Health and Social Care Committee

HSC(4)-11-12 paper 2

Inquiry into residential care for older people – Flintshire County Council


1.   The process by which older people enter residential care and the availability and accessibility of alternative community-based services, including reablement services and domiciliary care.


Social Services for Adults, working jointly with others, is responsible for safeguarding and improving the well being of vulnerable adults.  We seek to promote independence and choice; support people to live full and active lives; support carers to be able to continue in their caring role, keeping service users and their carers at the centre of assessment and care planning.  In order to achieve this we aim to plan strategically to anticipate developments and changes and make effective use of resources to meet demand.


The overall purpose of Older People’s Services is to provide, in partnership, a range and choice of individual quality services for the older residents of Flintshire, and their carers.  To do so in a timely and equitable manner, with the focus on maintaining and promoting independence, health & well-being and keeping people safe within their own homes and communities.


Flintshire is successful in its priority of supporting people to remain in the community and as a result has a relatively low number of residential care placements.  Performance indicators within Social Services for Adults evidence this.  


There is an increasingly strong reablement focus within Social Services for Adults.  At the beginning of March ’11, in Social Services for Adults in Flintshire, 23% of people received a reablement service from the reablement team and 78% of those people had no ongoing needs after exiting the service.  Since March, staff in Social Services for Adults have been working to increase the numbers receiving a reablement approach and it is envisaged that by March ’12, up to 80% of referrals will benefit from a reablement approach and about 60% should have no ongoing intervention after a reablement service.  This includes providing a reablement service with people with low level dementia needs.


There are numerous other services within Flintshire that promote independence and support people to remain at home, including Telecare, OT aids and adaptations,  Wellcheck, NEWCIS, Alzheimer’s, Age Concern, Care & Repair, Extra Care, Neighbourhood Watch (including Owl alerts) and Red Cross. 


Social Services for Adults has a strong Brokerage system which facilitates an efficient use of independent sector and local authority home care.  Local authority home care focuses on reablement, end of life care and specialist / complex / dementia services.   


Direct Payments are encouraged in order to maintain people’s independence and has been highlighted as an area of further improvement within older people’s services in Flintshire.


Flintshire works to a high threshold of domiciliary support packages, enabling people to remain at home for as long as possible.


Social work teams are professional, qualified staff who identify needs and provide support in the context of promoting independence and encouraging people to retain control over their own lives.  


Where individuals are supported to access residential care, information is provided as to Approved Providers within and outside of Flintshire.  Each individual is at the centre of all decisions making regarding planning for his or her care, and family, carers or advocates may be involved as appropriate.  Advocacy services within Flintshire include generic advocacy via Age Concern, via IMHA and IMCA. 


Any new Learning Disability (LD) service provision in Flintshire is channelled through the LD service panel, all options are considered and if it is deemed that residential service is the preferred option a referral is made to the North Wales LD Partnership which sources at least 3 options based on need, preference geography etc.  There are very few new applications for residential services for people aged over 65 with learning disability in Flintshire.



2.   The capacity of the residential care sector to meet the demand for services from older people in terms of staffing resources, including the skills mix of staff and their access to training, and the number of places and facilities, and resource levels.


Within local authority residential homes, managers follow staffing guidelines  for each centre and are responsible for ensuring the homes are adequately staffed as the best interest of service users are paramount.  All staff receive full induction and mandatory training including: manual handling, infection control, food hygiene, POVA, risk assessment, medication and first aid.  These courses are scheduled for refreshers as appropriate.  All staff are encouraged and supported to consider their own personal development and apply for courses that cover:  equality & diversity, end of life care, dementia, reablement, violence and aggression, oral hygiene, tissue viability, falls, communication, visual / deaf / stroke awareness, catheter care, lass & bereavement, continence management etc.  Managers and duty managers within Local Authority residential homes are trained to high standards, including:  Registered managers Award, NVQ Level 4 in Care, Dementia Care Mapping, and Competent Persons.  


The Contract monitoring team requests workforce information from the independent sector on an annual basis and the information is used for training development.  FCC is in receipt of funding from the Welsh Government to train the workforce (including independent sector / foster carers and personal assistants).  FCC operates a voucher scheme where they provide training vouchers which can be used to purchase mandatory training from approved trainers.  The independent sector can also access FCC training – 30% of places overall in the year are committed to the independent sector, although this is exceeded each year.  Some courses are specifically commissioned by FCC for independent sector providers, this year has included ‘learning to inspire’ and adult protection.  There is also access to qualification through the QCF centre in Flintshire.   


FCC operates an Approved Provider list (APL) for residential and nursing homes.  There are agreed rates for APL and non-APL placements.  Capacity within the residential sector in Flintshire varies.  There are vacant beds within the residential category; however demand outstrips availability in both EMH residential and EMH nursing beds in the county.


It is identified that within Flintshire homes, an increased focus on reablement and maintaining independence should be encouraged as well as enhancing skills and knowledge in relation to dementia as the numbers of people with the condition increases.


The residential market in terms of LD is mapped via the North Wales Partnership, there is currently in the region of 60 - 70 bed space voids across North Wales, the quality of these services will be monitored via a regional system currently being designed using outcome focused monitoring developed in Flintshire; this monitoring process is currently being piloted across North Wales.



3.   The quality of residential care services and the experiences of service users and their families; the effectiveness of services at meeting the diversity of need amongst older people; and the management of care home closures.


There are a number of mechanisms for collecting the views of service users and carers within the Local Authority residential homes in Flintshire, including:

·               Quality Standard Questionnaires

·               Residents’ meetings

·               Individual reviews

·               CSSIW Inspection reports

·               Contract monitoring reports

·               Rota visit reports


Local Authority homes work in a person centred way in order to identify and work to meet individuals’ diversity of needs including language and health needs.  There are some Welsh speaking staff working within the homes and where service users have  other language needs (such as Chinese, polish, Italian and German) the homes work with families to establish communication mechanisms according to the person’s needs. 


Flintshire is currently working alongside Wrexham to develop an outcome focused monitoring tool which they will use in collaboration to monitor homes across Wrexham and Flintshire.  The tool will consider aspects such as diversity of needs.


Social Services for Adults’ contract monitoring team works closely alongside all Flintshire homes to support and improve standards of care.  Where a home is in difficulty the team works closely with them and CSSIW to try and avoid closure.  Where home closure is inevitable, there are agreed procedures for working together in the best interests of the residents in the most effective manner according to the ‘Escalating Concerns and Home Closures Guidance’ produced by the Welsh Assembly Government in 2009, promoting a standardised approach in dealing with concerns and closures.



4.   The effectiveness of the regulation and inspection arrangements for residential care, including the scope for increased scrutiny of service providers’ financial viability.


The contract monitoring team in Flintshire works closely with the CSSIW however it is felt that partnership approach to raising standards of care could strengthen the process somewhat.


The effectiveness of services in terms of LD provision will be captured from a service level perspective by measuring outcomes; the financial viability aspect of these services is addressed via an open book accounting system used to manage the market on a regional basis. This is undertaken by a series of negotiations with a provider where viability and sustainability is addressed.


5.   New and emerging models of care provision.


The three Local Authority homes have 6 short term assessment / reablement beds where people can be supported to regain independence and return home, either following a period in hospital or in a bid to avoid hospital admission.


The future model of care in Flintshire will seek to improve outcomes for service users, encourage support within the community and develop new approaches to outcome focussed commissioning.  Increasing use of Citizen Directed Support and Direct Payments will also drive innovation and creativity.



6.   The balance of public and independent sector provision, and alternative funding, management, and ownership models, such as those offered by the cooperative, mutual sector and third sector, and Registered Social Landlords.


The independent sector provides 87% of the permanent residential and nursing care placements for older people in Flintshire in comparison with the local authority’s 13%.


In line with our commissioning strategy for carers we commission a wide range of support for both Young and Adult Carers from the third sector, and work in partnership with BCUHB to commission the Home from Hospital Scheme from the Red Cross.


With the Transforming Social Services for Adults agenda in Flintshire, there is an intention to review the balance of internal and external providers and structure the market to focus upon reablement and independence.  The continued drive to seek alternative means of providing Extra Care housing for older people is one such example where alternative funding mechanisms are being discussed.


For LD providers this is addressed via ongoing discussion with the market both formally and informally. It is also expected that the market balance, new models of provision and alternative funding.  These will all form part of emerging commissioning strategies both locally and regionally.