1. Care and Extra Care Housing in Salford
@HWSalford
#speakup
Care and Extra Care Housing in Salford
Safia Griffin, Engagement Officer – Healthwatch Salford
Phil Morgan, Chair – Healthwatch Salford

2. Who we are, what we do Healthwatch Salford is the independent consumer champion for everyone using health and social care services in the city of Salford
We are an independent charitable company, commissioned by the local authority to carry out statutory functions, to ensure the voices of people are heard and listened to within the health and social care system
We work with people, groups and statutory organisations to encourage and empower local people, especially those who are most marginalised or vulnerable, to have more control in their lives and to influence the healthcare organisations that affect them through:
Functions:
Gather views, understand experiences
Make views known
Recommend investigation or review to Care Quality Commission
Promote / support involvement of people in planning, providing and checking services
Signposting people with queries and concerns
Rights and powers:
Seats on Health and Wellbeing Board
Agencies’ duty to respond to reports and recommendations – 20 working days
Enter and view publicly funded adult health and social care premises
Escalate issues to Healthwatch England or Care Quality Commission
Influencing good health and social care by gathering views and experiences and telling the providers where services are working well and not working so well
Signposting people into correct pathways for raising a complaint and referring them for advocacy support
Watchdog monitoring existing health and care services especially during periods of change

3. A systems view
Healthwatch listens and communicates throughout the system

4. What is ‘Enter and View’?
We have statutory powers as set out under the Health and Social Care Act Part of these powers allow us to Enter and View any publicly funded adult health or care premises on an unannounced or announced basis
Often used to observe, collect views and report on specific areas of adult health and social care services, at the point of service delivery
Enter and View is just one of many different tools used by a Local Healthwatch to collect information and listen to patient experiences
Enter and View’ is a statutory power of a Local Healthwatch to enter publicly funded adult health or social care services to observe and gather views
It is often used:
To go into health and social care premises to hear and see how the user experiences the service
To collect the views of service users (patients, residents) at the point of service delivery
To collect the views of carers and relatives of service users
To observe the service – observation involving all the senses
To collate evidence-based feedback
To report to providers, CQC, Local Authority and NHS commissioners and quality assurers, Healthwatch England and any other relevant partners
Role of the volunteer (authorised rep)

5. The Whole Enter and View (E&V) Process
Scoping meeting with commissioners
Strategic need and alignment identified as part of rationale
This process shows the steps that are undertaken for every enter and view program we undertake.
To maximize the influence of our projects we try and align the timing and focus of project to wider work or service reviews being undertaken.
From start to finish enter and view programs can take anything from 6 months to 12months.
Steps:
- Scoping and strategic alignment - approval and planning – provider to contact and pre-visit meetings –visits, with trained volunteers termed (authorized reps) - survey analysis and draft report with recommendations – typically the provider takes 2-4 weeks to fully respond to our recommendations in writing and this gets added to the report. The final report is published and circulated. 2-3 months later we have follow-up meetings with every provider to check on the progress of the recommendations

6. Why our focus on Extra Care housing?
Strategic Drivers
1. Commissioner review
2. CQC inspects the Extra Care but not the facility
3. Dignity and choice in an Extra Care setting (and independence)
4. Social inclusion
5. Accessibility
The main question on our mind was;
• Commissioners were in the process of reviewing these schemes and our engagement would provide an opportunity for the voice of tenant to be heard more fully in this process
The care provided is regulated by the Care Quality Commission (CQC) but the facility itself is not inspected i.e. the areas managed by the housing landlord
• Healthwatch Salford wants to understand how care is experienced by tenants and dignity and choice is maintained within an extra care housing scheme
• Little is known about whether schemes of this type support the reduction of social isolation and loneliness and/or promote social interaction
• To assess whether communication is fully accessible for tenants
and, to assess and understand the interplay between all these factors
Does extra care housing work in Salford to the appropriate standards? … both for the people delivering the service and those receiving it…

7. The project – ‘Care and Extra Care Housing’
Surveying both the care providers and housing landlords
Visits and teams - between August and end of September 2018
3. We surveyed 115 people in total;
49 tenants > 37 care staff > 13 housing staff > 9 relatives > 7 Care Coordinators
We made 46 recommendations in total over 6 reports
– 21 were about the 2 care providers – 25 were about the 3 housing landlords
Activities
Information and communication
Staffing
Food and mealtimes
Care
Physical accessibility
Relationship between the providers
Standards and appearance
Due to the cross-over of some responsibilities in some schemes and variation in Extra Care models and because the care is being provided within a scheme that is managed by another company (the landlord), both the care provider and landlord, where relevant, were surveyed and reported on in the Enter and View visit reports.
we visited all 6 of the extra care schemes, with teams of 3 or 4 people. We visited during the week, over a 2/3 hours either in the morning or afternoon
Inclusion and variety
Activities = 6 recommendations
4) The themes from the 21 care provider recommendations were:
Supporting role in activities
Communication, involvement and feedback
Who is who
Information and communication = 5 recommendations
Tenant privacy and data access consent
Busy and rushed
Staff hours
Staffing = 6 recommendations
Having a say (morale and conditions)
Food and mealtimes = 1 recommendation
Relationships between providers = 2 recommendations
Developing relationships at all levels
Shared office space
Care review = 1 recommendation
Activities = 10 recommendations
The themes from the 25 housing provider recommendations were:
Staff and activities
Involving volunteers
Information and communication = 4 recommendations
Feedback, ‘you said, we did’ board
Tenant meetings and feeding back
Name badges
Noticeboards
Wheelchair accessibility
Physical accessibility = 2
Maintenance = 1 recommendation
Noticeboards and large print
Colour and background
Signage
Dementia friendly = 3 recommendations
Standards and appearance = 3 recommendations

8. Over 90% of tenants thought their care needs were being met
What people told us
Over 90% of tenants thought their care needs were being met
“ Staff are excellent…” Tenant comment
Over 90% of tenants said that staff treated them with dignity and respect
“Happy but frustrated because it could be so much better.” Tenant comment
Over 75% of tenants thought that living in an extra care scheme had been of benefit to them and their health
“ I couldn’t be in a better place. I was very lonely at home on my own.” Tenant comment
Over 85% of tenants were still able to do things for themselves and retain some independence
“Most tenants want to stay independent and social. We encourage them to come out of their flats” Care staff member comment

9. Key findings 1. Service quality - Caring and Responsive?
2. Community feel
3. High and complex care needs
4. Activities and social inclusion
5. Equity and equality of opportunity
6. Provider support and offer
7. ‘A home for life’ and independent living
Extra Care schemes in Salford was caring, safe, well-led and effective on the whole, although improvements were needed in being responsive
The design, layout and communal areas of the housing scheme effected how homely and community ready a scheme felt like to visit and live. Half of the schemes had been successful in creating a community feel.
3. Most of the schemes had more than a third of tenants with high care needs.
4. Activities and social interaction was as important to tenants as their care yet there was little to no commissioner funding for the schemes to provide or support activities.
Schemes had to fundraise for and resource activities on the whole. Schemes that struggled to raise funds, ran less activities and were less able to provide dedicated support to tenants who needed more assistance to get involved in activities. These schemes also had more critical comments from their tenants.
5. There were issues of equity within schemes, often with those least mobile and able less being likely to be able to utilise and make the most of things like activities and social interaction, as these were often unfunded by commissioners and not contracted for on the par with care. It was often down to the scheme or care team themselves to fill any gaps.
6. All landlords and care providers were providing more resources and support than they were funded for.
7. There are inherent tensions between a home for life and independent living, with many schemes homing more tenants with high complex needs that were less able and inclined to be independent. There were also tensions in tenant expectations of what an ‘independent living’ model was and a perception of suitability of those with declining mental health living in an extra care housing scheme.

10. The answer
The main question in our minds when we began this project was;
The answer;
Does extra care housing work in Salford to the appropriate standards?
… both for the people delivering the service and those receiving it…
Extra care in Salford was working to appropriate standards in most areas
… despite operational challenges, staffing issues and resource constraints

11. What happened next Commissioners The 3 housing landlords
The response to this project and its reports;
From
Commissioners
The 3 housing landlords
The 2 care providers
Commissioners – were pleased to have the insight and information they could use in their review and recommissioning process
Housing landlords – were cooperative but found it more challenging than they anticipated but all wrote a point by point response to our recommendations
Care providers – were also cooperative and receptive throughout the process and responded well to the entire process. They also replied point by point to our recommendations.
In the next week I will be contacting all the housing landlords and care providers to arrange times to meet with each individually to talk through their scheme report and recommendations to see what progress has been made. Key notes and progress will be written up and added to the reports following each meeting.

12. Thank you!