Contact: Gill Duncan Ext: 01962 833018 E-mail: [email protected]

1 Background

1.1 The Nursing Care Investment Strategy Programme Board has commissioned 10 nursing homes to be built in Hampshire, to develop additional nursing care capacity by creating up to 500 new places by 2006. This has been developed by the health and social care community in Hampshire, the prime focus being the need to create additional long-term care capacity for older people.

In developing this project there has been a focus on improving the experience for service users through the design of modern facilities and providing environments that promote privacy, dignity and security.

This has been supported by the development of a Clinical Governance strategy for nursing and residential care, which aims to ensure that the quality of care provided to individual residents is of a high standard and that overall systems of accountabilities and assurances are put in place so that Hampshire County Council is able to discharge its functions legally, ethically and effectively.

These decisions support four of the Aims of the Corporate Strategy:

Aim 1 (Maximising Life Opportunities by assisting timely delivery of caring services);

Aim 2 (Stewardship of the Environment by minimising the use of paper within the service);

Aim 5 (Improving Services by improving the productivity of staff); and

Aim 6 (Developing Councillors and Staff by enabling staff with the appropriate systems and resources in delivering appropriate services).

2 Buildings

2.1 The overall development programme is to deliver the first 300 beds (six new build schemes) between Christmas 2004 and the end of March 2005; and for the full 500 new beds by the end of 2005.

2.1.1 The project was launched in October 2002, it is now 24 months into the 38 month programme and still on track to deliver the 500 new nursing care beds by the end of 2005, and within the capital development budget of 60 million. Appendix 1 illustrates the bed numbers and development schedule.

2.2 Development Programme / Progress:

2.2.1 With regard to the first two phases (300 new beds), all six schemes are on programme to meet the completion dates: and the two front runner schemes are now entering the more intensive period for the contractors in coordinating the maximum number of trades and operatives (almost 100 operatives at Hawthorne Court being built on the former Coldeast hospital site). They are also "pioneering" the construction interface issues to the benefit of the following schemes.

2.2.2 The planning application for the scheme at Emsworth House was approved at Regulatory Committee on 7 September, following the members' visit to the site. The application for the scheme at Tatchbury Mount has been submitted.

2.2.3 The first refurbishment scheme at Ticehurst is being developed to enable a review of the refurbishment programme budget allocation during October. Advance fire precautions work is being instructed on the remaining six residential homes, as the work at Fleming House has now been implemented.

2.2.4 An updated master programme is attached with this report. The scheme at Bickerley Green is likely to be early, although actual start dates will depend on discussions with the appointed contractors to seek to maximise continuity of project teams.

3 Recruitment

3.1 Recruitment:

3.1.1 Hampshire Apprenticeship Scheme:

The recent recruitment campaign generated approximately 50 enquiries but did not generate as many actual application as we anticipated. All candidates were interviewed and offered placements. We will be exploring the reason for the low return and a meeting has been set up with the Learning Skills Council and Recruitment to find ways of ensuring that we recruit to the remaining placements that are currently vacant.

3.1.2 Return to Practice:

Return to practice is a course that supports nurses who have not recently worked and who need to update in order to remain on the register and deliver high quality care. Interviews for Return to Practice Nurses will take place in September. The numbers of applications received were not as high as anticipated, but we are looking into the reason why the numbers of applicants were low.

3.1.3 Adaptation / Indian Nurses:

Adaptation training is currently taking place for the 17 nurses based within the Portsmouth, Southampton, Basingstoke and Andover area. This is going well and feedback on the level of support provided by HCC has been good. The remaining 3 nurses have now arrived in the country and started their Adaptation training on 13 September, they are based at the North Hampshire Hospital in Basingstoke.

3.2 Overseas Recruitment:

3.2.1 In support of the nursing care strategy Hampshire County Council in conjunction with the Department of Health have recruited nurses from India. This recruitment process is supported by an intergovernmental agreement between India and the UK which recognises the need for additional nurses in this country, and the interests of the nurses from India in developing their expertise.

The first tranche of nurses have undergone up to six months of adaptation training to ensure they meet the requirements of the Nursing and Midwifery Council to practice in this country, as well as familiarising themselves with day to day living. Their training has been delivered by NHS Hospital Trusts in Southampton, Portsmouth, Basingstoke and Andover which already have experience of nursing adaptation training.

The second tranche of our recruitment campaign to recruit nurses from India is taking place in November. In addition to this we have had applications from overseas nurses working within the UK and have successfully appointed 13 nurses to commence adaptation training .

We are planning to support up to 20 nurses to start adaptation training February / March 2005. This number will, however, depend on clinical placements that can be secured with the NHS Trusts and Independent Sector.

3.3 Recruitment of Care Staff:

3.3.1 Care staff are crucial to the delivery of residential and nursing care services, with significant differences in recruitment potential across Hampshire. The new services will require an additional 260 fte members of staff between December 2004 and September 2006.

3.3.2 The recently approved supplement for care staff which is in advance of the Pay and Benefits Review will enable Hampshire County Council to compete with pay offered by the independent sector and other local employment opportunities (e.g. supermarkets, office work etc.).

3.3.3 The recruitment campaign for care assistants has begun (for Hawthorne Court in Fareham) and additionally, in association with Southampton Care Association we have recently successfully recruited 4 care staff from Europe from our first attempt.

3.3.4 The County Council has a contract with Manpower for the provision of agency staff and discussions are underway to ensure that they will be able to meet any shortfall in recruitment.

3.3.5 Clearly there are risks that any staff recruited from overseas will not remain in employment for long periods and that risk has to be evaluated in the context of the potential damage to reputation if services to residents are compromised and the high cost of agency staff and repeat advertising and recruitment activities.

4 I.T.

4.1 One of the cornerstones to enable and support this improvement for the individual resident is the Nurse Call and Management I.T. system that will provide the essential I.T. functionality for the management of their records, medication, and key aspects of Clinical Governance such as risk assessment and clinical audit.

Without this the delivery of the overall approach to modernisation and delivery of nursing care within a framework of a social care setting will be compromised, as other systems will not be able to deliver the functionality required to deliver bedside, resident focused care.

4.2 Additional benefits of the management IT system include:

4.2.1 Care Management capability, including drug regimes that can be held centrally and in a paperless form; avoiding large document storage requirements and administration;

4.2.2 More efficient processes and improved data accuracy;

4.2.3 Enabling the achievement of a full electronic social care and health record.

4.2.4 The decision regarding the investment in the Management I.T. system has not yet been made.

4.3 Nurse Call system:

4.3.1 The new nursing homes will be fitted with the latest technology to monitor the health, safety and well-being of residents. These will allow alerts to be raised in the event of a fall or other unusual activity, as well as supporting monitoring of each resident. This system will be vital in assisting staff in providing the highest level of care and safety of environment to the residents.

4 Operational Planning

5.1 The operational service planning is now underway; we have recruited to the posts of Nurse Manager to the first 3 sites. These will be admitting their first nursing residents in January/February 2005. The planning is split into 3 phases. The 7-week period up to Christmas which will focus on recruitment and training of staff, agreeing operational polices and procedures and the ordering of all furniture, fixtures and consumables. We are also working with the PCTs regarding medical cover and provision of other community services, such as Chiropody.

5.2 The next crucial phase being the handover of the building and delivery of all goods and fitting of equipment such as the Nurse Call system, and preparing the individual bedrooms and the building to receive its first residents. For all sites there will be a phased opening of beds to ensure safe transfer of residents into the new facilities.

5.3 At all sites, during the period prior to admission of the first residents we will be planning open days. For Hawthorne Court it is anticipated this will be in the week beginning 24th January 2005.

5.4 The final phase being the admission of the first residents in late January/early February 2005.

5 Diversity Statement

6.1 In writing this report and developing the strategy regard has been given to the County Councils' duties in relation to the Race Relation Amendment Act 2000 and Hampshire County Council's own race equality scheme.

7 Recommendations

7.1 The committee are asked to note the progress of the nursing care investment strategy which is on target for phase one completion and to support the proposal for open days which will include invitations to local members to visit sites in their constituency.

Section 100 D - Local Government Act 1972 - 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 preparation of this report.

NB the list excludes:

1. Published works

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

None

Appendix

NURSING CARE INVESTMENT STRATEGY

DEVELOPMENT SCHEDULE

October 2004

OPMH = Older people with a mental health need

GN = Older people with a general nursing need