Hampshire County Council

Social Care Policy Review Committee Item: 7

Nursing Care Investment Strategy-Progress Review

11 July 2003

Report of the Director of Social Services

Contact: Andrew Brooker 01962 847281

1. Introduction

1.1 Members of the Cabinet approved a strategy in October 2002 to form a number of partnerships with NHS bodies to create 500 additional nursing home places in Hampshire

1.2 This report summarises the background, the partnerships being formed with NHS bodies and identifies the progress made against the objective to create 300 additional places by the end of 2004 with the remaining 200 places to be completed during the 2005/6 financial year.

1.3 A copy of a report to the Executive Member for Social Care on 20 June 2003 is attached, at appendix 1, for information regarding the legal agreements being formed with each Primary Care Trust in the County Council area.

2. Background

2.1 There are 3450 nursing home places, registered with the National care Standards Commission, for older people provided by the independent sector in Hampshire. The County Council purchases in the order of 1500 of these places with private fee payers taking up the remaining capacity. The number of places available in Hampshire is low, compared with the national average, and additionally private fee payers take up a greater proportion of the available capacity in Hampshire than the national average.

2.2 Since 1999 there has been a reduction of over 400 places as homes have closed and over the same period of time the price the County Council agrees to pay for places has increased by 38% . This level of price increase has enabled the County Council to maintain and slightly increase the proportion of available places it is able to access for residents who need support from public funds.

2.3 Over a similar period the number of older people whose discharge from hospital was delayed, due to waiting for a nursing home place to become available, has increased and in March 2002 over 150 acute and community hospital beds were affected by this factor.

2.4 An analysis of the need for nursing care places in Hampshire was undertaken and taking into account existing deficits causing delays in hospital discharges, the need to replace lost capacity and the need to create additional capacity to respond to rising demand in an aging population it was estimated that between 800 and 1000 additional places would be required by 2007.

2.5 Taking into account the extent to which the development of better health and social care services may reduce the need for nursing care in a residential setting and the potential for the independent sector to invest in creating additional capacity as market conditions respond to the relaxation of registration requirements announced by the Government in 2002, Members of the Cabinet confirmed their support to the strategy to create an additional 500 places in Hampshire by 2006/7 at their meeting in October 2002.

2.6 The policy to seek to create additional nursing care capacity within the public sector was considered as part of the Best Value review of residential care for older people during 2002 and a business case was supported by the Board of the Hampshire and Isle of Wight Strategic Health authority in November 2002.

2.7 The District Auditor will undertake a review of the business case and procurement arrangements, jointly with the Auditor for the Strategic Health Authority, and include any comments in the annual letter to the Authority in 2003.

3 Partnerships with the NHS

3.1 In order to pursue the strategy, two key partnerships have been formed with NHS partners. Firstly the County Council, the Strategic Health Authority, Primary Care Trusts and Hospital Trusts in Hampshire have formed a partnership to make land and capital available. Secondly the County Council will form a partnership agreement with the 7 Primary Care Trusts in Hampshire for the delegation of the NHS nursing function to enable the County Council to employ nurses and manage nursing care homes. A copy of the report to the Executive Member for Social Care regarding the legal agreements being formed with NHS partners is attached for information.

3.2 The DoH have confirmed that £20m additional capital will be allocated to the Strategic Health Authority who will make an additional £20m available from their existing capital allocation. Members of the Cabinet, at their meeting on the 23^rd June, confirmed the capital programme which included options to raise the remaining £20m capital requirement in order to complete the full programme.

3.3 Feasibility studies have been completed on a number of HCC and NHS sites and planning applications on 10 sites are to be made where developments can be undertaken within the timescales established for the project. These include 3 NHS sites where new buildings are envisaged to provide for 220 places and 7 HCC sites where extensions to existing HCC residential care homes are being considered to provide for 286 places. A schedule of sites where planning applications have been made, or will be made in the near future, is attached at appendix 2.

3.4 Tenders have been undertaken for contractors and once the outcome of the planning applications are known it is intended to let the first construction contracts from September 2003 for the first 300 places to be available by the end of 2004.

3.5 The Boards of each Primary Care Trust will consider, in July, recommendations to make capital grants to the County Council for the construction costs utilising £40m of NHS funds. These grants will be made under Section 28A of the 1977 NHS Act and will include arrangements to protect NHS land and assets created using NHS capital should the service no longer be required or if the partnership with the County Council should end.

3.6 In order for the County Council to be able to employ nurses and manage care homes with nursing, which will be registered with, and inspected by, the National Care Standards Commission, it is necessary to form a partnership agreement with each PCT under section 31 (2) (c) of the Health Act 1999.

3.7 Legal Opinion has been obtained which confirms the legal basis for the County Council to form partnerships with PCT s for the purpose of transferring the NHS nursing functions, defined in Section 3 (1) of the 1977 NHS Act, to the County Council.

3.8 The necessary consultation with PCT s and other stakeholders has been undertaken and each PCT Board will consider recommendations in July to confirm that an agreement under Section 31 will be signed in order that construction contracts can be let from September 2003.

4. Summary

4.1 The necessary analysis of need and the business case to support the strategy to create additional nursing care capacity, to be managed in the public sector, across Hampshire has been undertaken and the necessary capital support has been obtained. The revenue implications and part year costs will be confirmed as the budget for 2004/5 is developed.

4.2 Site feasibility studies have been completed and planning applications are being made on sites where developments can be achieved to provide for a better choice of service to consumers across Hampshire within the time scales agreed with partners.

4.3 The necessary legal agreements for PCT s to make capital grants towards the cost of construction and for the transfer of the NHS nursing function to enable the County Council to manage nursing services are being put in place.

4.4 The outcome of planning applications will be known by September 2003 when it will be possible to confirm the development schedule in order to create 300 additional nursing care places by the end of 2004 and for the full programme of 500 places to be completed during 2005/6.

5. Recommendations

5.1 That members note the progress being made to create additional nursing care services in partnership with local NHS bodies and the legal agreements being formed with each Primary Care Trust in the Hampshire County Council area.

Section 110 D - Local Government act 1977 - Background Documents

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the provision of this report.

NB the list excludes

1. published works

2. Documents which disclose exempt or confidential information as defined in the Act.

Title

None

Appendix 1 to report to Policy Review Committee on 11 July 2003.

Hampshire County Council

Executive Member for Social Care

20 June 2003.

Report of the Director of Social Services

Nursing Care Investment Strategy - Agreements under Section 31 of the Health Act 1999 and Section 28A of the NHS Act 1977

Contact: Andrew Brooker. Ext 7281

1. Introduction

1.1 Members of the Cabinet on 28 October 2002 supported a proposal to seek capital funding to create additional nursing care capacity in Hampshire in partnership with the Hampshire and Isle of Wight Strategic Health Authority.

1.2 In order for the County Council to manage nursing care homes it is necessary to form a partnership agreement with each of the 7 Primary Care Trusts in Hampshire under Section 31 (2) (c) of the Health Act 1999. This allows for the NHS nursing functions, defined in Section 3 (1) of the 1977 NHS Act, to be transferred to a partnership within which the Local Authority is enabled to deliver nursing care in a residential setting.

1.3 It is also proposed that the appropriate Primary Care Trust will make a capital grant to the County Council under Section 28A of the NHS Act 1977 for the cost of construction and for any necessary purchase of NHS land.

1.4 This report seeks the necessary authority to enter into a Section 31 partnership agreement with the 7 PCT s in Hampshire and also to enter into Section 28A agreements for land purchase and construction costs.

2 Partnership arrangements

2.1 Two key partnership arrangements are being forged between the County Council and NHS organisations in Hampshire.

· Firstly a partnership between the County Council, The Hampshire and Isle of Wight Strategic Health Authority, Primary Care Trusts and NHS Trusts in relation to land and capital.

· Secondly a partnership between the County Council and the 7 Primary Care Trusts in Hampshire for the operation of nursing care homes

2.2 Within the land and capital partnership it is proposed that the County Council and NHS organisations make land available for extensions and new buildings and that £40m is made available via the Strategic Health Authority to support construction costs. Cabinet on the 23 June will consider options to raise the remaining £20m capital requirement needed to complete the strategy to create an additional 500 nursing care places and for the necessary refurbishment to existing HCC homes where extensions are being considered.

2.3 Whilst the negotiations to make land and capital available have included Primary Care Trusts, Hospital Trusts and the Strategic Health Authority it will be necessary for the appropriate Primary Care Trust to make a capital grant to the County Council under Section 28A of the 1977 NHS Act to support construction costs for any development in their area. These grant Agreements will contain arrangements to protect NHS land and assets created with NHS capital for future NHS use should the nursing care service not be required in the future or the partnership is ended.

2.4 Section 31 (2) (c) of the Health Act 1999 authorises the forming of partnerships between NHS bodies and Local Authorities which would enable, inter alia, the delegation of functions from one body to another.

2.5 Legal Opinion has been obtained which confirms the legal basis for the County Council to form a partnership with PCT s for the purpose of transferring the nursing function to the Local Authority under Section 31 (2) (c) of the Health Act 1999.

2.6 The proposed partnership with the 7 Primary Care Trusts in Hampshire supports the County Council's policies to sustain a mixed economy of care provision by developing nursing care services within residential homes to be managed by the Authority.

2.7 Additional capacity created in this way will provide for better access to care services to support vulnerable older people whose nursing needs can not be met in their own homes and will also support the joint target with the NHS to reduce the level of delayed transfers of care in acute and community hospitals.

2.8 The guidance for reaching Section 31 agreements requires consultation with stakeholders and a consultation paper has been widely circulated within the existing public forums in each PCT area in Hampshire. The partnership proposal has also been made available to County Wide organisations including the Hampshire Care Association, local Councils of Voluntary Action, Carer and Consumers groups, Community Health Councils and NHS Hospital Trusts in Hampshire and in surrounding Authorities. The proposals have also been made available to the Local Authority and NHS Staff representative organisations.

2.9 Where extensions to existing County Council residential care homes are being considered, meetings have been held for staff, residents and relatives. A number of comments have been received regarding the potential disruption to residents during construction work which can be addressed as any contracts are agreed. In general residents and relatives supported the proposals as existing residents might benefit from improvements to their surroundings and from the reassurance that nursing care would be available if the needs of residents changed in the future. The views of existing staff included concerns for the recruitment and retention of additional staff and support for the potential of better career development opportunities within the new service. Both of these issues will be addressed in the workforce strategy being developed with NHS partners.

2.10 Each PCT Board has now received a report noting any comments made during consultation and has confirmed agreement in principle to entering into a partnership with the County Council. A draft agreement setting out responsibilities and purpose has been made available and it is intended to seek the authority of each PCT Board in June and July 2003 for an agreement to be signed.

2.11 Within these partnerships the County Council will be able to offer a range of nursing care services to older people in homes registered with the National Care Standards Commission. These services could include long stay care, respite care, and Intermediate Care for physically frail older people and for older people with dementia. The National Care Standards Commission have confirmed their support of the separate registration of nursing care services in extensions to existing services and to the use of shared kitchen and laundry facilities on some sites.

2.12 The partnership agreement will also enable the Council to offer continuing care to older people who are the responsibility of the NHS due to their level of need, in these cases the NHS will be financially responsible for the cost of care. In all cases the Primary Care Trusts will be responsible for determining the level of financial contribution the NHS should make towards the cost of nursing care. (currently within a range between £40 and £120 per week)

2 Summary

3.1 The DoH has been able to confirm capital funding of £40m over 2003/4 and 2004/5 to support the creation of additional nursing care services and Members of the Cabinet will consider a report on the 23 June identifying options for raising the remaining £20m capital requirement to create 500 places by 2005/6.

3.2 Site feasibility studies are being completed and it is intended to make planning applications on 11 sites that could potentially be developed within the capital limit and timescales agreed between partners. To date planning applications have been made in respect of extensions at Ticehurst residential care home in Aldershot, at Oakridge in Basingstoke and a site in the ownership of the Fareham and Gosport PCT at the former Coldeast Hospital in Fareham. In all cases public consultation events will be held and arrangements made to seek the views of local NHS staff. Once the outcome of these and subsequent planning applications are known it will be possible to determine a development schedule within which it is intended to commence construction in late 2003 with the first places being available late 2004.

3.3 The necessary public consultation has been undertaken in order to form agreements within Section 31 of the Health Act 1999 and PCT Boards are considering their support to partnership agreement which are intended to be in place during the summer of 2003 to support construction contracts being let later in the year.

4. Recommendations

4.1 That the Executive Member approves the proposed partnership between the County Council and the 7 PCT s under Section 31 (2) (c) of the Health Act 1999 and the signing of the partnership agreement on behalf of the County Council by an authorised signatory.

4.2 That the Executive Member approves the proposed grants to the County Council under Section 28A of the 1977 NHS Act and the signing of the agreements on behalf of the County Council by an authorised signatory.

Section 100D - Local Government Act 1972 - background papers

The following documents disclose facts or matters on which this report, or an important part of it, is based and has been relied upon to a material extent in the preparation of this report.

NB the list includes:

1. published works

2. Documents which disclose exempt or confidential information as defined in the Act.

TITLE FILE

None

Appendix 2 to report to the Social Care Policy review Committee on 11 July 2003.

Sites where planning applications have been, or will be, made.

Note: IC refers to the potential to offer Intermediate Care services subject to further discussions with PCT s.

Location PCT area Total beds OP with Dementia General nursing IC

Ticehurst

in Aldershot BV&H 48 20 28 yes

Marlfield

in Alton Nth Hants 40 20 20 yes

Oakridge in

Basingstoke Nth Hants 48 20 28 yes

Andover

NHS site Mid Hants 60 30 30 yes

Westholme

in Winchester Mid Hants 30 30 00 no

Fleming House

in Eastleigh E&TVS 30 30 00 no

Tatchbury NHS site

in Totton NF 80 40 40 yes

Bickerley Green

in Ringwood NF 30 00 30 no

Coldeast NHS site

in Fareham F&G 80 50 30 yes

Emsworth House

in Emsworth East Hants 60 30 30 yes