NHS Redbridge Clinical Commissioning Group Governing Body ... · 11/30/2017 · Mychem Ltd Phoenix...

NHS Redbridge Clinical Commissioning Group Governing Body meeting

30 November 2017

1.30pm – 2.15pm

Boardrooms, Becketts House, Ilford, IG1 2QX

Item Time Lead director Attached, verbal or to follow

1.0 1.1

Welcome, introductions and apologies Declaration of conflicts of interest

1.30 Chair Attached

2.0 Questions from the public 1.35

3.0 Proposed changes to services at Meadow Court nursing home

1.50 RK Attached

4.0 Close 2.15

1

Glossary of terms and abbreviations

Term Explanation

AO Accountable Officer

ACS Accountable Care System

ADL Activities of Daily Living

APC Area Prescribing Committee

ASH Accredited Safe Haven

BCF Better Care Fund

BHR Barking and Dagenham, Havering and Redbridge

BHRUT Barking, Havering and Redbridge University Trust

BPPC Better Payment Practice Code

CAPS Clinical Application Services

CCG Clinical Commissioning Group

CCS Complex Care Service

CD Clinical Director

CDOP Child Death Overview Panel

CEO Chief Executive Officer

CFO Chief Finance Officer

CHC Continuing Healthcare

CHS Community Health Services

CHSCS Community Health and Social Care Services

CIL Community Infrastructure Levies

CO Chief Officer

COO Chief Operating Officer

CQC Care Quality Commission

CQRM Clinical Quality Review Meeting

CQUIN Commissioning for Quality and Innovation

CSU Commissioning Support Unit

2

CTT Community Treatment Team

CVS Council of Voluntary Services

CYPP Children and Young Person Plan

DOH Department of Health

DTOC Delayed Transfer of Care

ECG Electrocardiogram

EHC Education, Health and Care

ELHCPB East London Health and Care Partnership Board

EMT Executive Management Team

EoI Expression of Interest

EOL End of Life Care

FNP Family Nurse Partnership

FRPB Financial Recovery Programme Board

FRPDM Financial Recovery, Planning, Delivery and Monitoring

FT Foundation Trust

FYE Full Year Effect

GBAF Governance Board Assurance Framework

GP General Practitioner

H4NEL Health for North East London

HCAIs Healthcare Associated Infections

HE NCEL Health Education North Central and East London

HLP Healthy London Partnership

HSC Health Scrutiny Committee

HWBB Health & Wellbeing Board

IAPT Improving Access to Psychological Therapies

ICPB Integrated Care Partnership Board

ICM Integrated Case Management

ICSG Integrated Care Joint Health and Social Care Steering Group

IFR Individual Funding Request

IRS Intensive Rehabilitation Service

IST Intensive Support Team

3

JAD Joint Assessment and Discharge Service

JCB Joint Commissioning Board

JEC Joint Executive Committee

JHWS Joint Health & Wellbeing Strategy

JSNA Joint Strategic Needs Assessment

KGH King George Hospital

KPIs Key Performance Indicators

LAC Looked After Children

LAS London Ambulance Service

LETB Local Education and Training Boards

LMCs Local Medical Committees

LPC Local Pharmaceutical Committee

LSCB Local Safeguarding Children’s Board

LTC Long Term Conditions

MASH Multiagency Safeguarding Assessment Hub

MLU Mid-wife Led Unit

MOU Memorandum of Understanding

MSRB Maternity Systems Readiness Board

NEL North East London

NELCSU North East London Commissioning Support Unit

NELFT North East London Foundation Trust

NHS National Health Service

NHSE NHS England

NHSI NHS Improvement

NICE National Institute for Health and Care Excellence

OFSTED Office for Standards in Education, Children’s Services and Skills

OD Organisation Development

ONEL Outer North East London

PALS Patient Advice and Liaison Service

PEFs Patient Engagement Forums

PELC Partnership of East London Cooperatives

4

PMCF Prime Minister’s Challenge Fund

PMO Project Management Office

POD Point of Delivery

POLCV Procedures of Limited Clinical Value

PPGs Patient Participation Groups

PSED Public Sector Equality Duty

PTL Patient Tracking List

QIPP Quality, Innovation, Productivity and Prevention

RAG Red, Amber, Green

RTT Referral To Treatment

SAB Safeguarding Adults Board

SCB Safeguarding Children’s Board

SCN Strategic Clinical Network

SDPB System Delivery Programme Board

SRO Senior Responsible Officer

STP Sustainability and Transformation Plan

TDA Trust Development Agency

TSCL The Transforming Services – Changing Lives

UCC Urgent Care Centre

UCL University College London

UCLP University College London Partners

UEC Urgent and Emergency Care

UTI Urinary Tract Infection

VFM Value for Money

WELC Waltham Forest, East London and City

WICs Walk in Centres

YTD Year to Date

5

1

Register of interests 2017/18

Last updated: September 2017

Name Role Organisation Nature of interest

Amendment and date

Dr Anil Mehta

Chair

Fullwell Cross Medical Centre Metropolitan Police The cleaning company NHS England (Feb 2015) Healthbridge Direct (from September 2014) Fouress Enterprises Ltd

GP Partner Forensic Medical Examiner Owner - Sister in law GP Appraiser Shareholder Director

Dr Sarah Heyes

Clinical director

The Shrubberies Medical Centre Healthbridge Direct (from September 2014)

GP Partner/Principal Shareholder

Dr Muhammad Tahir

Clinical director Forest Edge practice, Hainault Health Centre Dagenham & Redbridge

GP Partner Medical adviser & club

6

2


Amendment and date

Football Club Redbridge local medical committee Healthbridge Direct (from September 2014)

doctor Member Shareholder

Dr Mehul Mathukia

Clinical director Mathukia surgery Dr Chawla & Partners Valia Consultancy – Healthcare & research consultancy PELC NOCLOR and NIHR Healthbridge Direct (from September 2014)

GP Principal GP Partner from 1/5/16. Brother is a GP Principal Director/Owner/Shareholder GP Locum GP research champion Share Holder

Dr Shabana Ali

Clinical director

Southdene Surgery Healthbridge Direct (from September 2014)

GP Partner/Principal. Daughter is receptionist/admin Shareholder. Daughter works is receptionist/admin.

7

3


Amendment and date

North East London Foundation Trust Avicenna Ltd BMA RCGP NHSE

GP with special interest in cardiology Director. Husband is also a director Member Member GP appraiser (B&D CCG, Havering CCG)

Dr Syed Raza

Clinical director Seven Kings surgery Raza Syed Medical Ltd Healthbridge Direct (from September 2014) PELC

GP partner (Oct 2017) Director (June 2014) Employed at surgery that is a shareholder. Employed as locum in the Hub. Locum GP

Redbridge Fairness Commission – removed Jan 2017 Chadwell Heath surgery – removed Sept 2017

Dr Jyoti Sood

Clinical director Newbury Group Practice ESS Wanstead Ealing Hospital NHS Trust

GP Partner (2003) GPwSI – Diabetes & Dermatology (2011) GPwSI – Diabetes & Dermatology (2010)

Redbridge GP Alliance Federation – removed April 2017

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4


Amendment and date

Soods Limited – Locum agency NHS England London Deanery Imperial College Communitas Clinics (Havering) Redbridge LMC Care Quality Commission (CQC) Healthbridge Direct DMC Healthcare (1/8/17) Health Education England

Director. Husband is a partner (2005) GP appraiser (2003) GP trainer (2004) Undergraduate GP trainer (2011) Provide minor surgery (2013) Member (Sept 2016) Special Advisor (Sept 2016) Shareholder (April 2017) GPwSI – diabetes and dermatology Associate director of education (Ilford & Romford)

Dr Anita Bhatia Clinical director Southdene surgery Healthbridge Direct

GP partner Shareholder (Sept 2014)

9

5


Amendment and date

Mychem Ltd Phoenix Medics Ltd Essex Local Prescribing Committee

Husband is owner/director of pharmacy – Mid Essex CCG Brother is a director – freelance GP-services to NHS/private sector Husband does remunerated ad-hoc work

Dr Shujah Hameed

Clinical director Castleton Road surgery Partners in Healthcare Healthbridge Direct PELC BHR GP Solutions

GP Partner Director (1/2015) Locum GP (1/2015) Locum GP (1/2015) Locum GP (1/2016)

Added May 2017. Locum GP at Castleton Rd – removed 24/5/17

Ah-Fee Chan

Secondary care consultant

North Middlesex University Hospital NHS Trust Nadia Medical Services Ltd (March 2015)

Consultant in Anaesthetics and Intensive Care Medicine Director of the company providing consultant services at a range of private facilities in London where practice privileges

10

6


Amendment and date

are given

Charles Beaumont

Associate Independent Lay Voting Member for Audit Committee and Individual Funding Request Panel

None None North Essex Partnership Foundation Trust – removed 25/4/17

Conor Burke

Accountable officer

None Your business works (not trading) - removed Jan 2017 Redbridge college – removed Jan 2017

Louise Mitchell

Chief operating officer None None

Tom Travers

Chief financial officer

Royal Free Foundation Trust

Wife works in finance department

Jacqui Himbury

Nurse director

None

Khalil Ali

Lay member

Dr Joseph’s GP practice, Collier Row, Romford St Francis Hospice, Havering Cancer Research

Family GP Spouse is donor Spouse is a donor

11

7


Amendment and date

Kash Pandya

Lay member - Governance

Essex Ministry of Justice Advisory Committee Her Majesty’s Inspector of Constabulary Brentwood Citizen’s Advice Bureau Barking and Dagenham CCG Havering CCG PricewaterhouseCoopers Accenture University of Essex Southend on Sea Borough Council

Lay Member (2010-18) Associate Inspector (2011) General advisor (2009) Lay Member Lay Member Kiren Pandya (son) Management consultant (2013) Anand Pandya (son) Solicitor Independent Audit Committee member (2013-19) Independent Audit Committee Member (2016-18)

Hillcroft College for women, Surbiton – removed May 2017. Health & Safety Executive – removed May 2017. Berwin Leighton Paisner (BLP) removed May 2017.

12

8


Amendment and date

Gina Shakespeare

Director, Delivery & Performance (Interim)

Regina Shakespeare Consulting

Owner

Jane Gateley Director, Strategy & Integration

Hurley Group Partner is a director

Sarah See

Director, Primary Care Transformation

NELFT Churchill Medical Services, Chingford

Partner is an employee Family registered with the practice.

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To: Meeting of the Redbridge CCG Governing Body From: Dr Raj Kumar, clinical lead for mental health

Date: 30 November 2017 Subject: Proposed changes to services at Meadow Court nursing home Executive summary

Redbridge Clinical Commissioning Group (CCG) commissions 48 beds from Care UK at Meadow Court nursing home under a block contract arrangement and the current contract value is £2,993,192 per annum. The beds have historically been used for NHS continuing healthcare (CHC) patients with dementia and those with physical disabilities. Redbridge CCG is facing significant challenges to its budget and is currently in legal directions from NHS England as a consequence of the financial position. Commissioners are required to maintain a very close focus on where they are using their funds, ensuring that they are making the most effective use of every penny that goes into the local NHS.

This business case sets out the proposed changes to the contract for Meadow Court nursing home, the consultation and engagement process which was carried out, a report on the consultation responses, the methodology used to reach the recommendation, the quality impact assessment and equality impact assessment. At the time the consultation launched, only 14 of the 48 beds commissioned by the CCG were occupied, meaning the CCG has been paying for 34 empty beds under the block contract.

The recommendation of the clinical panel is that the patients currently cared for in Meadow Court can be safely and appropriately cared for in other facilities, that the contract with Care UK for Meadow Court nursing home does not offer value for money and that the Governing Body should agree to end the contract.

Recommendations

The governing body is asked to: Consider the Meadow Court decision making business case report Agree the recommendation and mitigating actions set out in the recommendation and conclusion

sections of the report.

1.0 Purpose of the Report

1.1 To seek governing body agreement to end Redbridge CCG’s contract with Care UK for 48 CHC

beds at Meadow Court nursing home in Goodmayes.

2.0 Background

2.1 Meadow Court is a 70 bedded unit situated in the grounds of King George Hospital in Goodmayes. The unit is leased by the North East London NHS Foundation Trust (NELFT) to

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Care UK who provide a nursing or personal care service for people including those over 65 years with dementia and physical disabilities. The 48 commissioned beds are commissioned under a block contract arrangement and the current contract value is £2,993,192 per annum.

2.2 The demand for these beds has been reducing for a number of years, in August 2017 34 of the 48 commissioned beds were vacant, which means the CCG is paying £2.44m a year for these empty beds.

2.3 The CCG has been in negotiations with Care UK regarding the renewal of the contract for

Meadow Court with the shared objective of securing a contract that represents good value for money for the taxpayer and provides sufficient income for Care UK to provide a high quality sustainable service. However, we have been unable to agree a contract that delivers these objectives.

2.4 The CCG is therefore proposing to end its contract with Care UK for Meadow Court nursing home and settle patients into suitable alternative homes that meet their care needs.

2.5 The CCG undertook a 12 week consultation with the public, focusing on engaging with the

families and carers of those who live at Meadow Court. Responses were received from 23 individuals or local stakeholders which have been considered as part of this report and recommendation.

3.0 Decision making case for Meadow Court

3.1 This business case sets out the proposed changes to the contract for Meadow Court nursing home, the consultation and engagement process, a report on the consultation responses, the methodology used to reach the recommendation, the quality impact assessment and equality impact assessment.

3.2 Due to the number of empty beds at the home the CCG is paying £2.99m a year for 14 patients

who could receive an equivalent standard of nursing home care for £0.56m from providers on the AQP framework.

3.3 The CCG has a responsibility to ensure that NHS resources are deployed in the most efficient

way to deliver the best care for patients.

3.4 The recommendation and mitigating actions set out in this report consider the consultation feedback, alongside financial and other evidence to reach a recommendation that the contract with Care UK should end and the patients should be settled into alternative homes.

4.0 Resources

4.1 The recommendation, if approved, would realise a potential financial saving to the CCG of £2.43m.

4.2 There are no further resource implications.

5.0 Equalities

5.1 An equalities impact assessment is included as part of the decision making business case. 6.0 Risk

6.1 The risks identified for this recommendation have been captured within a risk register and have been mitigated through additional actions set out in the recommendation.

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7.0 Managing conflicts of interest

7.1 There are no conflicts of interest relevant to this report.

Attachments:

1. Meadow Court decision making business case

Author: Sharon Morrow, Senior Responsible Officer for Unplanned Care, BHR CCGs Date: November 2017

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Proposed changes to Meadow Court nursing home

Page 1

Proposed changes to Meadow Court Nursing Home

Decision making business case

For Redbridge CCG Governing Body

30 November 2017

17

Redbridge Clinical Commissioning Group

Page 2

Contents Executive summary ........................................................................................................ 3

Clinical leads statement ................................................................................................. 4

Introduction and context ................................................................................................. 5

Consultation process .................................................................................................... 16

Clinical recommendations methodology ................................................ ………………..17

Financial impact ........................................................................................................... 21

Equality impact ............................................................................................................. 22

Conclusion ................................................................................................................... 22

Appendices .................................................................................................................. 23

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Page 3

Executive summary

Redbridge Clinical Commissioning Group (CCG) commissions 48 beds from Care UK at Meadow Court nursing home under a block contract arrangement and the current contract value is £2,993,192 per annum. The beds have historically been used for NHS continuing healthcare (CHC) patients with physical healthcare needs and dementia. At the time the consultation launched, only 14 of the 48 beds commissioned by the CCG were occupied, meaning the CCG has been paying for 34 empty beds under the block contract. Redbridge CCG is facing significant challenges to its budget and is currently in legal directions from NHS England as a consequence of the financial position. Commissioners are required to maintain a very close focus on where they are using their funds, making sure that they are making the most effective use of every penny that goes into the local NHS. This business case sets out the proposed changes to the contract for Meadow Court nursing home, the consultation and engagement process, a report on the consultation responses, the methodology used to reach the recommendation, the quality impact assessment and equality impact assessment. The recommendation of the clinical panel is that the patients currently cared for in Meadow Court can be safely and appropriately cared for in other facilities, that the contract with Care UK for Meadow Court nursing home does not offer value for money and that the Governing Body should agree to terminate the contract.

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Clinical leads statement

As local GPs and clinical leads it is our role to care for the health of local people whilst also ensuring the CCG can protect essential services at a time when it is facing a significant financial challenge. This can make our role challenging at times. We, along with our other governing body colleagues, sometimes need to make difficult decisions. These are not decisions that are taken lightly. To reach this recommendation we analysed and debated a large range of evidence from multiple sources in detail, calling on advice and constructive challenge from experts which included those with safeguarding and continuing healthcare. The discussions we had and evidence we reviewed, provided us with a robust process with which we were able to consider extensive evidence, the views of those who responded to our consultation, alongside a strong financial case. Having met many of the families who have a loved one at Meadow Court, and hearing their views on our proposal, they were in our minds throughout our discussions. We can understand and empathise with the uncertainty these families have felt and their desire for the best for their family member. Had we not been certain that quality nursing care that met the specific needs of those at the home is available in the area, we would not have been able to come to the recommendation we are putting forward. Whilst we are strongly committed to the CCG’s challenge of reducing its deficit, this doesn’t mean we rubber stamp every proposal which will result in financial savings for our CCG. This was shown earlier this year with our Spending NHS Money Wisely consultation where, following debate and lengthy discussions, using the same structured approach as we have used for this proposal, only 22 out of the 33 proposed changes were approved. Having a tried and tested, specifically designed approach and scoring procedure ensured we debated the proposal from a number of angles, keeping the patients, their families, and the public at the centre of our discussions. Using this procedure for other difficult commissioning decisions provides consistency for the CCG and our residents. What we have agreed to recommend, we believe, will have in context, a limited impact on Redbridge’s population of around 293,000 people, but will help make the necessary significant savings to protect things like cancer and emergency care along with life threatening conditions and mental health services – for the coming years. Knowing that current patients and their families may be impacted to some degree by our recommendation, as part of our discussions with our expert panel we have created a number of mitigating actions which form part of our recommendation.

Dr Raj Kumar Dr Syed Raza

Clinical Lead, Mental health Clinical Director

BHR CCGs Redbridge CCG

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Page 5

Introduction and context Meadow Court is a 70 bedded unit situated in the grounds of King George Hospital in Goodmayes. The unit is leased by the North East London NHS Foundation Trust (NELFT) to Care UK who provide a nursing or personal care service for people including those over 65 years with dementia and physical disabilities. Redbridge Clinical Commissioning Group (CCG) contracts for 48 beds which have historically been used for NHS continuing healthcare (CHC) patients with dementia. The beds are commissioned under a block contract arrangement and the current contract value is £2,993,192 per annum. Of the remaining 22 beds in the home, 10 are available for purchase by out of area commissioners and the remaining 12 beds are mothballed. The CCG has a responsibility to ensure that NHS resources are deployed in the most efficient way to deliver the best care for patients. The financial situation for the Barking and Dagenham, Havering and Redbridge CCGs (BHR CCGs) has been challenging for many years, from both a commissioning and provider perspective. In 2017/18 commissioners face specific challenges to their budget across the three CCGs, reaching a point where there is not enough money to continue to buy all the services in the same way we have been. To achieve financial balance during the year, BHR commissioners need to address a financial shortfall of £55m, which is just over 5% of the total annual joint budget of just over £1 billion. This is made up of £45m of Quality, Innovation, Productivity and Prevention (QIPP) savings together with a £10.2m agreed planned deficit (where an organisation is permitted by NHS England to spend more than it receives). Further QIPP savings will need to be made in 2018/19 to achieve financial balance. The CCGs are currently in legal directions from NHS England as a consequence of their financial position. To balance the books commissioners have, therefore, had to maintain a very close focus on where they are using their funds. This has meant ensuring that they are making the most effective use of every penny that goes into the local NHS - whilst making sure that that local people can access the healthcare that is most needed, safe and effective, and that ensures people with equal need have equal opportunity to access treatments. When entering into a contract for services, the CCG is required to ensure it meets the needs of NHS service users, provides high quality care and offers value for money. It is good practice periodically to review the value for money of contracts. The CCG has been in negotiations with Care UK regarding the renewal of the contract for Meadow Court with the shared objective of securing a contract that represents good value for money for the taxpayer and provides sufficient income for Care UK to provide a high quality sustainable service. However, we have been unable to agree a contract that delivers these objectives. The CCG is therefore proposing to end its contract with Care UK for Meadow Court nursing home and settle patients into suitable alternative homes that meet their care needs.

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CCG commissioning strategy for continuing healthcare The CCG is responsible for the care planning, commissioning of services and the case management of people who are eligible for continuing healthcare. The CCG applies the principles and processes set out in the National Framework for NHS Continuing Healthcare and NHS-funded Nursing Care in discharging its commissioning responsibilities. NHS continuing healthcare and funded nursing care NHS continuing healthcare services – often called CHC - is the name given to a package of care that is arranged and funded solely by the NHS for individuals who are not in hospital and have been assessed as having a ‘primary health need’. The NHS care package is informed by the individual’s needs. It is a holistic process, with a strong focus on helping people and their carers to achieve their desired outcomes. NHS continuing healthcare services can be provided from a variety of settings, for example:

in an individual’s own home – the NHS will pay for healthcare such as services from a community nurse or specialist therapist, and personal care, such as help with bathing, dressing and laundry

in a care home - as well as healthcare and personal care, the NHS will pay for care home fees, including board and accommodation.

To be eligible for continuing healthcare an individual must be over 18 years of age and have substantial and ongoing care needs. Eligibility for NHS continuing healthcare is reviewed regularly and if an individual’s needs change then the funding may also change. NHS funded nursing care is the funding provided by the NHS to homes providing nursing to support the provision of nursing care by a registered nurse.

Care planning When a person is identified as possibly being eligible for CHC they are referred to the CHC team for a needs assessment by a multi-disciplinary team, which includes a nurse and a social worker. The needs assessment will determine whether the individual has a primary healthcare need and is eligible for NHS CHC or has care needs that would be met by the local authority. Following the assessment a care plan is developed which informs the commissioning of a care package that is tailored to an individual’s needs. Commissioning of services Redbridge CCG spends circa £22.66m each year on continuing healthcare services. Currently there are 509 patients on the CHC caseload (October 2017). The CCG takes a strategic, as well as an individual approach, to fulfilling its NHS CHC responsibilities.

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Care home placements NHS-funded care is commissioned from a wide range of care home providers, in order to secure high-quality services that offer patient choice and value for money. Redbridge is one of 32 CCGs that is signed up to the pan-London procurement process for Any Qualified Provider (AQP) for CHC in nursing homes. Any Qualified Provider The AQP for CHC in nursing homes is a procurement process run by London CCGs and is the main route for CHC nursing home placements for the London CCGs that are part of the AQP. The AQP framework is for CHC eligible service users and includes:

mental health adult (including dementia); physical disabilities adult (including frail elderly).

Care Quality Commission (CQC) registered providers (or proprietors) can apply to join the AQP on behalf of the care homes they own and the application process can be opened up several times a year for new providers and CCGs to join.

AQP providers are approved by NHS commissioners and nursing home care is commissioned using the NHS standard contract - the specification and set weekly price for nursing home care is set out in the contract. AQP is the main route for placements for all participating CCGs. London wide and local CCG policy is that the commissioning of nursing/care homes moves away from block arrangements such as this one with Meadow Court and towards cost and volume arrangements, preferably under AQP arrangements. The benefits of this are that:

providers who apply to become an AQP compete on quality and not price against a specification set by NHS commissioners, which encourages innovation

patients are able to choose a provider that has had NHS commissioner approval to deliver the services

prices are set across London which provides transparency and ensures that providers are treated equitably

the AQP supports personal health budgets. A list of approved AQP providers is distributed to NHS commissioners, discharge teams and patients’ families. Whilst the CCG’s commissioning strategy is to make placements into AQP homes, the CCG will fund placements into a non-AQP home when there is a clear preference expressed by a patient/relative for a non-AQP home such as Meadow Court, or where there are clear reasons why a patient needs some form of enhanced care provided by a non-AQP home and the needs cannot be met by an AQP home. Over 2016/17, a greater number of providers moved onto to the AQP framework, so there has been an increase in the proportion of patients placed in these homes, as compared to previous years.

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Page 8

On average over the last 12 months, approximately 50% of patients in Barking and Dagenham, Havering and Redbridge were placed in homes on the AQP framework, in Redbridge this figure is around 65%. Core NHS services Residents in care homes continue to have access to the wider range of health services that are commissioned by the NHS e.g. primary, community and secondary care services. Many people living in care homes have complex needs and there is evidence that a more proactive approach and more responsive support can improve health and quality of life. The BHR CCGs have tested a number of commissioning models to enhance health services to care homes: some GPs are providing an enhanced service to care homes in Barking and Dagenham and Havering; a specialist GP service for people with 5 or more long term conditions has been supporting four nursing homes in BHR to pilot a new model of care. Enhanced services are not consistently commissioned across all homes. Meeting the needs of a growing and ageing population is one of the key challenges for the health and care system. To respond to this challenge the Next Steps on the NHS Five Year Forward View (March 2017) which calls for “… better integration of GP, community health, mental health and hospital services, as well as more joined up working with home care and care homes”. The London Clinical Senate discussed the topic of enhancing services in care homes at its meeting in May 2017 and recommended that systems should focus on spreading and adopting initiatives that have been proven to work, adapted to a local context as necessary. A plan for developing a model for enhanced services for care homes in being developed across the BHR CCGs. Personalisation and choice The CCG’s commissioning strategy for NHS continuing healthcare is guided by the Government’s commitment to increase choice and personalisation in NHS-funded services. Choice for patients can be about the way care is provided, or the ability to control budgets and self-manage conditions. From April 2014, people receiving NHS CHC funding have had the right to request a Personal Health Budget (PHB). A personal health budget (PHB) is an amount of money to support the identified health and wellbeing needs of an individual, which is planned and agreed between the individual, or their representative, and the CCG. PHBs are intended to enable people with long term conditions and disabilities to have greater choice, flexibility and control over the healthcare and support they receive. In October 2014 it became a right to receive a PHB, rather than a right to request. When a request for a PHB is made by or on behalf of an individual eligible for CHC, the CCG must grant that request unless it is not appropriate, given the circumstances of the individual’s case, to secure provision of all or any part of the CHC service by a PHB.

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Page 9

In order to be able to fund personal health budgets the CCG will need to ensure there is flexibility in the CHC budget to support personalised packages of care - where funding is tied up in block contract arrangements this is difficult to achieve. Provider market The local authority has a leading role in shaping and developing the market where individuals purchase care and support. As part of their joint commissioning responsibility, CCGs and local authorities work in partnership, and share information, where reasonable, to enable them to commission the most appropriate packages of care for their populations. Since March 2015, the number of residential beds (care homes without nursing) across London has decreased by 2%. Redbridge has seen a 25% increase in residential beds between March 2015 and March 2017, and a 22% decrease in nursing home beds. This change is partly attributable to two homes with a combination of 175 beds converting from nursing bed provision to residential beds. There are a total of 39 nursing homes (care homes with nursing) within Barking and

Dagenham, Havering and Redbridge (BHR) borough boundaries (Table 1) which

provide a total of 2208 beds. 35 of these nursing homes are registered to provide

services for people with dementia.

Table 1 Care homes with nursing 4 October 2017 (CQC) CCG Number of locations Number of beds

Redbridge 13 640 Barking and Dagenham 7 518 Havering 19 1050 Total 39 2208

Figure 1 shows all nursing homes in the BHR area, colour coded to indicate if the home

is an AQP home.

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Figure 1

Quality monitoring of care homes All care homes are registered with the Care Quality Commission (CQC). The Care Quality Commission is the independent regulator of health and adult social care in England. They are responsible for registering care providers, monitoring inspecting and rating services. The CQC undertakes inspections of care home providers, generally every three years and will provide a rating based on their assessment of whether the service is safe, effective, caring, responsive and well led at the time of the inspection, which the provider is required to publish. Where people using a service are not at immediate risk of harm but the service is rated as “requires improvement”, the provider is required to develop an improvement action plan. The CQC ratings of care home providers in BHR are summarised in Appendix 1 (CQC - November 2017). Meadow Court is rated as “good” by the CQC. The CQC ratings represent a snapshot of quality at the time the home is inspected. Commissioners monitor the quality of care homes at a local level through local performance management processes. AQP homes are commissioned against an agreed service specification which includes standards relating to quality and safety. Performance against measures for patient safety, end of life care, patient deaths and staffing is monitored by the NHS London Purchased Healthcare Team (LPH). Reports and quality concerns are shared with CCG commissioners on a monthly basis.

AQP homes

Non- AQP homes

Meadow Court

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Some locally commissioned homes (non- AQP homes), with the exception of a few block contracts such as Meadow Court, have been procured within the last three years on standard NHS contracts that include the same specification and quality requirements as AQP contracts. Performance monitoring information is submitted quarterly by these homes when placements are commissioned by BHR CCGs and reviewed by the contracting team working with the CCG safeguarding nurses and the CHC commissioning team.

The Quality Surveillance Group (QSG) is a local forum for sharing information on local care homes between local commissioners (local authorities and CCGs) with attendance by the CQC. The QSG is chaired by the BHR CCGs Designated Adult Safeguarding Manager. The group shares and discusses information relating to local care homes’ general standards of quality and safety, commissioning and contracting concerns, any safeguarding concerns and outcomes from the CQC inspection regime. Further feedback is provided around recent quality assurance/safeguarding visits, and updates in connection to improvement plans. Any serious quality concerns raised by the QSG are escalated to the BHR CCGs’ Quality and Safety Committees, who have oversight of quality improvement plans and provide assurance to the Governing Bodies that quality risks are being addressed.

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Contract for beds at Meadow Court Nursing Home

Introduction

The beds at Meadow Court are commissioned under a block contract arrangement and the current contract value is £2,993,192 per annum. This block contract commits the CCG to funding these beds regardless of whether they are occupied or not. When entering into a contract for services, the CCG is required to ensure it meets the needs of NHS service users, provides high quality care and value for money; it is good practice to periodically review the value for money of contracts. The CCG has been in negotiations with Care UK regarding the renewal of the contract for Meadow Court with the shared objective of securing a contract that represents good value for money for the taxpayer and provides sufficient income for Care UK to provide a high quality sustainable service. Activity delivered under the contract As beds at Meadow Court are commissioned under a block contract, the CCG is required to pay for empty beds and when the unit is not full this impacts on the value for money of the contract Bed occupancy over the past two years is profiled in Table 2. The maximum bed occupancy over the past three years has been 36 out of the 48 block beds (September 2014). At the start of the consultation (4 August 2017) 14 beds were occupied by Redbridge residents. Table 2: Meadow Court bed occupancy trend

2014 2015 2016 2017 Sept Dec Mar June Sept Dec Mar June Nov Mar Aug

No. of patients in Redbridge CCG commissioned beds

36 35 33 29 26 27 25 23 18 16 14

Total number of beds in CCG block contract

48 48 48 48 48 48 48 48 48 48 48

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Table 3 sets out the bed occupancy at the start of the consultation. As of 4 August 2017, when the consultation began, the CCG was paying for 34 empty beds. This represents a cost of £2.12m per annum at the current bed rate of £1,199 per week.

Table 3: Meadow Court bed usage as at 4 August 2017

Commissioner Number of beds occupied Number of empty beds

Redbridge CCG 14 34 Newham CCG 1 N/A - spot purchase LB Redbridge 2 N/A - spot purchase LB Newham 1 N/A - spot purchase LB Redbridge and Redbridge CCG

1 N/A - spot purchase

City & Hackney CCG 1 N/A - spot purchase London Borough of Hackney 1 N/A - spot purchase East London NHS Foundation Trust

1 N/A - spot purchase

Privately Funded 1 N/A - spot purchase Not contracted 0 1 Not contracted (mothballed) 0 12 Total 70

Bed cost A bed at Meadow Court costs £1,199 per week, which compares to a benchmark cost of £769 per week for a home on the AQP framework. The bed cost for Meadow Court in part reflects higher staffing costs on account of inherited staff Transfer of Undertakings (Protection of Employment) (TUPE) commitments as Care UK took over the service from the NHS about ten years ago. TUPE is an important part of UK labour law that ensures that employment is protected when a business transfers from one organisation to another. Care UK and other care home providers have also notified the CCG about various cost pressures arising from the national living wage and other factors. Meadow Court had a reputation for providing a specialist service and being able to care for patients with more challenging behaviour and more severe dementia than in other homes. If that was the case the CCG would expect the service to be provided within the contract price. However, in practice, Care UK has requested additional CCG funding for their most challenging patients at Meadow Court. Redbridge CCG spent an additional £367K on top of the block contract costs in 2015/16, and an extra £287K above the block contract in 2016/17 for this purpose.

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Service quality The home was subject to a review by the Quality Surveillance Group in October 2016 following concerns raised by a GP providing services to Meadow Court. Further to this improvements were made in the quality of documentation and training. In May 2017, the CCG Designated Safeguarding Manager met with families of residents of Meadow Court who had raised some concerns about the care of their relatives. An action plan was subsequently implemented to address the concerns raised. There are no current quality concerns in respect of the service provided at Meadow Court. Meadow Court was given an overall rating of “good” by the Care Quality Commission (CQC) on 8 September 2016. It followed an unannounced inspection to check that the provider had made improvements to meet the legal requirements after an inspection on 19 and 20 March 2015 (when the home was rated as “requires improvement”). During the consultation process some relatives and stakeholders responded to say that in their view Meadow Court provides superior care or services for people with dementia or physical health problems that is unavailable elsewhere and that staffing ratios were considered to be better than in other nursing homes. There is a view that this is a specialist home for people with multiple sclerosis but there is no evidence that this is the case. Having reviewed staffing levels in Meadow Court and in 17 nursing homes in the area it was not possible to make a direct comparison of staffing ratios as the CCG pays for a block contract of 48 beds and the provider is expected to staff the unit to this level. Also, if an individual with challenging behaviour is assessed as requiring 1 to 1 support then this would be commissioned by the CCG as part of the care package. Public Health England report that the quality rating for dementia residential and nursing home beds (65+) in Redbridge is above the national benchmark1. Assurances on the standards of care to be delivered by providers are specified in the contract. The contract for AQP requires providers to demonstrate that they meet standards for staff training and qualifications, including the maintenance of relevant clinical knowledge, keeping up to date with best practice guidelines, continuing professional development and safe and effective recruitment practices. A review of the ratio of nurses to carers across Meadow Court and these 17 homes on 31 August reported that the ratio of nurses to carers in Meadow Court fell mid-range across the 17 homes, which suggested that the level of nursing support was not significantly higher than other homes.

1 Public Health England: Dementia profile 2017. 30


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Options for commissioning more cost effectively Agree a new contact with Care UK that reflects demand The CCG has looked at introducing efficiencies into the contract and significant savings were achieved in 2014 when the commissioned block was reduced from 60 beds to 48 beds. In recent negotiations, Care UK has stated that they are not able to reduce the block further and cannot accept the CCG spot purchasing beds according to actual current need. Care UK has stated that to reduce the block capacity or to provide on a spot purchase basis only would be economically unviable and so the home would have to close. Care UK report that because the beds in Meadow Court are laid out in 12 bedded units it is less efficient for them to staff the home than Care UK’s more modern homes which are designed around 18 or 24 bed units allowing optimum staff to patient ratios. Care UK also report their view that patients and their families see Meadow Court as having a “clinical” feel whereas patients tend to prefer a more homely and welcoming design that is less apparent at Meadow Court. Care UK have reported that they have had very limited success in marketing any of their spare capacity (i.e. the non-block beds and the mothballed beds) to other CCGs and local authorities. This is because other CCGs prefer to place patients into AQP homes which cost £427 less per week while providing an equivalent standard of care. Similarly, the rates that local authorities are prepared to pay are much lower than the price that Meadow Court has to charge primarily owing to the TUPE costs. Procure the contract from a different provider (market test the contract) The service has not been market tested directly. However, all local service providers have been invited to join the AQP framework specification and price thereby making them CCG preferred providers. Care UK has decided not to join this framework as they contend it would be uneconomic for them to do so. Care UK has reported that the high staffing costs associated with the transferred TUPE staff mean that a decrease in bed price would push the service into a loss making position. Re-provide the contract to NHS management The CCG is unable to take over the direct management of the contract as it is a commissioning organisation and is not registered with the Care Quality Commission to provide services. The transfer of the contract to another NHS organisation would require a procurement to take place. NHS providers locally do not provide care home services with nursing and in addition to the issues raised above this option is not considered viable. End the contract with Care UK and commission placement in suitable alternative nursing homes The remaining option for the CCG is to terminate the block contract with Care UK and settle patients into suitable alternative homes that meet their care needs.

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Consultation process From 4 August to 27 October 2017, Redbridge CCG carried out a consultation – proposed changes to nursing care services at Meadow Court nursing home in Goodmayes, Redbridge – to seek local people’s views on a proposal to end the contract with Meadow Court and settle patients into alternative homes in the area. During the twelve week consultation, all local stakeholders were contacted and invited to respond with their views on the proposal. As those directly affected by the proposal could be identified and were a relatively small group of people – those that live in the home, their relatives and carers – the CCG’s approach was to focus on engagement with this group in line with NHSE guidance. CCG staff and the clinical lead met with the families of residents of Meadow Court twice and presented the proposal to the Redbridge Scrutiny Committee. The CCG received responses from 23 individuals or organisations: 14 respondents completed the CCG questionnaire and nine respondents provided feedback by letter or email. Five relatives of residents at the home provided more than one response by submitting multiple letters/emails to the CCG. Of the respondents, 48% of respondents had a relative or friend living at Meadow Court (so would be affected by the proposal) and 61% of respondents had a relative or friend living with dementia. Not all of the 23 respondents provided feedback on all of the CCG’s statements or

questions.

Of the respondents who responded to the CCG’s four statements on its proposal:

61% agreed or strongly agreed that the local NHS needs to get the best value for money from its services. No respondent disagreed.

47% agreed or strongly agreed that the local NHS shouldn’t be paying for beds

that are not used, 30% neither disagreed nor agreed.

72% disagreed or strongly disagreed that the CCG should end its contract at Meadow Court – this includes all those affected by the proposal. 18% of respondents agreed or strongly agreed that the contract should end.

55% of those who agreed that the CCG needed to get value for money disagreed that the CCG should end its contract at Meadow Court.

Other comments

52% of respondents said they believed moving patients would have detrimental impact on their health or care

52% were concerned that if the home closed there would not be enough nursing beds in the future in the area for the growing aging population

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43% said Meadow Court provided high-quality care, and some of these believed

it was care they felt wasn’t available at alternative homes in the area.

To note, as with all consultations more responses were received from those who would be directly affected by the proposal. Despite being a public consultation open to all residents of Redbridge and promoted to local stakeholders, only 23 responses were received, 48% of which were from a family member of a resident at the home.

Details of the consultation and the report on the responses are available in appendices 1 and 2. Clinical recommendations methodology

Clinical evaluation panel

It was decided to convene a ‘clinical evaluation panel’ in order to review and consider the evidence and make recommendations on the proposals. The panel reviewed the following evidence (all contained in this document or the appendices).

1. Meadow Court consultation report 2. Capacity in alternative homes analysis 3. Meadow Court quality impact assessment 4. Meadow Court initial equality impact assessment 5. Meadow Court decision making support document (or the scoring

methodology and process) 6. Redbridge CCG Meadow Court case for change (referenced in this

document)

The clinical panel met on 10 November 2017 and consisted of the following CCG clinical leads:

Dr Raj Kumar (Clinical Lead Mental Health, BHR CCGs) Dr Syed Raza (Clinical Director Redbridge CCG)

They were supported on the day by a panel of non-voting experts including:

Mark Gilbey-Cross –Designated Adult Safeguarding Manager – BHR CCGs Khalil Ali –Lay Member – Redbridge CCG Donna Hurley – Continuing Healthcare Business Manager – Redbridge CCG Samantha Brooker – Senior Communications Manager – NEL CSU

And by a non-voting supporting team:

Sharon Morrow (Chair of Panel) Tracy Butterworth (Facilitator) Beverley Lignum (Facilitator)

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Clinical Evaluation Process

The objective was to arrive at a balanced recommendation for the proposal that considered:

the amount the proposal was likely to save the impact that proposal was likely to have on affected individuals who use the

service now or those who might use it in the future the potential the health of the population as a whole as well as other health and

social care services.

Clinical leads scored on the following:

1. Experience of patients, families and carers: how much their quality of life might be affected by the proposal. A score of zero would indicate minor inconvenience to most individuals impacted by the proposal. A score of ten indicated that most individuals would see a significant impact on their quality of life, a likelihood of having to travel further and additional inconvenience based around affordability or availability of transport.

2. Clinical impact: how much patients’ health will be affected by the proposal. A

score of zero would point to no impact on the health of most patients whereas a score of ten would see most patients experiencing significantly poorer health.

3. Equality impact: the extent to which the change will disproportionately impact

one part of the community. A score of zero suggested that proposals will not negatively affect inequalities in health or access to health services. A score of ten would point to a disproportionate effect on a group in society in a way that would most likely increase inequalities in health or access to health services.

4. Impact on other services: the extent to which the proposal will affect the way

that other services operate. A score of zero would suggest no noticeable effect on demand for other services whereas a score of ten would point to a noticeable effect on demand for services elsewhere in the health or social care sector.

Each of these scoring criterion were weighted 25% and clinical members gave a score out of 10 (0=low and 10=high) across all categories for each proposal. Their combined and weighted score was then contrasted with the likely saving, the consultation responses and advice and guidance from the expert panel. Taking account of the best information available, panel members were then asked to vote, recommending either for or against implementation of the proposal. In order to provide some consistency in applying scores, calibration guidance was provided. The scoring process is detailed in Appendix 4.

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Scoring process

Experience of patients, families and relatives

Scoring category Impact Further mitigations proposed

Impact on patient experience

Low See recommendation reached.

Panel discussion:

The panel considered a number of different aspects with advice from the expert panel. Feedback from the consultation has shown that families of patients are very concerned about the health and wellbeing of their relatives as a result of relocating. It was acknowledged that the families were responding as advocates of the patients who had not responded themselves during the consultation process. It was considered that there might be a differential experience of younger and older patients in the home where a change of environment can be either beneficial or detrimental to the emotional welfare of patients. Families and carers could be highly impacted if care provision is provided further away – entailing longer travel times, alternative travel arrangements and higher travel costs. The experience of the family of a younger patient who had transferred to a different home had been positive. The panel heard about concerns that had been raised by families and GPs in the past.

On balance the panel felt that, taking into account the experiences of past, current and future users of the service the impact on patient experience would be relatively low and could be mitigated. The expert panel felt the impact score was low and invited clinical members to revisit their impact assessment to ensure it accurately reflected the likely impact of change – before mitigating action was taken into account.

Clinical impact on patients


Clinical impact on patients

Low See recommendation reached

Panel discussion:

Following the deaths of two Meadow Court patients who transferred to other homes in September, some families feel that moving patients will negatively impact the health of their family member. A review into these transfers by the CCG Safeguarding Lead concluded that there was no causal relationship between the transfer and the deaths

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and that there had been good quality care before, during and after the planned transfers.

It was reported that a third patient who had transferred from the home recently had seen an improvement in health outcomes.

There is a perception that Meadow Court provides superior specialist dementia care, however there are 15 alternative homes also rated “Good” by CQC in the BHR CCGs catchment area with sufficient dementia beds. Eleven of these homes are able to take dementia patients with challenging behaviour. Regular quality surveillance visits are monitoring ongoing quality of care, providing a mechanism to quickly identify and address areas of concern.

Impact on equity of service provision

Scoring category Impact Further mitigations

proposed

Impact on equity of service provision

Low See recommendation reached

Panel discussion:

This proposal by its very nature disproportionately affects older people with dementia and people with physical and/or mental disability but because alternative accommodation and care is available locally at a similar standard, this does not represent the withdrawal of service leading to a loss of equity. Carers and families would be impacted in different ways depending on location of care provision. Care located further away from the homes of families and carers will entail longer travel times, increased cost and possibly reduced access where affordable transport is not available. However, care may be equally likely to be located closer to families and carers- there are 17 homes within 4.7 miles of Meadow Court. To mitigate potential negative impacts, the CCG will build in additional tailored support where needed to support low income families to understand and access wider support available to them.

Impact on other services


Impact on other services

Low No

Panel discussion:

There is sufficient capacity and provision to sustain good quality care for older patients with dementia in BHR to meet the needs of the existing Meadow Court patients and future patients should Care UK decide to close Meadow Court.

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Concerns were raised during the consultation that taking beds out of the system would mean that older people would be discharged less quickly in the acute trust. It was noted that the percentage of delayed transfers of care (DTOCs) in the local acute trust was low compared to the national average and the panel did not consider that the proposal would cause delayed discharges”. It was noted that the continuing healthcare team place on average 50-60 patients per week across the BHR CCGs and there is capacity in the provider market to accommodate this level of activity.

Recommendation reached

After robust discussion, the clinical evaluation panel recommended that the proposal to end the contract at Meadow Court be implemented.

In order to mitigate the negative impact of this proposal on patients, carers and their families, four key actions were identified by the clinical panel:

1. A commitment to early and ongoing engagement of carers, patients and families in careful assessment and care planning before, during or after transfer to ensure patients are moved with care and in line with best practice.

2. Frequent and ongoing quality surveillance visits to enable ongoing monitoring of the quality of care before, during and after transfer, providing the mechanism to identify areas of concern quickly

3. Provide additional support to low income families, helping them to better understand and access the wider support available to them during the implementation process.

4. Ensure that there is a robust transfer and follow up process in place, overseen by a CHC nurse

Financial impact

Redbridge CCG commissions 48 beds at Meadow Court under a block contract arrangement. The annual block contract value for the Meadow Court contract is £2,993,192. Out of the 48 beds commissioned under the block contract there are 34 that are vacant and this has a significant impact on the value for money of the contract. The CCG is paying £2.43m, or five times more than it would do if the residents were placed in alternative homes on the AQP rate. That is, it is paying £2.99m a year for 14 patients who could receive an equivalent standard of nursing home care for £0.56m from providers on the AQP framework.

Quality impact

A quality impact assessment of the proposal was undertaken by the CCG quality team before the consultation began. This has been updated to include the mitigating actions to address quality risks as recommended by the panel and is attached as Appendix 5.

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Equality impact

During the consultation, an initial equality impact assessment (EIA) was produced looking at the potential impact on the groups of individuals in the following categories known as ‘protected characteristics’:

age disability gender reassignment race religion or belief sex sexual orientation marriage and civil partnership pregnancy and maternity The EIA has been revised and expanded to take into account responses to the consultation and is attached as Appendix 6. Conclusion

In conclusion we believe that the patients currently cared for in Meadow Court can be safely and appropriately cared for in other facilities, that the contract with Care UK for Meadow Court nursing home does not offer value for money and that the Governing Body should agree to terminate the contract.

We recognise that this decision would impact on the patients in the home, carers and families and recommend that the CCG takes forward the recommendations from the panel to mitigate the impact of this proposal:

1. A commitment to early and ongoing engagement of carers, patients and families in careful assessment and care planning before, during or after transfer to ensure patients are moved with care and in line with best practice.

2. Frequent and ongoing quality surveillance visits to enable ongoing monitoring of the quality of care before, during and after transfer, providing the mechanism to identify areas of concern quickly.

3. Provide additional support to low income families, helping them to better understand and access the wider support available to them during the implementation process.

4. Ensure that there is a robust transfer and follow up process in place, overseen by a CHC nurse

Appendices

1. Alternative nursing homes in Barking and Dagenham, Havering and Redbridge

2. Meadow Court consultation document

3. Meadow Court consultation report

4. Clinical evaluation panel process

5. Quality impact assessment

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6. Equality impact assessment

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Alternative nursing homes

Name Borough CQC Status - Updated 17/11/2016 AQPChestnut Court Care Home B&D http://www.cqc.org.uk/location/1-150166309 YBennetts Castle Care Centre B&D http://www.cqc.org.uk/location/1-117294310 YChaseview Care Home B&D http://www.cqc.org.uk/location/1-3153731434 YCherry Orchard B&D http://www.cqc.org.uk/location/1-469602584 yPark View B&D http://www.cqc.org.uk/location/1-125861732 YHanbury Court Care Home B&D http://www.cqc.org.uk/location/1-119099319 YAlexander Court Care Centre B&D http://www.cqc.org.uk/location/1-2258796361 NHeatherbrook Havering http://www.cqc.org.uk/location/1-139851870 NBeech Court Care Centre Havering http://www.cqc.org.uk/location/1-2259197176 yAshbrook Nursing Home Havering http://www.cqc.org.uk/location/1-131442266 YAbbcross Nursing Home Havering http://www.cqc.org.uk/location/1-118284715 YCranham Court Nursing Home Havering http://www.cqc.org.uk/location/1-135230067 YHillside Nursing Home Havering http://www.cqc.org.uk/location/1-3618720737 YMoreland House Care Home Havering http://www.cqc.org.uk/location/1-128100919 YRavenscourt Nursing Home Havering http://www.cqc.org.uk/location/1-125520928 YRomford Care Centre Havering http://www.cqc.org.uk/location/1-118135530 YRomford Grange Care Home Havering http://www.cqc.org.uk/location/1-318156195 YThe Hornchurch Care Home Havering http://www.cqc.org.uk/location/1-3112635931 YUpminster Nursing Home Havering http://www.cqc.org.uk/location/1-118297341 YWillows Care Home Havering http://www.cqc.org.uk/location/1-1555693520 YBarleycroft Care Home Havering http://www.cqc.org.uk/location/1-132536307 NDerham House Havering http://www.cqc.org.uk/location/1-125855829 N Fountains Care Centre Havering http://www.cqc.org.uk/location/1-3979621870 N Abbey Care Complex Redbridge http://www.cqc.org.uk/location/1-136143611 YSeabrooke Manor Residential and Nursing Home Redbridge http://www.cqc.org.uk/location/1-127514996 YSt Josephs Rest Home Redbridge http://www.cqc.org.uk/location/1-408294801 NWoodland Nursing Home Redbridge http://www.cqc.org.uk/location/1-122612020 YBakers Court Care Home Redbridge http://www.cqc.org.uk/location/1-3152160938 YCambridge Nursing Home Redbridge http://www.cqc.org.uk/location/1-122191502 YChurchfields Nursing Home Redbridge http://www.cqc.org.uk/location/1-114685536 YGable Court Care Home Redbridge http://www.cqc.org.uk/location/1-3139625492 YSpringfield Care Centre Redbridge http://www.cqc.org.uk/location/1-3979621910 NThe Chestnuts Nursing and Dementia Care Home Redbridge http://www.cqc.org.uk/location/1-426498419 YLadyville Lodge Havering http://www.cqc.org.uk/location/1-311019424Havering Court Havering

KEYOverall InadequateOverall Requires ImprovementOverall Goodblank - CQC have not inspected yet

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http://www.cqc.org.uk/location/1-150166309


































Name Borough CQC Status - Updated 17/11/2016 AQPGlebe House Havering http://www.cqc.org.uk/location/1-834125900 NDunelm Redbridge http://www.cqc.org.uk/location/1-122577740 NGreen Lodge Respite Care Unit Redbridge http://www.cqc.org.uk/location/1-299470690 NHarts House Care Home Redbridge http://www.cqc.org.uk/location/1-128272532 N

KEYOverall InadequateOverall Requires ImprovementOverall Goodblank - CQC have not inspected yet

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Proposed changes to dementia care at Meadow Court nursing home 0

Proposed changes to nursing care services at Meadow Court nursing home in Goodmayes, Redbridge

What do you think of our proposal? Tell us your thoughts by

27 October 2017. www.redbridgeccg.nhs.uk/meadow-court

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Foreword

Dr Raj Kumar, Clinical Director and mental health lead, Redbridge Clinical Commissioning Group As local GPs we know how vital it is to get the best service we can for local people. When someone is cared for 24/7 by the NHS this becomes all the more important. Advances in healthcare and technology mean more and more of us are living longer. As a person ages their risk of developing dementia and

complex illnesses which require continuous care from health professionals increases.

These changes can become severe and when combined with other ongoing healthcare needs, as many patients in Meadow Court nursing home experience, it means they need 24 hour specialist care. It is the nursing care that is provided at Meadow Court in Goodmayes that the local NHS now want to hear your views on. This document explains how and why we want to make some changes to the nursing services the NHS pay for at Meadow Court. Please read this document and let us know what you think of our proposal by filling in the questionnaire at the back, or online at www.redbridgeccg.nhs.uk/meadow-court.

About Meadow Court Meadow Court is a purpose-built nursing home near King George Hospital in Goodmayes that is run by a company called Care UK. There are 70 beds in the home for people aged over 65 with dementia and physical disabilities. Redbridge Clinical Commissioning Group (CCG) – the local NHS – has a contract with Care UK to pay for 48 beds in the home to care for local people who have dementia and need full-time nursing care. Other NHS groups and local authorities from the wider area pay Care UK to use the remaining 22 beds as and when they need them. At the moment seven of these beds are being used. Like most nursing homes Meadow Court provides expert round-the-clock care from staff who are specially trained to look after older people with dementia. The building itself is owned by NELFT NHS Foundation Trust.

Dementia is a progressive illness which is caused when the brain is damaged by disease, such as Alzheimer’s or a series of strokes. People with dementia experience memory loss, difficulty thinking, speaking, or solving problems. It may also affect their mood or behaviour.

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Why we want to change the service People who need full-time nursing care can choose which home they would like to live in. In recent years fewer people are choosing to be cared for at Meadow Court. At the moment only 14 people, whose care is paid for by the local NHS in Redbridge, are living at the home. This means only 14 of the local NHS’s 48 available beds at the home are being used, and this number keeps reducing. This means that because of the contract we have with Care UK we are paying for 34 empty beds. The cost to the NHS of these empty beds is £2.44m1 a year. Clearly this contract is no longer able to provide good value for money. There are 17 nursing homes within four miles of Meadow Court which provide the same dementia care as Meadow Court and have beds available2. The local NHS has changed how it buys its services to avoid situations like this in future. Instead of having contracts where we pay for a pre-agreed number of beds or services, we think it’s fairer to only pay for services that patients use. It also means we make sure we get the best value for money for our services so we can continue to pay for essential healthcare.

1 Figures correct at time of print 2 Correct at time of print

Options for the future of Meadow Court We have tried to offer the empty beds to other suitable patients, but we are continuing to see people choose other nursing homes in the area, so we’ve not been able to fill these beds at Meadow Court. We’ve also looked at how we could just pay for the beds that we use. However this is not an option as if we did this Care UK may not be able to afford to run the home anymore. It is also very unlikely that another organisation would come in and run the home instead because of the high cost of running it. For these reasons we are proposing to end our contract with Meadow Court and settle patients into alternative homes in the area which we know provide the same nursing and dementia care, and have beds available. If this happened, the NHS would help you and your relative or friend to do this, from choosing the right home for them to moving in. There are 17 nursing homes within four miles of Meadow Court which provide the same dementia care as Meadow Court and have beds available. If we did end our contract at this home, with even fewer people to care for this would mean Care UK may not be able to afford to run Meadow Court and the nursing home may need to close.

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Why we want to change the service Patient care is our priority We appreciate that moving patients with dementia is not an easy decision, and patients’ wellbeing is our first priority. We will be speaking to those who live at the home to make sure they are aware of the proposed changes and have their say. If, after taking people’s views on board, a decision is taken to end our contract at Meadow Court, we would work closely with patients, their families or representatives, and Care UK to arrange for patients to move to a suitable alternative nursing home of their choice in the area. Next steps We will be speaking to people who live at the home, their representatives, local stakeholders, the local authorities and other local NHS groups who pay for beds at the home, clinicians, and the public to explain the proposal and get their feedback. We will then use this feedback, and that from members of the public, to inform our final decision on the service at Meadow Court, which we will make in the late autumn 2017. Please complete the short questionnaire at the back of this booklet, or online, by 5pm on 27 October 2017 to give us your feedback.

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Questions and answers Q. Why can’t you just put other patients in the empty beds? A. People can choose which nursing home they want to live in and we are continuing to see people choose other homes in the area rather than use one of the beds we have available at Meadow Court. As our contract with Care UK is for specialist nursing care it would not be appropriate, or fair on those that already live there, for people with general health needs to stay at the home. For a number of reasons it costs more to pay for a bed at Meadow Court than other nursing homes. Because of this Care UK have not been able to find other NHS organisations or local authorities who would like to pay to use the empty beds for their patients. Q. Is this just about saving money? A. No. Making sure people receive the quality healthcare they need at a home of their choice is our priority. As fewer and fewer people are choosing to live at Meadow Court it is clear this home is no longer what most people are looking for; they are choosing to get the care they, or their family member, need elsewhere. As well as this we, like all of the NHS and local authorities, face significant financial challenges. We need to make sure our services provide the best possible value for money for taxpayers, and that we’re only paying for the services we need. We know that due to our contract at Meadow Court we are paying £2.44m3 every year for beds which are not being used. Q. How will you help patients find another home? A. If the decision was taken for the local NHS to stop paying for beds at Meadow Court the NHS, and Care UK, would help you and your relative or friend to choose an alternative nursing home to move to. We would support you throughout the process from choosing the home, to moving in. There are 17 nursing homes within four miles of Meadow Court which provide the same dementia care as Meadow Court and have beds available4.

3 Figure correct at time of going to print 4 Correct at time of print

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Questions and answers What about the staff at the home? A. We are asking the staff who work at the home for their thoughts on our proposal. We will take their feedback on board and it will inform our final decision. If a decision is taken for the local NHS to stop paying for beds at Meadow Court, with even fewer people to care for this would mean Care UK may not be able to afford to run Meadow Court and the nursing home may need to close. If this happened, Care UK would work with the nursing home staff to discuss their individual situations and options. Q. Who will have the final decision on the proposal? A. We will review and consider all the feedback we receive from people about our proposal. We will use this to shape our final recommendation. This will then be presented to Redbridge CCG’s governing body – which includes local GPs – who will make a decision. Q. Where can I get independent advice? A. Age UK can provide free, independent and confidential advice to older people, their relatives, carers and friends. You can contact them on 020 8220 6000 or email [email protected]

Photo of Meadow Court

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mailto:[email protected]


Other dementia nursing homes in the area If, after taking people’s views on board, a decision was taken to end our contract at Meadow Court, we would work closely with patients, their families or representatives, and Care UK to arrange a suitable alternative nursing home of their choice for them in the area. There are 17 nursing homes within four miles of Meadow Court suitable for people who currently live at Meadow Court with dementia who need full-time care. You may want to arrange to speak to or visit one of these homes to understand what other nursing homes offer in the area. See the homes on a map online, or on the following page. Name of

nursing home

Address Distance from Meadow Court

CQC rating Contact details

1 Abbey Care Complex

23-29 Abbey Road, Newbury Park, Ilford, IG2 7NE

1.1 miles Good www.abbeycarecomplex.co.uk 020 8554 3743

2 Woodlands Nursing Home

Gordon Road, Ilford, IG1 1SN

1.7 miles Good www.abbeytotalcaregroup.co.uk

3 Bennetts Castle Care Centre

244 Bennetts Castle Lane, DagenhamRM8 3UU

1.8 miles Good www.bennettscastle.co.uk 020 8517 7710

4 St Joseph’s Rest Home

16-18 The Drive, Ilford, IG1 3HT

2.2 miles Good www.stjosephsresthome.co.uk 020 8518 3004

5 Sherrell House

414 Fencepiece Road, Chigwell, IG7 5DP

2.6 miles Requires improvement

www.excelcareholdings.com 020 8501 3389

6 Chestnut Court Care Home

Frizlands Lane, Dagenham, RM10 7YD


www.mmcgcarehomes.co.uk 020 8003 1055

7 Seabrooke Manor Care Home

Lavender Place, Ilford, IG1 2BJ


www.bupa.co.uk 020 3468 4593

8 Heatherbrook 80 Como Street, Romford, RM7 7DT

2.7 miles Good www.careuk.com/heatherbrook 01708 871 890

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Name of nursing home

Address Distance from Meadow Court

CQC rating Contact details

9 Bakers Court Care Home

138-140 Little Ilford Lane, Manor Park, E12 5PJ

2.9 miles Good www.bupa.co.uk 020 3432 7569

10 Chaseview Care Home

Off Dagenham Road, Rush Green, Romford, RM7 0XY

3.1 miles Good www.bupa.co.uk 020 8003 4881

11 Cherry Orchard 1 Richard Ryan Place, Dagenham, RM9 6LG

3.3 miles Good www.careuk.com 0333 434 3014

12 Mornington Hall Care Home

76 Whitta Road, E12 5DA

3.3 miles Requires Improvement

www.bupa.co.uk 020 3797 2754

13 Beech Court Care Centre

298-304 South Street, Romford, RM1 2AJ

3.3 miles Good www.orchardcarehomes.com 01708 720123

14 Ashbrook Nursing Home

217 Chase Cross Road, Collier Row, Romford, RM5 3XS

3.4 miles Good www.ashbrooknursinghome.co.uk 01708 736588

15 Park View 1-2 Morland Road, Dagenham, RM10 9HW

3.4 miles Good www.barchester.com/parkview 020 3613 4848

16 Cambridge Nursing Home

61 Cambridge Park, Wanstead, E11 2PR

3.5 miles Good 020 8989 1175

18 Folkestone Nursing Home

25 Folkestone Road, East Ham, E6 6BX

4 miles Requires Improvement

020 8548 4310

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http://www.bupa.co.uk/


http://www.orchardcarehomes.com/



http://www.barchester.com/parkview

tel:02036134848





Other dementia nursing homes in the area This map shows the location of suitable alternative nursing homes and their distance from Meadow Court which is marked by the red pin. You can view this interactive map online.

Name of care home 1 Abbey Care Complex 2 Ashbrook Nursing home 3 Bakers Court Care Home 4 Beech Court Care Home 5 Bennetts Castle Care Centre 6 Cambridge Nursing Home 7 Chaseview Care Home 8 Cherry Orchard 9 Chestnut Court Care Home 10 Folkestone Nursing Home 11 Heatherbrook 12 Meadow Court Nursing Home 13 Mornington Hall Care Home 14 Park View 15 Seabrooke Manor Care Home 16 Sherrell House 17 St Joseph's Rest Home 18 Woodlands Nursing Home

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How to have your say We want to know what you think of our proposal. Please complete our questionnaire by 5pm on 27 October 2017 to give us your feedback. An Easy-Read version of this document and questionnaire are available. Please pick up a copy from Meadow Court reception, download it online at www.redbridgeccg.nhs.uk/meadow-court, or contact 020 3688 1615 to request a copy.

Questionnaire We want to know what you think about our proposal. Tell us about yourself…

1. Why are you completing this questionnaire? (please tick)

I am a local resident

I live at Meadow Court

My relative/friend lives at Meadow Court

If so, which borough did your relative/friend previously live in: ____________________

I care for someone with dementia

I represent a local organisation (please state which) __________________________________

Other (please state) __________________________________

Prefer not to say

2. What borough do you live in? (please tick)

Redbridge Barking and Dagenham Havering Other (please state)

If you are not able to access the internet please fill in the questionnaire below and send it to us at FREEPOST BHR CCGS (please write this in capital letters on the front of the envelope - no stamp is needed). Contact us on [email protected] or call 020 3688 1615.

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http://www.redbridgeccg.nhs.uk/meadow-court



3. What is the first half of your postcode?

Tell us what you think of our proposal after reading this document…

4. Do you understand the explanation in our engagement document of why the local NHS needs to change how it buys beds at Meadow Court? (please tick)

Completely understand

Somewhat understand

Don’t understand

5. What do you think of the following statement: “The local NHS needs to get the best value for money from its services?” (please tick)

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

No opinion

6. What do you think of the following statement: “The local NHS should not pay for beds that are not used”? (please tick)

Strongly agree

Agree


Disagree

Strongly disagree

No opinion

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7. What do you think of the following statement: “The local NHS should end its contract for paying for beds at Meadow Court”? (please tick)

Strongly agree

Agree


Disagree

Strongly disagree

No opinion

8. What do you think of the following statement: “The local NHS should move patients

from Meadow Court into suitable alternative homes”? (please tick) Strongly agree

Agree


Disagree

Strongly disagree

No opinion

9. Please tell us anything else about our proposal that you think is important for us to know.

Questionnaire continues on the next page…

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10. Are there any actions you think the local NHS should take to minimise disruption to people should they need to move to a different home?

11. Are there any specific elements of the service at Meadow Court that you think the

local NHS should look at replicating elsewhere?

12. If you would like to be kept up to date with information about the local NHS, including the results of this engagement, please provide your email or postal address in the box below:

Thank you for completing this questionnaire. We will publish the result of this engagement on our website at www.redbridgeccg.nhs.uk/meadow-court Monitoring questions We would find it useful if you could tell us a bit about yourself so we can see what sorts of people are responding to this consultation and whether they think differently from other groups. This helps us to understand if the change we want to make might have more of an impact on some groups of people than others.

13. Are you? Male Female Prefer not to say

14. Do you consider yourself to have a disability? (please tick) A disability is defined as having a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities. Yes No Prefer not to say Questionnaire continues on the next page…

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15. Do you have a family member or friend with dementia?

Yes No Prefer not to say

16. How old are you? (please tick) Under 16 16-25 26-35 36-45 46-55 56-65

66-75 76-85 85 or over Prefer not to say

17. What is your ethnic background? (please tick) Any white background Any Black background

Any mixed ethnic background Any Asian background

Prefer not to say

Any other ethnic group (please tell us which) ________________________________________

Please send your completed questionnaire to: FREEPOST BHR CCGS (please write this in capital letters on the front of the envelope - no stamp is needed).

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Consultation report: Proposed changes to Meadow Court nursing home

Page 1

Proposed changes to

Meadow Court nursing home

Analysis of consultation responses

Prepared for Redbridge Clinical Commissioning Group

November 2017

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Page 2

Contents

1. Executive summary ................................................................................................. 3

2. Background ............................................................................................................. 3

3. Proposal .................................................................................................................. 4

4. Governance and responsibilities ............................................................................. 4

4.1 Clinical leadership ....................................................................................... 4

4.2 Policy overview ............................................................................................. 4

5. Consultation preparation ......................................................................................... 5

5.2 Consultation document .............................................................................. 5

5.3 The questionnaire ......................................................................................... 6

5.4 Other consultation materials .................................................................... 6

5.5 Consultation approach ............................................................................... 6

6. Consultation activity ................................................................................................ 7

6.2 Ongoing consultation methods and activity ....................................... 8

6.3 Attending meetings ...................................................................................... 9

6.4 Engagement with Redbridge health scrutiny committee ................ 9

6.5 MP engagement ............................................................................................. 9

7. Other interest ......................................................................................................... 9

7.1 Correspondence and calls ......................................................................... 9

7.2 Department of Health information request ........................................ 10

7.3 Webpage views and downloads ............................................................. 10

7.4 Media coverage ........................................................................................... 10

8. Responses ........................................................................................................... 11

8.1 Summary of responses ............................................................................. 11

8.2 Who responded to the proposal ............................................................ 12

8.3 Common issues raised ............................................................................. 14

8.4 Analysis of responses .............................................................................. 14

8.5 Other identified themes ............................................................................ 21

9. Next steps ............................................................................................................ 25

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1. Executive summary

From 4 August to 27 October 2017 Redbridge Clinical Commissioning Group carried out a consultation to seek local people’s views on its proposal to end its contract for 48 continuing healthcare (CHC) beds at Meadow Court nursing home in Goodmayes.

The CCG has changed how it commissions CHC beds to increase choice for patients and so is moving away from block contracts like Meadow Court. In addition, as with all NHS and local authority organisations, Barking and Dagenham, Havering and Redbridge CCGs need to deliver significant savings and ensure its contracts provide value for money.

The number of people using the 48 commissioned beds at Meadow Court has reduced over time and means the CCG is currently paying £2.44m per year for empty beds at the home. After all other possible options were explored with Care UK, the provider, the CCG proposed to end its contract with Care UK, and engaged with the public on this proposal.

During the 12 week consultation the relatives of those that live at the home, home staff, stakeholders and the public were communicated with to raise awareness of the proposal and encourage people to have their say on it.

As the proposal directly affected a relatively small group of people – those that live at the home and their relatives or carers – the CCG met with them face to face during the 12 weeks, as well as offering one to one meetings.

Responses to the proposal were received from 23 individuals or organisations, almost half of which (48%) had a relative or friend living at Meadow Court.

2. Background Meadow Court is a purpose-built nursing home run by Care UK, which is located on the site of King George Hospital in Goodmayes. Redbridge CCG has been in negotiations with Care UK regarding the renewal of its contract for beds at Meadow Court, which commits the CCG to paying for all its 48 block-commissioned beds regardless of whether they are occupied. Barking and Dagenham, Havering and Redbridge CCGs’ (BHR CCGs) commissioning approach for continuing healthcare (CHC) is to move away from block contract arrangements, such as the one at Meadow Court, and to increase choice and personalisation for patients in NHS-funded services. This is done through the roll out of personal health budgets and purchasing individual beds as and when they are needed in nursing homes which are on the London-wide any qualified provider framework.

Redbridge CCG also needs to demonstrate value for money in the services it commissions. This is in the context of the CCG running a financial deficit in 2016/17. To achieve financial balance, BHR CCGs would need to deliver £55 million savings – just over five percent of the total annual joint budget of just over £1 billion for the three boroughs.

As part of this savings plan, BHR CCGs have looked carefully at their contracts and the services they commissioned to ensure they are providing value for money, and meet the needs of local people.

The shared objective of Redbridge CCG’s negotiations with Care UK on Meadow Court was to secure a contract that represents good value for money for the taxpayer and provides sufficient income for Care UK to provide a high quality, sustainable service. The number of people currently using the beds at Meadow Court means the CCG is paying £2.44m per year for empty beds. Care UK has stated that it is not able to reduce the block contract further and cannot accept the CCG spot purchasing beds according to actual current need. Care UK has stated that this would be economically unviable for them and so it would have to close the home.

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After all other possible options were explored the CCG proposed to end the contract with Care UK, and move CCG funded patients to alternative homes in the area. The CCG consulted with the public on this proposal. This report is an evaluation of the consultation undertaken and the consultation responses.

2.1 Objectives of the consultation

The aims of the consultation were to:

inform and engage residents of the home, their families and other interested stakeholders about the proposal for the CCG to end their contract at Meadow Court

receive feedback from people on the CCG’s proposal.

3. Proposal Meadow Court is a purpose-built nursing home run by Care UK, which is located on the site of King George Hospital in Goodmayes. There are 70 beds in the home for people aged over 65 with physical disabilities and dementia. Redbridge CCG has a contract with Care UK to pay for 48 beds in the home to care for local people who require full time nursing care (continuing healthcare). In recent years fewer people are being cared for at Meadow Court. At the time the proposal to end the contract at the home was launched only 14 people, whose care is paid for by Redbridge CCG, were living at the home. This means only 14 of the 48 available beds were being used, and this number has been reducing over time. Because of the contract the CCG holds with Care UK it is paying for the empty beds. The cost to the NHS of these empty beds is currently £2.44m a year.

For these reasons the CCG proposed to end its contract with Meadow Court and settle patients into alternative homes in the area which provide the same nursing and dementia care, and have beds available. The CCG invited the public to provide feedback on this proposal.

4. Governance and responsibilities

4.1 Clinical leadership

The mental health clinical lead for BHR CCGs, Dr Raj Kumar, is the clinical responsible officer for this project, supported by Sharon Morrow as senior responsible officer (SRO) for unplanned care for BHR CCGs.

The information in this report will be carefully reviewed by the clinical and CCG leads, and other Redbridge CCG clinical directors, and used alongside other evidence to inform a recommendation to the Redbridge CCG governing body on the proposal. The governing body will consider the CCG’s decision making business case, including this report, and make a decision about the proposal to end the block contract for beds at Meadow Court.

4.2 Policy overview

The CCG has a legal duty to involve the public in commissioning plans. There are two main relevant legal requirements relating to consultation and engagement:

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For the NHS to promote public involvement and consultation

(Section 14Z2, Health and Social Care Act 2012, as amended)

This duty applies where there are changes proposed in the way in which services are delivered, or in the range of services available. The duty applies to health services commissioned by clinical commissioning groups, which are responsible for involving or consulting the people who are or may be using the service.

For the local authority to review and scrutinise the NHS

(Part 4, Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013)

Under the Local Authority Regulations 2013, local authorities may review and scrutinise any matter relating to the planning, provision and operation of the health service in their area.

Cabinet Office and NHS England statutory guidance, as well as other best practice guidance was followed for the consultation process, document and questionnaire.

5. Consultation preparation

5.1 Pre-engagement

The CCG’s chief officer meets regularly with local MPs and in those meetings had alerted MPs about its financial situation and that it was reviewing its contracts due to the financial challenge BHR CCGs face.

The CCG’s senior responsible officer for Meadow Court and director of corporate affairs discussed the identified option for its contract with Care UK for beds at the home with a range of local stakeholders – including councillors, health and social care partners, and Redbridge Healthwatch. These conversations took place in the context of the wider discussions on BHR CCG’s financial challenge.

Following these discussions the CCG chose to run the consultation on the proposal for 12 weeks in line with the Redbridge Compact and advised by Redbridge Health Scrutiny Committee. Whilst those directly affected by the proposal are a relatively small group, the 12 week consultation provided time for those affected, and the public, to understand and reflect on the proposal, and provide their feedback.

5.2 Consultation document

A consultation document was created to clearly set out the CCG’s proposal.

The document explained that the CCG was proposing to end its contract for beds at Meadow Court, and gave the reasons why. The consultation document included information on the CCG’s approach to commissioning care for people with continuing healthcare needs, the cost

of the empty beds, alternative options considered, as well as frequently asked questions (FAQs). A list and map of nearby nursing homes was also included to ensure readers were aware of alternative services so they had all the information they needed to inform their response to the consultation.

The aim of the document was to provide the information needed to support a response to the proposal. It was written in plain English and designed to be as easy as possible for the general public to understand. The CCG also took learnings and feedback from previous consultations into account, and as advised by Healthwatch Redbridge produced an easy-read version of the document.

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A Healthwatch representative, the CCG chair, clinical directors and the local authority health scrutiny committee coordinator were asked to review and comment on the consultation document at draft stage. Advice on engaging people with dementia and their families was sought from a Consultant Psychiatrist from NELFT NHS Foundation Trust, who also recommended that an easy-read proposal document was produced, and contact details for independent advice or support was included in the document. The CCG followed this advice.

The document also included contact details - a dedicated consultation email address, [email protected], and phone number 020 3688 1615. These were publicised so that people could direct any questions and queries to the CCG.

The public and stakeholders were encouraged to view the consultation document online and complete the online questionnaire. Printed copies of the full document, and easy-read version were made available throughout the 12 weeks to staff and visitors in the nursing home. They were also distributed to attendees at engagement meetings.

5.3 The questionnaire

The consultation document included a questionnaire, where respondents were asked to indicate how they felt about a set of statements. The questions were developed in line with Cabinet Office, NHS England and The Consultation Institute best practice guidance and were tested with volunteers before the questionnaire was finalised.

At the end of the questionnaire open questions were included for respondents to provide any further comments. The CCG also asked the public for any suggestions for how the NHS could minimise disruption to residents should they need to move from the home, or any elements of the Meadow Court nursing home service which they felt could be replicated elsewhere. An easy read version of the questionnaire was also produced and included in the easy read consultation document, this was also made available to download on the CCG’s website.

The public and stakeholders were encouraged to complete the questionnaire online via links on the CCG’s website. The link to the questionnaire was provided in all digital communications and promoted throughout the Meadow Court webpage on the CCG’s website and its Twitter

account.

Printed copies of the questionnaire were handed out at engagement events, and made available in the reception of Meadow Court. A freepost address was publicised so people could post their responses without incurring cost.

5.4 Other consultation materials

Presentation slides were developed for the CCG to present the proposal to Redbridge health scrutiny committee.

A Meadow Court webpage was established on the CCG website and the consultation document, easy read proposal, questionnaire, equality impact assessment and FAQs were also available to download. The additional FAQs were also handed out to relatives of residents at the home, made available in Meadow Court reception, and uploaded to the CCG’s website (www.redbridgeccg.nhs.uk/meadow-court) during the consultation.

5.5 Consultation approach

As those directly affected by the proposal could be identified and were a relatively small group of people – those that live at the home and their relatives and carers – in line with NHS England guidance the CCG’s approach was to focus on engaging with this group.

It was recognised that the majority of the residents themselves may not have the capacity to respond directly to the CCG’s consultation if they had dementia. The CCG therefore focused its

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engagement on the residents’ next of kin, families, and carers to ensure that all residents had the opportunity for someone to respond on their behalf. Through direct engagement with the families the CCG wanted to ensure that they understood its proposal and had opportunities to discuss them with the CCG, ask questions, and knew how to provide feedback on the proposal.

Another key element of the CCG’s activity was to engage local stakeholders, such as local MPs, clincians, health providers and interest groups, on the consultation and invite them to respond with their views on the proposal.

The CCG focused on promoting the proposal and consultation through letters to those directly affected and their next of kin, letters/emails to CCG partners, local stakeholders and interest groups, other commissioners of care at Meadow Court, and information on the CCG’s website and via social media.

All communications and consultation materials were shared with Care UK prior to launch, and their regional manager, operational projects director, and home manager attended engagement events at the home, and their regional director and HR manager led engagement with their staff. They supported the CCG in distributing materials to the next of kin of residents at the home, because as the care home provider they held the most up to date contact details.

6. Consultation activity

6.1 Consultation launch

The 12 week consultation ran from Friday 4 August 2017, closing at 5pm on Friday 27 October 2017.

Residents at the home

Residents who live at Meadow Court were given a letter in person and a printed copy of the easy-read consultation document on 4 August 2017.

Residents’ next of kin

The CCG invited relatives of all the residents at Meadow Court to a meeting at the home on 4 August 2017 to brief them on the proposal and consultation. The meeting was attended by the CCG clinical lead Dr Raj Kumar and the CCG senior responsible officer Sharon Morrow, as well as senior managers from Care UK and the home manager.

As the CCG doesn’t hold the contact details of these family members or carers, officers worked with Care UK to distribute letters using their database. In most cases this was one relative or family member for each resident at the home.

At the meeting the CCG representatives set out the proposal and explained how people could have their say. This was followed by a question and answer session. The consultation document and questionnaire were distributed to attendees of the meeting. The meeting was attended by approximately 20 relatives of residents at the home.

Following the meeting a letter was sent to the residents’ next of kin, using the contact details provided by Care UK. The letter set out the proposal, provided information on how to provide feedback by 27 October, and invited residents’ representatives to a second meeting at the home to provide a further opportunity to discuss the proposal.

Copies of the consultation document and posters to promote how to have a say on the proposal were displayed in Meadow Court reception from 4 August to ensure those visiting people at the home had an opportunity to see the proposal and knew how to feedback.

Staff

Meetings were held with staff who work at Meadow Court on 4 August to brief them on the proposal and how to have their say. As their employer these meetings were led by Care UK.

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Staff were also given a letter setting out the proposal and how to provide feedback. Copies of the consultation document were made available to staff, and available in the reception at Meadow Court.

Information about the proposal and consultation questionnaire was communicated to CCG staff through their staff intranet and newsletter.

Stakeholders

On the day the consultation launched, emails were sent to stakeholders with a link to the Meadow Court proposal page on the CCG’s website and information on how to respond.

The Redbridge stakeholders contacted were: GPs MPs and London Assembly Member Council health scrutiny committee chair, vice-chair and officer Directors of public health and adult services Cabinet member for health and adult services Ward councillors Health and wellbeing board chair and officer Redbridge Healthwatch Core providers - NELFT, Barking, Havering and Redbridge University Hospitals NHS Trust

(BHRUT), Barts Health and Partnerships of East London Co-Operative East London Health and Care Partnership Programme Director Professional organisations (Age UK, Dementia UK) Redbridge CCG’s patient engagement forum Patient groups, interest groups and community and voluntary organisations.

Other commissioners of beds at Meadow Court were also sent the consultation information and questionnaire. They were also informed that the residents whose care they fund had been contacted by the CCG to inform them of the proposal and invite them to have their say on it. These commissioners were: Redbridge Council, City and Hackney CCG, East London NHS Foundation Trust, Newham CCG, Newham Council and Hackney Council.

As the CCG director of corporate affairs had met with the chair of Redbridge health scrutiny committee and Redbridge Healthwatch to discuss the situation and consultation, they were informed of the launch date a few days before it occurred.

Public

The CCG website had a webpage on the consultation, including a link to the consultation document, easy-read document, online questionnaire, a questions and answers document. Tweets were also sent from the CCG’s Twitter account with a link to the proposal and consultation questionnaire on the website.

Copies of the consultation document, and posters to promote how to have a say on the proposal were displayed in Meadow Court reception from 4 August 2017.

6.2 Ongoing consultation methods and activity

Throughout the consultation the CCG continued to promote the proposal and raise awareness of how to provide views on it. This was done through Redbridge CCG Twitter account, website, and correspondence with stakeholders, interest groups and relatives of those at the home. It was also promoted at the joint BHR CCG patient engagement forum meeting.

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6.3 Attending meetings

A second meeting was held at the home for relatives of residents at Meadow Court on 22 September 2017 to discuss the proposals further and answer questions raised by relatives since the proposal launched. This meeting was attended by approximately 12 relatives or carers of those who live at the home.

To support families whose care is funded by the CCG to understand how the proposal may affect their relative they were offered an optional one-to-one meeting with the CCG to discuss their individual situation. Some relatives chose to meet with the CCG where a continuing healthcare adviser who had an understanding of each resident’s health needs could advise on

what alternative homes in the area could be suitable for their relative, and how the CCG would support them to move should a decision be taken to end the contract at Meadow Court. The CCG provided this information and support so families had all of the information they may have wanted to inform their consultation response, and understand what it could have meant for their family member.

During the consultation meetings were held with staff who work at the home to answer their questions and discuss the proposal, these meetings were led by Care UK’s regional director

and HR manager.

6.4 Engagement with Redbridge health scrutiny committee

Sharon Morrow presented the proposal in detail to the committee on 27 September 2017. Councillors discussed the proposals, asked questions to which were responded to. Where information was not immediately available to answer a question the information was supplied to the committee before the end of the consultation period.

The Redbridge health scrutiny committee coordinator corresponded with the CCG on the proposal on the chair’s behalf, asking questions and requesting additional information. This information was supplied during the consultation and discussed when the proposal was presented to the committee.

6.5 MP engagement

Redbridge MPs were sent an email on the day of launch informing them of the consultation. The email included a link to the Meadow Court webpage on the CCG’s website and information

on how to respond, and offering to discuss the proposal with them if they wanted to.

MPs and all other stakeholders were sent a reminder about the consultation and opportunity to give their feedback towards the end of the consultation period.

Three MPs wrote to the CCG for more information about the proposal after they were contacted by a constituent who was directly affected by the proposal. The CCG responded to these enquiries during the consultation.

7. Other interest

7.1 Correspondence and calls

Throughout the consultation, individual letters were prepared in response to the enquiries and correspondence received about the proposal. These enquiries were from relatives of some of the residents of the home, staff, interest groups, councillors and MPs. No printed copies of the consultation document, or easy read version were requested, however the CCG’s responses reminded people of the webpage where all the consultation information and questionnaire was available.

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In total the CCG received 33 letters or emails in correspondence about the proposal during the consultation. This includes multiple correspondence from some individuals or organisations.

The Redbridge Health Scrutiny Committee requested that the CCG present the proposal at their meeting which the CCG attended on 27 September 2017. No interest groups or stakeholder requested a presentation or briefing on the proposal.

7.2 Department of Health information request

During the consultation NHS England’s briefing team contacted the CCG (on behalf of the Department of Health) for information about the CCG’s proposal on Meadow Court and

consultation to enable them to respond to correspondence from a member of the public. This information was provided.

7.3 Webpage views and downloads

A webpage was created with the consultation materials – the consultation document, the easy read version and questionnaire, and Q&A documents. Each of the documents were available to download as a PDF.

Page impressions during the consultation are as follows:

Total webpage views: 424 Proposal document downloads: 229.

Of the webpage views there were 302 unique page views which indicate some people viewed the page more than once. Page views are not a true picture of how many people have read a page, as one individual could theoretically access the page from many different devices. It is, however, a good indicator of general levels of interest in a topic.

There is a disparity between the high numbers of webpage views and consultation responses, and the comparably lower number of times the consultation document itself was downloaded. This suggests that many people left the webpage before reading the proposal document, supporting information, or completing the questionnaire.

7.4 Media coverage Media coverage on the proposal was reported during the consultation period by two media outlets, Ilford Recorder and Care Home Professional online. Overall there were eight pieces of coverage which mentioned the CCG’s proposal on its contract at Meadow Court. Four articles by the Ilford Recorder were produced both in print and online, as they were the same articles these have been counted as one piece of coverage. The majority of the media coverage appeared in the Ilford Recorder, a local weekly print and online publication that is available in Redbridge. Five of the six pieces of coverage referred to and quoted individuals who would be affected by the proposal as they have a relative at Meadow Court, this included two readers letters in their print publication. The coverage echoed a common theme expressed by those directly affected by the proposal during the engagement meetings and correspondence with the CCG, that Meadow Court was better than other homes in the area, and they didn’t support the CCG’s proposal. Three pieces of coverage by the Ilford Recorder included statements or quotes from the CCG, with one including a statement from Care UK. Some of the coverage implied that the decision had already been made by the CCG and that the home was ‘threatened with closure’. Another piece of coverage in the Ilford Recorder was about the home winning an award for their gardens and included a quote from a resident’s family member about the garden potentially

being ‘bulldozed’, but didn’t mention the CCG or proposal directly.

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An online industry publication, Care Home Professional, published two articles in September. The first included a statement from the CCG, stating that the CCG needs to review its services to ensure that it meets the needs of local people and deliver the best possible care but also provide the best possible value for money. A statement from Care UK was also included. The second piece of coverage reported on an allegation that resident’s families were told that

clinicians were unable to refer patients to Meadow Court. The coverage included a statement from Care UK, but not from the CCG. Table 1: Circulation list for publications which featured the CCG’s proposal

Title Circulation1 No of web articles

No of newspaper articles

Total

Ilford Recorder 8,251 4 6 10

Care Home Professional N/A 2 n/a 2

Total 8,251 6 6 12

Based on these figures and using newspaper articles alone, articles on the proposal were viewed 49,506 times2 over the 12 week period.

National newspaper, Daily Mail, included a letter in their paper from a relative of a resident at the home as part of a debate about private providers running care homes rather than local authorities or the NHS. The letter explained that the CCG had a contract with Care UK which means it has to pay the provider regardless of whether the beds are used. The article didn’t mention the CCG’s proposal to end its contract.

8. Responses

8.1 Summary of responses

Number of responses

The CCG received responses from 23 individuals or organisations 14 respondents completed the CCG questionnaire (all received through the online

questionnaire) Nine respondents provided feedback by letter or email.

Five respondents provided more than one set of feedback (via letter, email, questionnaire) during the 12 week consultation. As a result 39 responses to, or pieces of feedback on the proposal were received in total, from 23 individuals or organisations. All 39 responses have been read and analysed.

To provide an accurate analysis of the feedback received it was analysed by individual respondent, and presented as such in this report.

1 All newspaper circulation figures obtained via Newspaper Society and Audit Bureau of Circulation. 2 This is calculated for each newspaper, by multiplying the circulation figure by the number of articles in that paper, then adding them all to reach a final total.

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Key findings

61% of respondents have a relative or friend living with dementia 48% of respondents have a relative or friend living at Meadow Court.

Not all of the 23 respondents provided feedback on all of the CCG’s statements or questions.

Of the respondents who responded to the CCG’s four statements on its proposal:

1. 100% understood the CCG’s explanation for why it needs to change how it buys beds at Meadow Court

2. 61% agreed or strongly agreed that the local NHS needs to get the best value for money from its services

3. 47% agreed or strongly agreed that the local NHS shouldn’t be paying for beds that are

not used 4. 72% disagreed or strongly disagreed that the CCG should end its contract at Meadow

Court.

Although the majority of respondents agreed that the CCG need to get value for money from its services, this didn’t mean they supported the CCG’s proposal to end their contract at Meadow

Court. Fifty-five percent of those who agreed that the CCG needed to get value for money from its services disagreed that the CCG should end its contract at Meadow Court

No respondent who had a relative or friend at Meadow Court agreed that the CCG should end its contract at Meadow Court, or move people from Meadow Court to an alternative home.

The vast majority of respondents also provided further feedback on the proposal. Many of the responses raised more than one reason for not supporting the CCG’s proposal. From this five themes were identified which are discussed in detail in sections 8.3 and 8.5.

8.2 Who responded to the proposal

Almost all respondents provided additional information about themselves or their organisation. Not all respondents provided information on all elements discussed below.

Of the 22 respondents who identified in what capacity they were responding to the proposal, 50% stated that they had a relative or friend living at Meadow Court, and 61% stated that they had a relative or family member with dementia.

Six respondents were representing local organisations including Healthwatch Redbridge, Redbridge Health Scrutiny Committee, One Place East, and Barking, Havering and Redbridge University Hospitals NHS Trust.

One respondent stated that they worked for the local NHS, another worked at Meadow Court and three respondents were local residents. No responses were received from anyone living in Meadow Court, it is likely that this is because most residents at the home may not have capacity to respond to the proposal due to having dementia.

Where respondents completed the questionnaire we were able to gather additional demographic information.

In terms of location, most of the respondents stated that they live in Redbridge, the borough which Meadow Court is located in. Respondents who answered ‘other’, were mostly relatives of residents at the home who lived across the country. This information is shown in table 1 on the following page.

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Table 2: Respondent demographic insight

Capacity in which individuals were responding Respondents

My relative/friend lives at Meadow Court 11 I live at Meadow Court 0 I care for someone with dementia 0 I represent a local organisation 6 I am a local resident 3 Prefer not to say 2 Representation from local organisations Healthwatch Redbridge 1 Barking, Havering and Redbridge NHS Trust Hospitals 1 Newham Community Mental Health Care for Older People 1 Redbridge Health Scrutiny Committee One Place East

1 1

Borough Redbridge 7 Barking and Dagenham 0 Havering 0 Other 9

The demographic information below relates to the individuals who completed the additional optional questions on the questionnaire. Not all respondents provided this information.

The majority indicated their sex with eight respondents identified as female and seven as male. Most indicated their age with the majority aged 16-25 and 46-55. No one under the age of 16 or over the age of 85 responded. In regards to ethnicity, 56% of respondents identified themselves as ‘any white background’. Three respondents identified as ‘any mixed ethnic background’, two respondents answered ‘any Asian background’ and two preferred not to say.

Table 3: Further respondent demographic insight

Disability Respondents Yes 0 No 15 Prefer not to say 1 Sex Female 8 Male 7 Prefer not to say 1 Age Under 16 0 16-25 3 26-35 2 36-45 2 46-55 3 56-65 2 66-75 2 76-85 1 85 or over 0 Prefer not to say 1 Ethnic background Any white background 9 Any mixed ethnic background 3 Any Asian background 2 Any Black background 0 Prefer not to say 2

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8.3 Common issues raised

In the feedback received from respondents there were some issues raised (across questionnaire responses and letters/emails), which were not directly related to the proposals. Of the responses where such an issue could be identified, the top two common issues raised were:

Belief that the CCG was closing the home: despite consistent messaging that the proposal was on ending the contract at the home, during the consultation and as reflected by a number of respondents (seven) some people believed that the home was closing. Other respondents also used this terminology in their responses.

Consultation process: some people said they were concerned a decision had already been made, or their feedback wouldn’t make a difference. This issue was raised by six (26%) respondents.

8.4 Analysis of responses

A consultation is a valuable way to gather opinions about a topic. However when interpreting the responses, it is important to note that whilst the proposal was open to everyone to respond to:

the respondents were self-selecting, and certain types of people may have been more likely to contribute than others

the responses therefore cannot be assumed to be representative of the population as a whole.

Typically with such proposals, there can be a tendency for responses to come from those more likely to consider themselves affected and particularly from anyone who believes they will be negatively impacted upon by the implementation of proposals.

Not all of the 23 respondents provided feedback on all of the CCG’s statements or questions. This is reflected in the analysis. In addition many respondents (nine) chose to provide their feedback by letter or email rather than or as well as the pre-prepared questionnaire. These responses were carefully evaluated and the majority provided a clear response to some, or most of the CCG’s statements and have been included in the relevant analysis sections below.

Whilst steps were taken to engage healthcare professionals, and the Care UK staff who work at the home, the CCG received a very limited response from these groups.

Eleven of the 23 respondents stated that they had a family member or friend who lived at Meadow Court. From this we can deduce that they would be directly affected by the proposal, and for the purpose of the analysis we have identified them as a group.

1. Understanding of the explanation for why the CCG need to change how it buys

beds at Meadow Court

Sixteen respondents (70%) answered this question, no respondent said they didn’t understand

the reason why the CCG needed to change how it buys beds at the home. One hundred percent stated that they understood to some level the explanation in the proposal document of why the local NHS needs to change how it buys beds at Meadow Court. Amongst those who responded, 56% felt they ‘completely understood’, and 44% felt they ‘somewhat understood’ the reasons.

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Graph 1: Understanding the CCG’s proposal

“In today’s NHS it is reasonable and expected that all existing contracts are reviewed and the commissioners get best value for money.”

Local organisation respondent

Whilst those that answered this question may not have agreed with the CCG’s proposal, they stated that they did understand the explanation for why it needs to end its block contract at the home. Some respondents indicated that they believe the contract should originally have been agreed to this effect.

“I understand that money needs to be saved but this is such a great facility and should not be closed.”

Email respondent

“The numbers [of people needing beds] would fluctuate from time to time and the contract should have reflected this by being drawn up on a bed-by-bed basis.”

Letter respondent

2. NHS needs to get best value for money from its services Eighteen respondents shared their view on whether the local NHS needs to get the best value for money for its services. No respondent disagreed with the statement. The majority 61% (11) of respondents agreed or strongly agreed that the CCG needs to get value for money.

“I agree to some extent that any organisation working to a budget should offer value for money.”

Letter respondent

“No one could possibly disagree with you about getting value for money.” Letter respondent

56%

44%

Do you understand the explanation in our proposal document of why the local NHS needs to change

how it buys beds at Meadow Court?

Completely understand Somewhat understand

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Graph 2: Should the CCG get best value for money from its services

The five remaining respondents (39%) said they neither agreed nor disagreed with the CCG’s

statement that the local NHS needs to get the best value for money from its services.

3. NHS should not pay for beds that are not used

Seventeen respondents provided feedback on whether the CCG should be paying for beds that are not used. Almost half of respondents (47%) stated that they agreed or strongly agreed that the CCG should not pay for beds which are not used. Of these eight respondents one said they would be affected by the proposal.

“I realise that you have a duty to manage your budget in the best possible way, and that spending money on empty beds is ridiculous.”

Email respondent

Graph 3: Should the CCG pay for beds that are not used

33%

28%

39%

The local NHS needs to get the best value for money from its services

Strongly agree Agree Neither agree nor disagree

0

1

2

3

4

5

6

Strongly agree Agree Neither agree nordisagree

Disagree Strongly disagree No opinion

The local NHS should not pay for beds that are not used

All respondents Those affected

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Of those who said that they disagreed or strongly disagreed (three), two of these respondents would be directly affected by the proposal. All five respondents (30%) who said they neither agree nor disagree that the NHS should pay for beds that are not used identified themselves as having a relative or friend at Meadow Court.

"Just because beds are not used at the moment it doesn't mean they won't be in the future."

Questionnaire respondent

“It’s a scandal that the CCG is not using the beds they are paying for when there is such a high demand.”

Email respondent

“The local NHS should be saving money through using this facility that they already have to its full capacity.”

Email respondent

4. NHS should end its contract at Meadow Court

The CCG received comments from almost all respondents (22) on whether the local NHS should end its contract for beds at Meadow Court. The only respondent who didn’t provide

feedback on this topic indicated that they believed a decision had already been made to close the home. Of those who responded the majority (72% or 16 respondents), disagreed or strongly disagreed that the local NHS should end its contract for paying for beds at Meadow Court. All but five of these respondents would be directly affected by the proposal. Although some respondents disagreed that the CCG should end its contract, they did recognise in their feedback that the current contract was no longer suitable.

“The old contract with Care UK needs to be torn up as it is totally unrealistic.”

Letter respondent

Graph 4: Should the CCG end its contract at Meadow Court

0

2

4

6

8

10

12

Strongly agree Agree Neither agree nordisagree

Disagree Strongly disagree

The local NHS should end its contract for paying for beds at Meadow Court

All respondents Those affected

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Four respondents (18%) stated that they strongly agreed or agreed that the local NHS should end their contact at Meadow Court. Three of these respondents were local organisations and none had a relative or friend at Meadow Court.

"The proposal is clear in its objectives to [achieve] financial prudence." Local organisation respondent

Two respondents answered neither agree nor disagree, both of these respondents would be affected by the proposal.

5. Residents from Meadow Court should move into suitable alternative homes

Twenty two respondents gave their views on whether the CCG should move people whose care they fund from Meadow Court into suitable alternative homes.

The vast majority of respondents, 82% (18 respondents), said they disagreed or strongly disagreed that residents of Meadow Court should move to alternative homes. Of these, 61% were respondents who have a relative or friend at the home.

“People should not be moved from Meadow Court… if the patients want to stay there then they should be able to.”


The responses to this question reflect the previous question in that all but one of those who disagreed that the CCG should end its contract, also disagreed that those at the home should move to alternative homes.

Graph 5: Should CCG patients be moved from Meadow Court

Again, three of the four respondents who stated they strongly agree that the local NHS should move patients out of Meadow Court were responding on behalf of a local organisation. All but one of these three respondents also agree that the CCG should end their contract at Meadow Court.

Amongst all 23 respondents eight stated that they didn’t believe alternative homes provided the same standard of care as Meadow Court.

18%

27%55%

The local NHS should move patients from Meadow Court

Strongly agree Disagree Strongly disagree

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Some of these respondents also highlighted that they believed Meadow Court was a superior home to others in the area. They were also concerned that homes with a lower Care Quality Commission (CQC) rating would result in residents of Meadow Court receiving lower quality care, should they be moved to one of these alternative homes.

“There are significant staffing variations between homes and it is important that patients and their relatives are assured that staffing ratios are appropriate to their needs.”

Redbridge Health Scrutiny Committee

Meadow Court has staff with specialist skills and knowledge about dementia, which appears to be lacking in many of the nearby homes.”

One Place East Four of these respondents also commented that the believed alternative homes were unable to provide suitable for care for those living at Meadow Court.

“I fear that [the alternative homes] will be unfit for the purpose of caring for my [relative]” Letter respondent

“I don’t believe that [my relative] would receive anything like the high standard of care [they] receive at the moment if [they] were to move elsewhere.

Letter respondent

“There will always be people whose illness affects them in a way that makes it impossible for the average care home to manage them.”

Email respondent

6. Any other comments

The CCG also asked respondents to feed back anything else they thought it was important for the CCG to know. The CCG also received feedback from respondents by letter and email. From these comments and feedback some themes were identified which are discussed in section 8.5.

7. Any actions that should be taken to minimise disruption to people should they

need to move to an alternative home

Thirteen respondents provided feedback on this question. Of these, six stated that they thought residents should not be moved at all.

“I think the NHS should aim to cause no disruption by allowing the current residents to stay at Meadow Court. Moving home can be stressful at times for most of us, but those living with dementia will suffer so much more, and be much more confused with any kind of new surroundings.”


Three respondents suggested that the CCG bring the service back into the NHS as an alternative to ending the contract currently held with Care UK.

“Can the service not be brought in-house and run in part of the home?” Redbridge Healthwatch

“Give home back to NELFT. Let them manage the continuing care patients.”


“It may be necessary… for the NHS to manage Meadow Court itself as it had originally done – even if only as a temporary arrangement.”

Letter respondent

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Other suggestions to minimise disruption for residents if they are moved included strong communications and support to relatives as well as residents, financial assistance to relatives if impacted by travelling to an alternative home, and redeploying staff from Meadow Court to other homes in the area should Care UK decide it can no longer run Meadow Court.

“Maintain good communication with residents and families with supportive visits to the other residential offers.”

Local organisation

“[Redeploying staff] will ensure that the service users are able to see familiar faces during the moving process which will reduce their confusion. Additionally it allows the local NHS to retain as many qualified nurses as possible within the local area.”


“The NHS should be exploring all options to keep the home open. Relocation should be a final resort only.”


8. Any elements of the service at Meadow Court that the NHS should think about replicating elsewhere

Fifteen (65%) of respondents provided comments on elements of Meadow Court that the NHS should consider replicating elsewhere. The element of the service that two thirds of these respondents referred to was the quality of care and facilities at Meadow Court.

“It has a very well designed interior with every facility incorporated – even its own hairdressing salon. It also has exceptional gardens where the residents, relatives and staff can find a truly peaceful and relaxing environment.”

Letter respondent “The staff work tirelessly to help those in need, and the environment is perfect for the residents. You cannot replicate the gardens or the stories in Meadow Court.”


“The quality of care at Meadow Court is an extremely high standard and should be considered as a role model for other facilities caring for dementia sufferers.


“No other home has such good ratio of staff to residents and offers anything like the same level of care.”

Email respondent

“Meadow Court is the only care home in Redbridge employing psychiatric nurses rather than general nurses.”

Questionnaire respondent Other elements were the close support network formed amongst relatives and carers of residents at the home and the home’s location near a hospital.

“Its location so close to King George Hospital should also be taken into consideration, being handy as it is for a number of clinics, emergencies, and having excellent transport links to the local areas as well as offering extra parking spaces for visitors to Meadow Court.”

Letter respondent

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“Meadow Court nursing home has been able to provide a high level of complex nursing care and is ideally located near to hospital services should these be required.”

Email respondent

“Meadow Court is a family. Relatives support one another… this simple contact helps to keep many relatives going, especially those who live alone.”

Letter respondent

8.5 Other identified themes

The CCG received additional feedback and comments from 21 respondents. Some of this feedback was in response the CCG’s questionnaire questions and is discussed in the section above. The additional feedback was reviewed and a number of themes were identified as respondents were providing the feedback on the same or very similar topic or view. These were:

1. Impact of moving people with dementia 2. Potential loss of a nursing home, or NHS owned building 3. Reasons for the reduction in people moving to the home 4. Proposal and consultation quality 5. Contract negotiations / alternative options.

Graph 6: Any other comments on the proposal

1. Impact of moving people with dementia

Twelve respondents, (52%) stated that they believed that there would be a detrimental impact on residents’ health or care if they were to be moved to an alternative home. Fifty eight percent of these respondents identified themselves as having a relative or friend at Meadow Court, two respondents were local organisations.

“It takes time for someone with dementia to settle into new surroundings…and to move somewhere unknown and with potentially lower standards of care than they are currently receiving could leave a devastating effect.”


25%

25%

14%

19%

17%

Other feedback by theme

Impact of moving people Loss of a nursing home

Contract options Reduction in bed use

Engagement process and proposal detail

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“I believe that changes to [my relative’s] care introduces unnecessary risks, in that by moving [them] from Meadow Court [their] life will be in jeopardy.”

Letter respondent

“I feel it would be detrimental to [my relative] to be moved at this stage in [their] life.” Email respondent

The NHS has a duty to safeguard those who are vulnerable not to take action to achieve the diametrically opposite effect.”

Letter respondent

Some of these respondents were also concerned that homes with a lower CQC rating would result in residents of Meadow Court receiving lower quality care, should they be moved to one of these alternative homes.

“If there is not the skill and expertise in a nursing home this can lead to an increasing dependence on the use of antipsychotic drugs for patients in care homes”.

One Place East

2. Loss of nursing home or building

Twelve respondents (52%) stated in their response that they believed the demand for nursing care was increasing, many referred to the national debate on the need for more nursing care beds due to an aging population. Some of these respondents also stated concerns that should Meadow Court nursing home close as a result of the CCG ending their contract, they were concerned that this would lead to a shortage of nursing home beds in the future.

"Whilst in the short term there is obviously a cost to maintain the current contract, there is an argument it might be more cost effective than building a new facility in a few years time."


“As the UK has an increasing population and we are all living longer there is a need for more care homes not less.”

Questionnaire respondent “With the rapid increase in elderly people needing round-the-clock care, reducing the number of homes is a backward step”.

Questionnaire respondent “The future demand of the likes of Meadow Court and staff will be ever greater when the country will need many more good care homes and staff in future.”

Letter respondent Five respondents, all whom identified as having a relative or friend at Meadow Court, stated that they were concerned Meadow Court would be replaced with housing if the CCG ended their contract.

“I am concerned that a purpose built resource may be lost… I can guess that the NHS will be looking to sell the land which Meadow Court sits on to complete the site for redevelopment.”

Email respondent

“It seems likely that the £10 million site that Meadow Court occupies would provide a tidy income for Redbridge NHS”.

Email respondent

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3. Reduction in people moving to the home

Nine respondents, (39%), said that they were unclear why the demand for the CCG’s

contracted beds at Meadow Court had reduced.

These respondents stated that they believed the CCG had not been placing people at the home when they requested a place.

“There does not appear to have been a progressive reduction in occupancy [of the home] since 2014, for which the only reasonable explanation would be that Meadow Court has not been promoted as much as other care homes.”


“I know that over 300 people have viewed the home and asked for a place since 2014.” Email respondent

This is also a topic which was raised and discussed at engagement events, the health scrutiny committee meeting and with individual relatives or residents at the home through correspondence. Additional information on how the continuing healthcare process works was shared with relatives and made available alongside the proposal online to address this.

4. Proposal and consultation questionnaire

Eight respondents questioned the validity of the proposal. Five of whom identified as having a relative or friend at Meadow Court. Some of these respondents said that more information was needed to evidence the reasons why less people where choosing the home.

The information which respondents said was not presented in the consultation document included; longer-term cost benefits, number of requests to move to the home, and that the proposal only focused on financial gain.

“Redbridge CCG has not set out a cost-consequences and cost-benefit analysis which would ensure all relevant benefits (health, non-health and community benefits) are taken into account… There does not appear to be an evidence base or document supporting the claim that there are 17 nursing homes within four miles of Meadow Court which provide the same dementia care as Meadow Court.”

One Place East

“There is no solid case supporting the decision to close Meadow Court nursing home” Letter respondent

“There is too much emphasis being made on poor decisions taken in previous years.”

Redbridge Healthwatch “The long-term financial impact has not been explained”.


“I believe this proposal is more to do with monetary gain rather than the job of caring for vulnerable people.”

Letter respondent

All but one of these five respondents also stated that they believed that the questionnaire questions were difficult to answer fairly.

“I found this document to be extremely biased in its questions and not really a consultation”.

Email respondent

“Your questions give little area for discussion; with statements that seem to aim for a 'black or white' response.”

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Five of respondents, as well as Redbridge health scrutiny committee members, also stated that they believed the decision on the CCG’s proposed change to their contract at Meadow Court had already be made.

“You appear to be going through the motions as you are not able to close the home without this.”

Email respondent

5. Contract negotiations and existing contract

Seven respondents commented on the need to explore and exhaust all options before the CCG takes a decision on whether to end their contract. This included suggestions of further negotiations with Care UK to find a solution to the contract and criticism that the existing contract was put in place.

“The committee is…disappointed regarding the apparent breakdown in the CCG’s contract negotiations with Care UK.”


“No effort has seemingly been made to make the existing contract between the NHS and Care UK work.”

Questionnaire respondent "We should not be closing the service to save money before confirming that the service isn't viable if run in another way… The CCG must consider other possible solutions, working with families throughout.”

Redbridge Healthwatch

“[The CCG and NHS groups]…have prematurely started on a consultation concerning the closure of Meadow Court before other sensible routes have been explored.”

Letter respondent “It is clear that the main reason why the home is no longer providing the best value for Redbridge is the outdated and unsustainable contract.”

Email respondent

“There have clearly been very poor decisions made at some point in time to allow such a contract to be made.”

Email respondent

“I would think that an amended contract with Care UK to pay for 24 fully funded beds… would be viable.”

Letter respondent

6. Other comments included:

The increased cost and time for relatives to travel to other homes rather than Meadow Court

The loss of a supportive network of carers and relatives that is currently experienced amongst some relatives of residents at Meadow Court

Suggested alternative uses for the building – a mother and baby unit for mothers facing mental health issues, or a neuro rehabilitation unit.

Concerns on the impact of the consultation process on relatives and carers health due to the uncertainty of the future care of their relative

Suggestions for increased use of the beds and attracting more people to the home. This included increasing parking, redecorating, advertising the home

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A suggestion to generate income to reinvest into the home through the sale of Goodmayes Hospital

Suggestion to close an alternative home in the area which has a lower CQC rating:

“Would it not be more sensible to close one of the competing care homes needing

improvement instead of Meadow Court.”

Letter respondent.

8.6 Conclusion

As mentioned earlier in this report a consultation is a valuable way to gather opinions about a topic, however it is expected that more responses would be received from those who would be affected by the proposal. This was the case for this consultation as 48% of respondents had a relative or friend living at Meadow Court. In addition only three responses were received from people who identified themselves as local residents, and not a local organisation or someone who had a friend or relative with dementia.

As would be expected, and has been shown in the analysis of the feedback received, those that would be affected by the proposal disagreed with the CCG’s proposals and all these respondents had a number of reasons for why the CCG should continue their contract. This has been reflected in their comments and suggestions as analysed earlier in this section.

It is also important to note that whilst the CCG corresponded or engaged with some respondents during the consultation to provide factual information on the themes they raised in response to their enquiries, this was not always reflected in the respondent’s consultation

response or responses.

In addition many of the suggestions received from all respondents demonstrate that some believed the CCG was closing the home, and didn’t have an understanding of the CCG’s role

as commissioner and Care UK’s role as provider.

Whilst the CCG aimed to be transparent during the consultation – that Care UK had advised them that should they end their contract, the home would be uneconomically viable for Care UK to run – this also led to some respondents including feedback that was inaccurate, or not directly related to the proposal, or not within the CCG’s remit.

9. Next steps This report will be submitted to Redbridge CCG to form part of the decision making evidence. It will be included in the CCG’s decision making business case for presentation to its governing body.

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Clinical evaluation panel processRedbridge CCG

27 October 2017 1

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IntroductionThe overall aim of this work is to support the CCG to make recommendations to the Governing Body regarding proposed changes to Meadow Court Nursing Home and future commissioning arrangements. In considering the proposed changes to Meadow Court Nursing Home, the CCG hopes to achieve greater financial sustainability, seamless and high quality care, greater patient choice around who provides care (in line with Continuing Health Care and personal health budgets).

Our support is centred on helping you reliably identify how well the proposed changes will deliver these outcomes. A key output is that the Clinical Lead accountable for making ultimate recommendations feels properly informed, prepared and ready to stand before their Governing Body as a result of the following inputs from NEL Healthcare Consulting:

• An initial scoping meeting to clarify needs and expectations and agree TOR

• Creation/adaptation of a structured approach to decision making based on agreed criteria that will robustly stand up to scrutiny

• A 2-3 hour facilitated event to consider the outcomes of public consultation alongside available evidence and expert advice in order to make tangible recommendations to the appropriate governing bodies.

• Production of a summary report bringing together outputs of this event

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From proposal to recommendation – the process

Introduction to methodology and

processOutputs of consultation Assess and recommend

Final report to

CCG Governing Body

Scoring criteriaScoring calibration

WeightingRecommendation

Review approach and plan in light of consultation outputs

Is the process, criteria, calibration and weighting fit for purpose and capable

to stand up to scrutiny?

Do we have the right level of information and input to make an

informed decision?

Road testing process Assessing proposal

Making recommendationCapturing scores

Logging comments

Project set up25 October 2017

Clinical Evaluation Panel –Fri 10th November (time tbc)

Write up recommendations for submission to CCG Governing Body

Report due 30 Nov 2017

Decision making support throughout

Preparation sessionWeds 7th Nov (tbc)

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Scoring

• Objective is to arrive at a recommendation for each proposal that balances:

• The amount that the proposal will save• The impact that the proposal will have on the affected individuals• The wider impact that the proposal could have on the health of the population as a

whole and on other services

• The process is to:

• Give a score to the impacts that the proposal will have taking account of the best information available

• Calculate a score (out of 10) for the combined impacts using an agreed weighting for each category

• Contrast the score of the proposal with the likely saving

• Purpose of the scoring is to:

• Structure the debate about what commissioning decisions to be made and why• Introduce consistency to the decisions across BHR

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Scoring categories

• Patients experience – how much will patients’ quality of life be affected by the proposal

• Clinical impact – how much will patients’ health be affected by the proposal

• Equality impact – the extent to which the change will disproportionately impact one part of the community

• Impact on other services – the extent to which the proposals will affect the way that other services operate

585

Calibration of scoring

6

0 1 2 3 4 5 6 7 8 10

Score zero: Minor inconvenience to most patients in Meadow Court, their families, carers and future patients.

Score 10: Most individuals’ quality of life is

significantly affected. No affordable alternatives available. Most individuals experience significant additional personal expenditure.

The higher the score the greater the (negative) impact from deciding to no longer commission the service.

Patients’ experience

Score zero: No impact on the health of most

patients affected. Consider challenging behaviour, patient safety, safeguarding, quality of care and clinical expertise.

Score 10: Most affected patients are likely to experience significantly poorer health (including mental health)

Clinical impact

Score zero: The proposals will not negatively affect inequalities in health or access to health services. Impact on carers.

Score 10: Proposals will disproportionately and significantly affect a group in society in a way that increases inequalities in health or access to health services.

Equality impact

Score zero: Likely to be no noticeable effect on demand for other services. Consider here wider impact on patient community and the system’s

capacity to treat increasing demand.

Score 10: Proposal is likely to have a noticeable effect on demand for services elsewhere in the health or social care sector

Impact on services

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Scoring the proposal

7

Proposal Proposal

Weighting Score Weighted Score

Impact on patients’ experience 25% 7.0 1.8

Clinical impact on patients 25% 5.0 1.3

Impact on equity of service provision 25% 6.0 1.5

Impact on other services 25% 3.0 0.8

Total score 100% 5.3

Anticipated saving £300,000

Weighting – should any of the categories score more

highly than others?

Agree the scores for each category, for each proposal

Gives a weighted score (out of 10) for each proposal

Consider – does this level of saving justify this level of impact? If not how much more would it need to be?

87

Matching up the impacts and the savings

8

High saving – low impact scoreRecommend to proceed

Low saving – high impact scoreRecommend to reject proposal

Low saving – low impact scoreProbably recommend proposal

High saving – high impact scoreMaybe recommend

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Questions we explored

1. Are the scoring categories, weightings and calibrations well suited to aid decision making in relation to the task at hand?Outplacement activity. Re-thinking care strategies. Evolving models of care. Whole patient community. Mental health strategy for CCGs – what is envisaged, what will be in place by way of transition? Redbridge Dementia Strategy. Carers/family support and impacts.

2. What information and/or guidance is needed in order to reliably assess the proposal against each of these categories? Outplacement activity. Re-thinking care strategies. Evolving models of care. Whole patient community. Mental health strategy for CCGs – what is envisaged, what will be in place by way of transition? Redbridge Dementia Strategy. Carers/family support and impacts.

3. What format/medium might this information and guidance be best provided?

4. What else?Need for a preparation session in advance of panel with the benefit of consultation outputs.

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Quality impact assessment - Meadow Court proposal

Area of quality Indicators Response Impact Risk mitigation

What is the impact on the organisation’s duty to secure continuous

improvement in the quality of the healthcare that it provides or commissions?

All care homes are inspected and have CQC compliance reports Low

N/A

Does it impact on the organisation’s commitment to the public to

continuously drive quality improvement as reflected in the rights and pledges of the NHS Constitution?

All care homes are inspected and have CQC compliance reports Low

N/A

Does it impact on the organisation’s commitment to high quality

workplaces, with commissioners and providers aiming to be employers of choice as reflected in the rights and pledges of the NHS Constitution?

Consider the impact on staff during this process

High

Subject to the CCG making a decision to end the contract Care UK will consult with staff on the service changes. Care UK has confirmed that it has followed due process regarding staff engagement and once a decision is made by the CCG, a staff consultation will follow if required. Care UK is confident that its staff consultation process is robust and follows good practice.

What is the impact on strategic partnerships and shared risk? (This also may have an impact on the system in regards to bed access and any impact of winter pressures on NHS)

This may have an impact on the wider system for health and social care. Need to ensure there is current capacity to take existing patients into similar or high standard care homes that meet the individual resident's physical, developmental, social and emotional needs. Need to understand impact on any other partners, including LA placements. Also need to consider impact on the wider system and any impact winter pressures may have had on activity and any wider impacts on bed occupancy.

High

The CCG has developed a stakeholder communication and engagement plan to support the engagement and consultation process and implementation of any decision. All stakeholders have had the opportunity to comment on the proposal through the consultation process. An assessment has been undertaken of nursing bed capacity and risks to DTOCs. Ending the contract is not expected to impact on winter pressures due to the low number of people affected by the decision.

What is the equality impact on race, gender, age, disability, sexual orientation, religion and belief, gender reassignment, pregnancy and maternity for individual and community health, access to services and experience of using the NHS? (Refer to CCG Equality & Diversity Policy)

An equality impact assessment will ensure we can meet patients' religious and cultural needs as well as ensure gender appropriate accommodation Need to consider if the placements are agreeable and accessible for patients and families and what process is planned if any families disagree.

Low

An equality impact assessment has been undertaken to inform the decision and implementation of any changes. All Redbridge CCG patients have had a CHC review in the past six months and have a care plan in place to meet their individual needs.

Are core clinical quality indicators and metrics in place to review impact on quality improvements?

Yes, This is managed via quality visits, contracts and CQCHigh

Consider a schedule of assurance visits

Will this impact on the CCG’s duty to protect children, young people

and adults?Potential impact on adult safeguarding requirements and risk assessments. Vulnerable adults may not be able to advocate for themselves and may need extra support regarding decision making. Dementia patients may be at risk of deterioration due to changes in environment and staff. It is potential that during this process safeguarding may concerns arise. Low

The CCGs' safeguarding lead has reviewed Care UK's transfer policy and the CHC assurance checklist. All patients have an advocate in the form of involved family/carers, or, where necessary, an Independent Mental Capacity Advocate (IMCA) or solicitor. A CHC nurse has been identified to oversee the transfer process and follow up and review of patients post transfer.

What impact is it likely to have on self-reported experience of patients and service users? (Response to national/local surveys/complaints/PALS/incidents)

Patients and family may complain if they are not happy with their choice, or if not given a choice. There may be increased local media coverage as a result. Low

The CCG has a robust communications plan in place and will provide 1:1 support for patients/families in seeking a suitable alternative placement. A complaints process is in place.

Duty of

Quality

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How will it impact on choice? Need a process that considers some degree of choice if possible in reallocation

Low

Patients/families have been provided with information on alternative nursing home providers during the consultation and will be offered a choice of provider.

Does it support the compassionate and personalised care agenda? If individual needs are met, care may exceed expectations. As this is individual, it is difficult to determine risk at system level and may have negative impacts if needs are not met

LowEnsure a transparent process and consider a process for feedback from each resident post transfer for assurance. The CHC team's nurse reviews Redbridge patients post-transfer within two weeks.

How will the proposal impact on patient safety? A full assessment will be required for each resident , to ensure safety needs are met Low

Ensure that each resident receives a new risk assessment to ensure appropriate placement and care needs are met

How will the proposal impact on preventable harm? There is a risk that patients being moved causes them to be confused/disoriented in their new, unfamiliar environment.

Low

The CHC commissioning team will ensure that placements are made in care homes that meet CQC standards. Ensure risk assessment process are in place prior to placement and once in the new home. This is done by the CHC nurse pre and post transfer and on review.

How will the proposal maximise reliability of safety systems? Incidents may arise in the transfer by the existing team or the new service Low A process is in place to review any incidents in regards to the transfer

processHow will it impact on systems and processes for ensuring that the risk of healthcare acquired infections is reduced?

Managed via quality visits, contracts and CQC Low Risk assessments in place to identify any risks for cross contamination and standards for infection control are met

What is the impact on clinical workforce capability care and skills? Individual staff at Meadow Court will be impacted on a personal level. Staff at the new homes will need to review the care plans for the new resident. Impact on staffing levels with transfer, staffing needs to maintained during the transition period

Low

There will need to be a managed process to ensure staff are consulted and any appropriate HR processes are followed, including any TUPE required for staff

Patient

Experience

What is the impact of the proposal in terms of positive survey results from patients, or from complaints about the proposal from patients and members of the public?

Patients, carers or families may oppose the proposal and may disagree with the new home or identify barriers. There may be limited choice.

Low

Give consideration to post experience assessment. Monitor any incidents or complaints occurring from the process and applying any learning to the wider system. Ensure that the outcomes are understand and impact after the move for quality.

What is the impact on patient choice, location of services, etc.? Patient experience may be variable and may improve or decline by the offer of a new placement Low

Patients/families need to be part of the process and we need to ensure we can meet their needs. Consideration to post experience assessment and unannounced quality visit

What is the impact on personalised and compassionate care? Each individual will need an assessment to find a suitable placement that meets the individual's needs. If needs are not met or disagreement on placements arise, this may have an impact on this agenda being met

Low

Patient experience will need to be captured. Assurance that needs were met at the end of the process

How does it impact on implementation of evidence based practice? All care homes are inspected and have CQC compliance reports High

Ensure all patients are placed in a care home meeting standards of care in line with CQC and local inspections

How will it impact on clinical leadership? Leadership is required to ensure a smooth transition and corporate response to the closure. There may be risk to reputational harm as a result of decommissioning the home

NClinical leadership in place. Communications plan will address potential reputational risks.

Does it support the full adoption of Better Care, Better Value metrics? Good high quality care will reduce unavoidable admissions, outpatients and follow up required High N/A

Does it reduce/impact on variations in care? Yes. There is a potential for variation in care if quality standards are not met. High

Ensure all patients are placed in an appropriate care home that meets their individual needs and isn't flagged as a risk by the Quality Surveillance Group. Ensure evaluation.

Are systems for monitoring clinical quality supported by good information?

Yes. All care homes are inspected and have CQC compliance reports High Quality Surveillance Group minutes and contract monitoring reports.

Does it impact on clinical engagement? Need to ensure that clinical teams are fully engaged so there is no break down in clinical care. Existing records will need a process for transfer and/or archive or appropriate processes to follow. Low

Ensure an effective transfer policy is in place and all transfers are supported by a CHC nurse.

Clinical

Effectiveness

Patient Safety

Duty of

Quality

91

Does it support people to stay well? Potential for variation in care if quality standards are not met.

Low

Ensure patient wellbeing is monitored after any transfer.

Does it promote self-care for people with long term conditions? Appropriate staffing and good quality provision will enhance this. High

Ensure patient wellbeing is monitored after any transfer.

Does it tackle health inequalities, focusing resources where they are needed most?

This is individual dependant. Each patient (or their family) will likely take a view if the move is improves or compromises their personal needs. Low

Assurance that an equality impact assessment has been completed. Ensure patients receive a needs assessment and all identified needs are met.

Does it ensure care is delivered in the most clinically and cost effective way?

By rationalising the beds, there is opportunity for scale, but there may be impact on the system availability of beds. High

There is sufficient capacity and provision to sustain good quality care for older patients with dementia in BHR to meet the needs of the existing Meadow Court patients and future patients.

Does it eliminate inefficiency and waste? Potentially, unless the reduced bed availability inversely impacts on efficiency in the system Low Ensure capacity and demand is up to date and meets the system-wide

needsDoes it support low carbon pathways? There may be an impact on family traveling to a new care

home to visit the patient.

Undetermined

Develop assurance report detailing the distance patients are being asked to move and the impact on family visiting.

Will the service innovation achieve large gains in performance? N/A High N/A

Does it lead to improvements in care pathway(s)? Potentially, unless the reduced bed available inversely impacts on efficiency in the system High

Consider an end of project evaluation

Prevention

Productivity

and

Innovation

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Meadow Court Final Equality Impact Assessment About this document This final equality impact assessment (EIA) takes account of the activities Redbridge CCG has undertaken since the original proposal for Meadow Court was published. The CCG has undertaken a public consultation on the proposal for the future of the contract it has with Meadow Court. As part of the analysis of the feedback from the consultation, the initial published EIA is reviewed and updated here. The assessment table on page 4 combines the considerations of the initial EIAs and the results of the subsequent work undertaken by the CCG. An equality impact assessment (EIA) is the process of assessing the impact of a proposal and its consequences for equality. There is a legal obligation to undertake EIAs to assess the impact of proposals on equality groups identified by the Equality Act 2010 (called protected characteristics):

Age Disability Gender reassignment Marriage and civil partnership Pregnancy and maternity Race Religion and belief Sex Sexual orientation.

Equality analysis is a way of considering the effect on different groups and serves to:

consider if there are any unintended consequences for some groups consider if the policy will be fully effective for all target groups.

It involves using equality information, and the results of engagement with protected groups and others, to understand the actual effect or the potential effect of functions, contracts, policies or decisions. Redbridge CCG is subject to the general public sector equality duty required by Section 149 of the Equality Act 2010. This states that the CCG must “have due regard to the need to:

1. Eliminate discrimination, harassment, victimisation, and any other conduct prohibited by the Act;

2. Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it;

3. Foster good relations between persons who share a relevant protected characteristic and persons who do not share it.”

This involves:

Removing or minimising disadvantages experienced by people due to their protected characteristics.

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Taking steps to meet the needs of people from protected groups where these are different from the needs of other people.

Encouraging people from protected groups to participate in public life or in other activities where their participation is disproportionately low.

Carrying out an equality impact assessment helps the CCG to make sure it has considered the needs of people with protected characteristics. This means it can:

identify unintended consequences and mitigate them as far as is possible. actively consider how the proposed change might support the advancement of

equality and fostering of good relations. Background Meadow Court is a purpose-built nursing home near King George Hospital in Goodmayes that is run by a company called Care UK. There are 70 beds in the home for people who are mostly aged over 65 and have dementia and physical disabilities. Redbridge Clinical Commissioning Group (CCG) has a contract with Care UK to pay for 48 beds in the home to care for local people who have dementia and need full-time nursing care. Other NHS groups and local authorities from the wider area pay Care UK to use the remaining 22 beds as and when they need them. At the moment seven of these beds are being used. In recent years the number of people choosing to be cared for at Meadow Court has been reducing. When the change to commissioning beds at Meadow Court was proposed, 14 of these beds were occupied. The beds are commissioned under a block contract arrangement which means the CCG has to pay for the 48 beds whether or not they are being used. This means the CCG is currently paying for 34 empty beds. The cost to the NHS of these empty beds is £2.44m1 a year. Like most nursing homes Meadow Court provides round-the-clock care by staff who are specially trained to look after older people with dementia. The building is owned by NELFT NHS Foundation Trust. The CCG has had extensive discussions with Care UK exploring the option of paying for beds on a usage basis. However Care UK has told the CCG it may not be able to afford to run the home if the move is made to this model. For these reasons the CCG is proposing to end the block contract with Care UK and commission beds for current Meadow Court patients in line with the CCG’s Continuing Healthcare (CHC) commissioning strategy, at alternative homes in the area. There are 26 homes across Barking and Dagenham, Havering and Redbridge which are considered as suitable providers for continuing healthcare. Seventeen of these are within four miles of Meadow Court. The average distance to these homes from Meadow Court is 4.7 miles and analysis suggests there is sufficient capacity locally to meet the demand for continuing healthcare placements. The continuing healthcare team place on average 50 people a week from BHR with continuing healthcare needs in nursing homes across the area. For these reasons the CCG is confident it has capacity to continue to place people in suitable care homes, should it end the contract at Meadow Court.

1 Figures correct at time of print

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Profile of patients in Meadow Court A profile of all CHC patients from Redbridge, Barking and Dagenham and Havering who have been cared for in Meadow Court between April and November 2016, shows that most patients (79%) are over 65 and more than two thirds (72%) have a diagnosis of dementia. When the change to commissioning beds at Meadow Court was proposed, out of the 14 patients placed by Redbridge CCG, 10 have dementia. Dementia is a progressive illness which is caused when the brain is damaged by disease, such as Alzheimer’s or a series of strokes. People with dementia experience memory loss, difficulty thinking, speaking, or solving problems. It may also affect their mood or behaviour. These changes can become severe and when combined with other ongoing healthcare needs, as many patients in Meadow Court nursing home experience, it means they need 24 hour specialist care. Local demographics Redbridge has a growing and rapidly changing population. In 2014, the population was estimated to be 293,055 (ONS mid-year estimate). There are fairly equal numbers of male and female residents. The population is very ethnically diverse. A majority (63%) of the population is from black and minority ethnic backgrounds with the largest group being of South Asian origin. Within Redbridge, ethnic composition differs widely across age groups with the greatest degree of diversity in the youngest category, in which 77% of the population are estimated to have Black or minority ethnic backgrounds, compared to 30% of people aged 65+years.

Redbridge population, 65 years and over

Source: GLA 2012 round ethnic group projections The Joint Strategic Needs Assessment (JSNA) highlights a projected 19% increase on 2011 census figures in the numbers of people aged 85+ years old by 2021. This age group in general has a higher need for health and social care.

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Updated assessment The table below identifies the considerations from the initial EIA and updates those by taking account of the consultation feedback and activities undertaken by the CCG. The consultation activities reached out to residents, carers, staff and relevant stakeholders over a 12 week period from 4 August to 27 October 2017. Included in the consultation questionnaire were voluntary questions relating to respondents age, gender and ethnicity. The feedback demonstrated responses from across the adult age groups, proportionately from men and women and proportionate ethnic backgrounds based on local population demographic figures. The proposed changes have been analysed against the protected characteristics to understand any unequal impacts on particular groups. This table sets out the findings of that analysis, the processes for developing mitigating strategies and the results of the consultation. Protected groups Initial EIA considerations Initial EIA recommendations/

mitigating actions Update following consultation

Age High: Redbridge CCG primarily uses the facility to care for people over the age of 65. The proposal therefore impacts older people disproportionately. Alternative accommodation and care of a similar standard would be offered to all residents. As such, this does not represent the withdrawal of service leading to a loss of equality. The JSNA predicts a growing older population in Redbridge.

Engagement will be conducted with residents, their carers and other relevant parties. Any specific impacts relating to the age of the residents will be identified and addressed as part of this process. Local nursing care capacity for people with dementia continues to respond to demand in the long term.

While the proposal was highlighted to impact older people disproportionately, this is considered acceptable due to the nature of the services provided by the contract, i.e. specific to dementia patients (primarily) over 65years old. The feedback received does not raise any specific age-related issues for further consideration.

Marriage/ civil partnership

Low: There are no couples currently living in Meadow Court. If the changes took place, some patients may be housed further away from their partner, with a potential impact on family life.

A range of alternative nursing homes has been identified within the BHR area; residents would be offered a choice of alternative homes. The engagement process will explore any impacts on the partners of residents

Feedback did not raise any specific issues relating to marriage/civil partnership status. Some feedback did highlight a concern that moving residents to an alternative nursing home may

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that could result and how these impacts could be minimised.

create increased costs (and time) for relatives to visit.

Disability High: (Mental health) Meadow Court is a facility predominantly treating people with dementia. The impacts of the proposal are therefore specific to this group. Neutral: (Physical disabilities) residents have a range of physical disabilities, with many requiring nursing care for those disabilities. Alternative facilities would offer a similar level of care, so this would not result in a loss of access to nursing care for people with disabilities. Moving patients could cause some distress.

If the decision is taken to end the contract at Meadow Court, the CCG is committed to working closely with the residents and relatives/advocates to ensure that they find an alternative home which provides the right level of care. This would be discussed with residents and their relatives on an individual basis as everyone has different needs. Other homes in the area have been awarded the same Care Quality Commission (CQC) rating for care as Meadow Court and all homes are subject to quality checks by CQC and by the CCG. If a carer cannot be found to advocate on the patient’s behalf, the advocacy service Voiceability would provide an independent advocate as necessary. Patients, carers and healthcare staff would be consulted about the implications of moving people with physical and mental disabilities. Patients would be moved with care and in line with best practice.

The feedback received highlighted strong concerns about moving residents to an alternative nursing home in terms of the quality of care and negative affect of change for the resident(s) given the nature of dementia. As shown, these areas of concern were raised in the initial EIA, which the consultation feedback now emphasises. The CCG commit, in the original proposal, to ensuring that any need to move residents to alternative nursing homes will be supported in line with best practice and minimal disruption possible for the patient, in terms of mental and physical health. The CCG maintaining this commitment is a key mitigation if the decision to end the contract at Meadow Court is taken.

Race and ethnicity

None: Meadow Court is a facility catering for all ethnicities equally. The majority of the resident are White British, in line with local age-specific demographics. The

Engagement with residents and relatives will explore any potential impacts due to ethnicity and how these impacts can be mitigated.

Respondents to the consultation self-identified from white and BME backgrounds, however no impacts specific to race and/or ethnicity

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proposed changes would not have any impact on equality of access due to ethnicity or race.

were highlighted from the feedback received.

Gender

None: Meadow Court is a facility catering for all genders equally. There are no identified impacts specific to gender.

N/A N/A

Sexual orientation

None: There are no identified impacts specific to sexual orientation.

N/A N/A

Religion

None: There are no identified impacts specific to religion.

N/A N/A

Gender reassignment

None: There are no identified impacts specific to gender reassignment.

N/A N/A

Pregnancy/maternity

None: As a home for older people, there are no impacts specific to pregnancy/maternity.

N/A N/A

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Additional relevant questions Does this proposal have the potential to cause unlawful direct or indirect discrimination? No Does this proposal have the potential to exclude certain group of people from obtaining services, or limit their participation in any aspect of public life? No Next steps This is the updated EIA, taking into account the feedback from the consultation activities. This will be included, along with the report on the consultation feedback, in the business case on the future of Meadow Court and will go to Redbridge CCG Governing Body for consideration.

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