority Public Health The public health team have contributed to the care home managers induction training with information on falls prevention, infection prevention, vaccine preventable illnesses, and promoting good health and well-being. Infection prevention in care homes Public Health has commissioned a MRSA screening programme from RWT Infection Prevention Team across all care homes since This has contributed to a very successful reduction in MRSA prevalence and acquisition in care homes across Wolverhampton, and has contributed to the low rates seen in New Cross over the past five years. In addition public health commissioned RWT Infection Prevention Team to develop and implement the highly successful PREVENT programme across care homes, to provide training and education on infection and control, and support for outbreaks in care homes. 9

10 /15 Workstreams The following outlines work that is continuing or is new proposals for 2014/ Priority Areas of Commissioning Medicines Optimisation Support to Quality Nurse Advisors (medicines management processes in care homes). The Central Support Unit (CSU) Medicines Safety Pharmacist supports the WCCG Quality Nurse Advisers by providing professional pharmaceutical advice and support to investigations in Care Homes, often in conjunction with CQC or local authority. The pharmacist will visit the care home and provide a report to support both the care home and the WCCG team Food First (Review of oral nutrition) The local dietetics service is commissioned to provide a malnutrition screening service in Wolverhampton to work with GP practices and care homes. The aim is to support care homes to detect malnutrition as identified by Malnutrition Universal Screening Tool (MUST) and treat effectively and in doing so seek to avoid hospital admission due to malnutrition. The service promotes a Food First approach to management of malnutrition and tries to ensure that oral nutritional supplements (ONS) are prescribed appropriately according to ACBS indications e.g. disease related malnutrition Medication Review (Primary Care Medicines Team) A programme of reviews of nursing home resident s medication was carried out during 2013/14. The project has been expanded for 2014/15 to include residential home residents. The Primary Care Medicines Team will also provide training of care homes staff in medication ordering to avoid waste. Benefits of this project include: Reduction in medication costs Ensuring residents are taking appropriate medication Reduction in medication waste 3.2 Priority Areas of Commissioning Support to Care Homes Home in reach team The home in reach team provides a rapid response service to residents of nursing homes when their health shows signs of deterioration. A successful pilot was conducted during 2013/14 that covered ten nursing homes and operated weekdays between 8am and 6pm. The CCG is planning to investigate expanding this service during 2014/15 to encompass all nursing homes and operate a seven day service. This will ensure all nursing homes within Wolverhampton have access to the same level of support. This project also contributes to the ambition to provide 7 day services across the NHS. The benefits of this service include: Fewer ambulances called Fewer trips to A&E Fewer residents admitted to hospital Improved care for residents in times of crisis Access to seven day services 10

11 3.2.2 GP linked to Care Homes WCCG is proposing to develop a pilot scheme in the South West area of the city to provide more proactive GP support to residents of care homes. The scheme will include a named GP for each home in the pilot, a care plan for each resident, weekly home rounds, advice and guidance to staff and visiting residents outside of weekly home rounds as required. The benefits of this proposal include: Fewer ambulances called Fewer trips to A&E Fewer residents admitted to hospital Improve care for residents If successful the pilot will be extended to cover all homes within the city Step Down Management Process Phase one A process has been developed to ensure placements in step down meet the appropriate criteria. WCCG is proposing to employ a step down manager who will proactively manage step down placements on behalf of the organisation. The benefits of the proposal include: Reduced length of stay in step down placements Fewer inappropriate step down placements Improved support for people in step down placements 3.3 Priority Areas of Commissioning Improving Quality Care Home Training Programme The 2014/15 WCCG funded Care home training education programme is designed to train and educate Wolverhampton nursing and residential homes staff in courses to improve their knowledge and skills. The programme will be delivered as 22 class room training courses; each course would be specifically aimed at either Nursing Homes staff or Residential Care Home staff. The training courses will cover such subjects as: Diabetes; Falls Prevention; Infection Prevention (Incl ANTT for nursing home staff); Care of the Deteriorating Patient; Dementia Awareness. A further programme will be delivered in year to care home staff on the subject of respiratory Tissue Viability and Pressure Ulcer Prevention Training (Nursing Home only) Nursing home staff members have been invited to attend a Tissue Viability Educational Sessions for Registered General Nurses ; Staff can attend a single day session or a 2 day session depending on the key skills they required, 6 course dates are available. Pressure Ulcer training has also been offered weekly from January 2014 to December Clinical Advice & Support Provided by Quality Nurse Team The quality nurse advisors are working with care homes to further develop care plans and support the implementation of clinical guidelines. Where gaps in knowledge and skills of care staff has been identified the QNAs have offered clinical advice to ensure evidence based practice is in place e.g. prevention and management of pressure ulcers. Where appropriate the QNAs have supported the home with referrals for specialist advice and input. 11

12 3.3.4 Development of Clinical Guidelines Nine clinical guidelines have been developed by experts in the field from the Royal Wolverhampton NHS Trust (RWT) and approved by WCCG Practice Development Group. The care home staff training programme is another vehicle that supports the implementation of the guidelines into care homes Inspections Undertaken by Quality Nurse Team The quality nurse team is in the process of extending its visit schedule for 2014/17. Priority has been given to inspection of care homes utilizing the following criteria:- CHC required Step down facility Large scale strategy Root cause analysis following an incident of grade 3 pressure ulcer Monitoring of sustained improvement following an inspection Data Collection (Clinical Indicators and Safety Thermometer submissions) There are 11 clinical indicators data that the WCCG/LA require on a monthly basis from nursing homes as detailed below 1. Measure of User Experience 2. Pressure ulcers 3. Place of Death 4. Management Turnover 5. Falls 6. Unplanned Hospital Admissions 7. Nutrition 8. Medicine Management 9. Safeguarding 10. Complaints 11. Infection Control The purpose of the indicators is to assist in the collection of clinical quality information that will ultimately enable care homes to deliver high quality safe services through targeting areas in need of improvement. WCCG will analyse the data and provide feedback to the homes on their Harm free status so that improvements can be made where applicable. The QNAs will continue to encourage all care homes to participate in the monthly programme so that sustained improvements can be made. 12

13 3.4 Priority Areas of Commissioning Continuing Healthcare CHC Assessments All individuals who are registered with a Wolverhampton GP and receive care within a nursing home environment require an assessment against the eligibility criteria for NHS Continuing Healthcare (CHC). The nursing homes within the city inform WCCG of any admission to their facility, once this information has been received payments for NHS Funded Nursing Care will commence as appropriate. An assessment will be completed within three months. An appointment will be made with the nursing home, family and local authority and a checklist will be completed; if this indicates consideration is required against the criteria for NHS CHC, a full decision support tool will be completed. All parties are informed of the outcome and the review dates. The individual is reviewed after a further 3 months and then at least annually If after checklist is completed it indicates that consideration for NHS CHC is not necessary, then a nursing assessment is completed to ascertain if NHS Funded Nursing Care (FNC) is appropriate. If after a full decision support tool is completed the person is not eligible for NHS CHC then the process of consideration for FNC would be followed as described above. Should an individual s level of health need change before the next review, an early review can be completed. All referrals are usually sent via WUCTAS; however nursing homes can contact the team to discuss any concerns they may have. Prior to considering a nursing home the commissioners liaise with the Quality Team to ensure there are no concerns regarding care delivery, they also check the CQC registration details. In order for WCCG to commission the care for individuals who are eligible for NHS CHC they require the nursing home to forward a comprehensive care plan, with associated costs, as soon as possible. Once the costs have been agreed this will be communicated to the nursing home CHC Placements (out of area) It is sometimes necessary to use providers who are not located in Wolverhampton. There are two reasons this is necessary, firstly that an individual s needs cannot be addressed in any care facility within Wolverhampton or because an individual wishes to move to be near relatives. In order to assure the CCG that an out of area placement is able to provide safe care the commissioners request a comprehensive care plan. They confirm with the local CHC department that there are no concerns with regard to quality of care. The commissioners also confirm the usual costs paid by the host CCG and then usually agree to pay the locally agreed rate to the care home Funded Nursing Care NHS Funded Nursing Care (FNC) is a contribution paid to all individuals who reside in a care home with nursing; this is not means tested as it is a contribution to a person s nursing needs that in a residential or home setting would be met by district nurses. 13

14 3.5 Priority Areas of Commissioning Wolverhampton Local Authority Single Commissioning Process Wolverhampton Local Authority is currently working with all residential and nursing home providers that are commissioned to provide a service by WCCG/CCG to agree a formal contract, Wolverhampton Local Authority are engaged with WCCG to develop a set clinical practice guidelines to be incorporated within the new contract. WCCG have also engaged with representatives of the Wolverhampton branch of the West Midlands Care Association, to build stronger links within this sector Infection prevention services Since April 2014 the MRSA Screening work has been re-focussed to a targeted service, ensuring resources are used to provide the service in higher risk homes. The work continues to look at latest innovations and how these can be effectively used in care homes and other settings across the city. In addition the PREVENT programme continues, and indeed has been extended to very sheltered accommodation across the city, and information being provided to sheltered accommodation. 14

15 4. Future Workstreams Step Down Caseload Manager/ Framework WCCG intends to look at the costings for step down placements. The proposal is to develop a framework agreement that mirrors the one in place at the Local Authority. The benefits of the proposal include: Consistency / Efficiency / Equity More effective management of the budget Training and Education programme for 2015/16 WCCG goal is to work in partnership with the care homes to reduce hospitalisation by providing training to staff that increases awareness and builds on existing knowledge in key areas. The training and education plan for 2015/16 will provide minimal training room courses and more in house staff development. Each care homes will be asked to nominate 3 staff members who will become educational champions and work with WCCG to develop and instigate new ways of working and understand the ways in which they can prevent unnecessary hospital admissions. The course contents will be revised to include assessment of competence for the learners Community Service Review WCCG intends to review the services within the current community contract. These services include community nursing, foot health, occupational therapy, physiotherapy, falls service etc. The support given to both residential and nursing homes will be an integral part of this review. The benefits of this project will include: Improved access to community based support for residents of residential and nursing homes End of Life The End of Life Care Strategy aims to support residents considered to be potentially in the last year of life, during the last few weeks of life the patient will be supported to remain in their usual place of residence. Some of the key headlines within the strategy, relevant to Care Homes are: Development of Advance Care Planning across all settings in the city so patients can make their preferences around End of Life care, such as their preferred place of death known. A rapid discharge home to die pathway to enable people who wish to die in their usual place of residence to be discharged from hospital with the necessary support Development of clinical guidelines on managing patients at the end of life in Care Home settings, to ensure a consistent approach across the city Development of a DNAR form that is transferrable across the local health economy including WMAS Care Homes Education in End of Life Care 15

16 4.2 Quality Further development of clinical guidelines WCCG practice development group has agreed a programme for developing further clinical guidelines over the next 6 months supported by the relevant specialists from RWT, the joint commissioning team and WCCG. The clinical guidelines to be developed are:- Completing a root cause analysis Care of the person with Dementia Dealing with challenging behaviour/de-escalation Care of the person with diabetes Implementing NICE guidance on medication review in care homes Palliative and end of life care Record keeping Delivery of years 2&3 of the Quality Nurse Action Plan The development of quality indicators and monitoring for Nursing Homes has commenced. Further revision is required to include new national guidelines and standards. The QNA action plan for the next 2 years includes:- A Quality Assurance framework to be developed for use across the care home sector complemented by robust monitoring processes and feedback mechanisms. Care homes with safeguarding and/or quality assurance challenges will be prioritised. QNAs will provide RCA support to care homes with a plan to build expertise with care home managers RCAs Expand the repertoire of clinical guidelines and ensure implementation through audit and inspection Work with partner organisations to enhance the current training programme to be more outcome focused and delivered for care home staff. Quality matters to be introduced across the care home sector to enable feedback on service provision & issues to be resolved in a more expedient & timely manner Improve quality standards of Care Planning The improvements in standards of care will arise from the delivery of the QNA action plan and the enabling initiatives already in place e.g. HIT Improving Quality in Care Homes (defining minimum standards) The WCCG will continue to advocate with the Local Authority for the inclusion of minimum quality standards in contracts. WCCG quality standards will be developed in line with national guidance. 4.3 Wolverhampton Local Authority Wolverhampton Local Authority (WLA) To respond to the challenge of meeting the needs and aspirations of an increasing population of older people, Wolverhampton Local Authority will focus its market investment on opportunities for independent living, those that focus on quality of life outcomes and those that deliver savings. For care homes Wolverhampton local authority will: Encourage the development of innovative models of service delivery 16

17 Ensure those who advise people about their care are well informed about the choices that are available Work with providers to focus their service delivery on outcomes Purchase from providers who can evidence that they are delivering services which are enabling people to keep their independence. Work with providers to review the services they offer and ensure services are not funded that may increase the demand for care Ensure that providers can afford to deliver quality care to people there is no viable community alternative by continuing to negotiate fees in partnership Work with the sector to identify other ways the market can diversify to support older people continuing to live in their own home Agree together where long term care placements are appropriate Improve end of life services to give people more choice Commission more care jointly with Wolverhampton Clinical Commissioning Group Work with providers to ensure more comparative data about care and support Work with providers who can develop more services to meet the range of specific needs of people in the Black and Minority Ethnic communities Future public health commissioned services for infection prevention will be dependent on the findings from the newly introduced surveillance system for infections in care homes, and what other local, regional and national intelligence is telling us. Public health commissioning for infection prevention needs to be responsive to changing local needs and therefore the services may change considerably if new risks and threats emerge. 4.4 Continuing Healthcare Repatriation of Out of Area Placement Over the course of the year we will work with the Wolverhampton Local Authority Quality Team and the CQC, to share information regarding patient quality and experience to develop our commissioning knowledge and business intelligence of the market so that we can re commission our re-ablement and recovery care pathway to support the repatriation of service users from out of area placements including secure and specialised services. We will do this to as part of our Better Care Fund mental health programme. There will be a focus upon improve the quality of life of our patients and support delivery of personalised service user outcomes within a nursing care environment, and ensure that local provision is commissioned to meet the needs of people stepping down from Hospital Care. We will continue support and pro-active case management of the patient cohort to ensure care close to home wherever possible and consistency of service user outcomes across the care pathway. We will align this with our commissioning plans with our main providers to ensure that local services meet the needs of people with severe and enduring mental needs and complex needs. This is to ensure that we are able to improve the quality of service user outcomes, and prevent re-admissions, relapse and delayed discharges and transfers of care and to focus the highest level of interventions and support upon those with the greatest level/s of need. 17

18 4.4.2 Contracts The commissioners are exploring the future contacting options for nursing home placements. It is proposed that WCCG will have a preferred provider list of nursing homes within the city. The commissioners will devise a framework which will identify three levels of need and associated prices for individuals eligible for NHS CHC. This framework will be closely aligned with quality indicators and the commissioners will be working closely with WCCG Quality Team to develop this work. The expertise of the contracting team will be utilised to ensure that appropriate contracts are developed in order that WCCG are achieving quality care provision and value for money. The Department of Health is currently updating the NHS Nursing Home Contract and this will be utilised when developing these specialist contracts locally. 18

19 Appendix One Wolverhampton Care Homes by Geographical Location (as at 1 st July 2014) 19

20 Appendix Two Better Care Fund Plan on a Page 20

21 Appendix Three Better Care Fund - Workstream 21

22 Appendix Four Care Home Programme - Workstream 22

23 Appendix Five 23

24 Appendix Six 24

25 Glossery Acute services Medical and surgical treatment provided mainly in hospitals Advance care planning Discussion between an individual and their care providers to make clear the individuals wishes about future care. Carers and family members must be included if the individual would like them. Care Homes Accommodations that provide additional care for residents. Care homes can be residential only or provide nursing care, The people who stay in care homes need more help with everyday things, like washing, feeding. Care Quality Commission The Care Quality Commission enforces the rules on all healthcare services and adult social care services in England regardless of who runs them. Commissioning Identifying health needs of local people, planning and purchasing health services which respond to their needs. CCGs are responsible for deciding what services their local residents need from the NHS and buy these services with public money from the most appropriate providers Commissioning Support Unit (CSU) The Commissioning Support Unit (CSU) is an organisation which provides services to CCGs. CCGs can decide on the services they wish to obtain through CSUs e.g. commissioning, IT services, information analysis. Co- morbidity Having multiple long term conditions DNAR Do not attempt resuscitation DoH Department of Health General Practitioner (GP) The local doctor - or family doctor - who will usually be the first person you see a person if they have a physical illness or emotional problem. They can help the person directly but can also refer the person on for specialist care or assessment. Many GPs have a community psychiatric nurse, psychiatrist or counsellor who works at the GP surgery 25

26 Harm Free Care A national initiative to increase the number of people who do experience harm free care (no pressure ulcers, no falls, no urine infections and not new VTEs) Intermediate care Care provided as an alternative to in-patient carer. Also allows patients to be safely discharged from hospital and complete their recovery at home or other suitable place. Long term conditions Conditions that cannot be cured but can be controlled by medication and other therapies Love great skin A regional initiative to raise awareness of pressure ulcers in care homes Multi Morbidity See co-morbidity National Institute for Health and Care Excellence (NICE) NICE is responsible for promoting clinical excellence and cost-effectiveness and producing and issuing clinical guidelines to ensure that every NHS patient gets fair access to quality treatment NHS Continuing Care NHS continuing care is care for someone who is ill or disabled that is funded by the NHS. Nursing Homes Nursing homes are needed if a person needs regular nursing care, either during the day or 24 hour care. This care is proved by the NHS and provides registered nursing care, so the staff need to be highly qualified and perhaps specialise in geriatric nursing. Primary care Primary care is the services provided by GP practices, dental practices, community pharmacies and high street optometrists. Around 90 per cent of people's contact with the NHS is with these services. Most primary care services are commissioned by NHS England, not the CCG. Quality Matters Wolverhampton CCG software for recording quality concerns about services Residential Homes The people who are more or less independent and are more able bodied the stay can be either temporary or permanent. 26

27 Root Cause Analysis (RCA) Systematic process to analyse the causes of incidents, learn from them and where possible reduce the risk of recurrence. Secondary care Secondary care is the services provided by medical specialists, quite often at a community health centre or a main hospital. These services are provided by specialists following a referral from a GP, for example, cardiologists, urologists and dermatologists. Stakeholders Any person, group or organisation that has an interest or concern in the work being undertaken Step down beds Beds in care homes for people who are unable to return straight home following a hospital stay Wolverhampton Clinical Commissioning Group (WCCG) The local group of GP practices responsible for commissioning a range of health services for patients within Wolverhampton Wolverhampton Local Authority (WLA) WLA is the governing body of the City of Wolverhampton. Wolverhampton Urgent Care Triage and Access Service (WUCTAS) A nurse led triage and single point of access telephone service into primary care services and appropriate secondary care services for healthcare professionals. Wounds UK UK wound care education company 27

28 Wolverhampton Clinical Commissioning Group Technology Centre Wolverhampton Science Park Glaisher Drive Wolverhampton WV10 9RU Telephone: