1. Doncaster Care Home Strategy Implementation April 2018 Lead Nurse Karen Tooley

2. Introduction
Ian Boldy - DCCG Designated Nurse for Safeguarding Vulnerable Adults and Head of Individual Placements
Rosemary Leek- DMBC Contracts Manager Adults, Health and Wellbeing
Karen Tooley – DCCG Lead Nurse for Implementation of Care Home Strategy
Dr Nick Tupper – Care Home Clinical Chair

3. Care Home Demographic Background
50 Care Homes
1,924 Beds
Looking after 1,596 residents at any one time
43 GP Practices; 4 Home Care providers;
Multiple Community individual clinician visits;
Multi morbidity and polypharmacy issues
2535 A&E attendances, an increase of 6% during 2016
Almost 50% patients are admitted into hospital – 30% have 0 or 1 day length of stay.
Majority of attendances occur between 8am & 8pm
20% of patients have nothing abnormal detected – 8% rise from 2015.

4. What is the national position?
Across England, we know that the quality of social care for older people is concerning, with more than one in four adult social care services being found to be ‘Inadequate’ or ‘Requires Improvement’ by the Care Quality Commission (CQC).
But what does this overall national picture mean when we look specifically at care home settings at a more local level? Independent Age is a registered charity that has analysed some CQC data for care home nationally. (taken from January 2017) to present care home performance by region and local authority.
Up to 20% of homes rated ‘Inadequate’ or ‘Requires Improvement’ – coloured green
 More than 20% and up to 30% of homes rated ‘Inadequate’ or ‘Requires Improvement’ – coloured yellow
 More than 30% and up to 40% of homes rated ‘Inadequate’ or ‘Requires Improvement’ – coloured orange
 More than 40% of homes rated ‘Inadequate’ or ‘Requires Improvement’ – coloured red
Looking at the picture of England that emerges, we quickly see that the North West is a particular area of concern, with concentrations of ‘red’ local authorities with a high proportion of care homes that are not performing well according to the CQC, as compared to just one in five in London and the East of England. Doncaster is NO 46.

5. Where is Doncaster?
Looking at individual local authorities around the country , Yorkshire and Humber do not sit in the lowest proportion of homes rated ‘Inadequate’ or ‘Requires Improvement’ :
However when looking at Yorkshire and Humber
Bradford- Yorkshire and The Humber-46.3%
Wakefield-Yorkshire and The Humber-46.0% are in the worst 20 with the highest proportion of homes rated ‘Inadequate’ or ‘Requires Improvement’ are:
Doncaster has the least no of care homes with inadequate or requires improvement at 18%.
Really good place to start….. Really good working process that looks at care home risks and actions to mitigate issues

6. Doncaster Care Home Strategy – Main Aims:
High quality care
Reduce premature admission to care homes
Reduce hospital attendances and admissions
Reduce out of area complex placements
Develop a Skilled work force
Commission for outcomes
Doncaster Strategy was developed and signed off in April With an implementation board and 5 sub groups set up to develop the work plans.
Ensure provision of individualised high quality care & reduce variation across care homes
Ensure individuals to live independently and remain in their own homes for longer supported by intermediate care, primary care and domiciliary home care strategies across Doncaster.
Reduce unnecessary conveyances to hospitals, hospital admissions- it is now widely accepted that hospital is not always the best place for older people. The longer they stay the more likely they are to develop problems secondary to the reason for admission, muscle strength reduces and skills in activities of daily living can be lost due to lack of opportunity to practice, often making it much harder for them to fulfil a full life.
Reduce the need for out of area complex placements – number of factors that are required to support care homes in achieving this
Ensure work force have the skills to drive service delivery and transformational change
Commission for Outcomes- Quality of life is maintained and enhanced for those people who receive care. People who receive care feel safe and protected Care is given to people is a kind, respectful, dignified and compassionate way.

7. NHS England Framework for Enhanced Health in Care Homes
NHSE Enhanced Care in Care Homes Initiative
7 Care Element work streams
Enhanced Primary Care Support
Develop of Multi- disciplinary team approach
Development of Reablement & Rehabilitation approaches
Development and delivery of High Quality Care
Joined –up commissioning across key agencies
Work Force Development
Data, IT & Technology
Number of benefits to implementing the framework and Doncaster strategy:
Residents would expect to see improvements in quality of care experience and better access to and continuity of NHS services.
Carers would expect to see greater confidence in the quality of care and more seamless provision of care, support and information
Care providers need improved access to work force, information technology and clinical support and development, better working relationships between NHS, local government commissioners and providers
For the NHS reductions in the use in inappropriate NHS hospital services, spend on prescribing and unplanned care.
Describe each element – use the implementation paper.

8. What are our priorities for 2018/19?
Primary Care Support and Care Planning
What does good look like? How do we measure core and advanced care?
Work Force Development
Development of Community Provision
Red Bag implementation

9. Primary Care Support
Map current support & identify Doncaster models and opportunities
Horizon Scan for best practice models
Engage with Trial sites to develop & roll out principles of support with GP practice and Care Home
Advanced & Emergency Care Planning
Resident and staff experience measures through engagement

10. Core and Advanced Care
Key Component of the Strategy is the development of the ‘Complex Tier’ of Homes
Core and Advanced Tool
Test the Tool, develop data capture & analysis method
Develop & agree methodology of case review
Identify cohort & trial sites
Conduct review
Report findings

11. Work Force Development
Core and Advanced Skills Tool – Exploration and development of a tool for use in planning future training development needs of the workforce
Locality Development Localities across the Doncaster area. Members comprise of Care Home Peers, Independent Strategic Lead Partnerships (LA)
Carer Career Pathway - Improving the ‘offer’ to carers with a career pathway working alongside locality peers/local & regional education providers/Skills for Care
CCAST Integrated Competency Tool – ‘Care and Clinical AssesSment Tool’. Currently developing with primary care and acute health providers (Rdash/DBTH/LA/SYREC)

12. Development of Community Provision
Identify opportunities
Horizon scan for development opportunities
Engage with My Life Team – possible work shop to engage and learn together
Develop implementation plan: to act as a conduit to community and other organisations

13. Red Bag Implementation
Sutton Vanguard
Engage stakeholders
Develop rollout plan in line with vanguard principles
Roll out across Doncaster
Analysis

14. Questions?