Hampshire County Council
		Social Care Policy Review Committee						Item: 12
		30 March 2005
		Progress Report of ENHANCE Nursing Care Investment Strategy
		Report of the Director of Social Services
Contact:			Gill Duncan	Ext:	833018	E-mail:	[email protected]

1 Objective

1.1 The purpose of this report is to inform the PRC members as to the progress of the Enhance Nursing Care Strategy and of the recommendations that are for approval by the Executive Member for Social Care. It provides information on key issues and areas of progress.

2 Background

2.1 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 lead by the County Council in partnership with local NHS organisations 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.

2.2 This project 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.

2.3 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).

3 Buildings

3.1 The overall development programme is to deliver the first 300 beds (six new build schemes) between Christmas 2004 and the end of May 2005; and for the full 500 new beds by early 2006.

3.1.1 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 early 2006, and within the capital development budget of 60 million.

3.1 Development Programme / Progress:

3.2.1 We are now regularly reviewing the completion programmes for the first six schemes in the light of experience gained on the first two, at Ticehurst and Hawthorne Court. This involves close working between Property, Buildings and Regulatory Services, Social Services and the contractors to co-ordinate the completion and handover arrangements.

3.2.2 Pressure to complete the first two schemes has impacted on the other projects regarding subcontractors priorities and resource allocation. This will impact on the completion dates for the schemes at Oakridge House, Marlfield, and Fleming House.

3.2.3 The programmes for all schemes have been reviewed and updated and are included in the development schedule appendices. They make allowance for a best estimate of the impact of the subcontractor pressures.

3.2 The quality of design and standard of workmanship are achieving our expectations, with very positive feedback from Social Services and other stakeholders at the Hawthorne Court open day.

3.3 The contract for Bickerley Green is let and work commenced before Christmas, and procurement is well advanced on Westholme and Emsworth House.

3.4 The last three sites are also more problematic to develop, particularly the restricted access arrangements for Westholme and the site enablement works at Tatchbury Mount.

3.5 The project is still at its most intense period with the first six schemes coming to completion including the handover/commissioning periods, the extended procurement process for the last three schemes, and the finalisation and commencement of the first four refurbishment schemes.

4 Eligibility and admission to Nursing Home Beds

4.1 At a locality level there has been close working to identify the individuals who are priority for admission to the new nursing home beds. This has involved close partnership working with Health to ensure we are delivering the stated aim of increasing long term nursing capacity which will assist in reducing delays in hospital. In the first phase therefore, the priority for admission of residents to the nursing home beds will be for those who have been waiting in hospital as delayed discharges awaiting nursing home placement or for those that have been placed in interim, short-term nursing placements.

4.1.1 Assessed through the care management process using the Social Services eligibility criteria for Older People.

4.1.2 Hampshire Residency as defined through ordinary residence rules as set out in Circular LAC 93/7

4.1.3 Registration with a General Practitioners within one of the seven Primary Care Trusts who are our partners as determined by the Section 31 Agreement.

4.2 This sets out the overall framework for admission and eligibility which allows us to apply consistency but also should be seen in our overall approach to care for Hampshire residents which is based on all referrals being treated on an individual basis.

5 Finance

5.1 Charging for the social care element of the in-house nursing provision will require financial assessments based on the nationally determined guidelines (Charging for Residential Accommodation Guide, CRAG) which is applied to the in-house residential provision and clients placed in independent sector accommodation.

5.2 The funding for the ENHANCE project has been based on planning for the required allocations including budgeting for the estimated levels of client contributions and income from the NHS funded nursing care contribution (RNCC).

5.3 The full year actual costs of running the homes will not be available until the review of charges for 2006/07, therefore, an initial charge to cover the estimated full cost of a placement has been based on budgeted levels:

Mandatory/National Charge	Proposed charge 2004/05	Effective Date	Proposed charge 2005/06	Effective Date
Nursing Care for Older People	£399.00	Feb 05	£420.00	April 05

These charges will be reviewed annually as part of the departments normal review of charges.

6 Recruitment

6.1 Overseas Recruitment:

6.1.1 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.

6.1.2 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. These nurses are now working in the units that are opening in the first phase.

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

6.2 Recruitment of Care staff:

6.2.1 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.

6.3 In order to meet this demanding target a range of approaches has been developed including partnership working with Southampton Care Association - Intercare Europe (SCA) to provide 2 distinct services.

6.3.1 The first is the recruitment and selection of care staff from Europe which also includes an initial induction into the UK. SCA will select suitable candidates, vie their Intercare Service Europe, for referral to the Department.

6.3.2 The second service is that SCA Intercare will supply and finance housing and associated costs, cultural support and education for the staff concerned.

6.3.3 To date a total of 30 care staff have been recruited to the homes in Aldershot, Basingstoke and Andover.

7 Care Governance

7.1 The structures and process to support Clinical/ Care Governance have been established across Residential/ Nursing care and have been integrated into the staff induction programme.

7.2 The operational procedures and protocols are complete and we have adopted the Royal Marsden manual for Nursing Procedures and will be adopting an established NHS Infection Control set of Guidelines. These are in addition to the Residential/ Nursing Care Practice manual.

7.3 Care Governance is to be supported by a new Care Governance Reporting process that is integrated into the new Hampshire County Council Incident reporting system. This will enable us to record all incidents within residential/ nursing units, taking immediate management action and monitor trends. This will be fully implemented by September 2005.

8 Information Technology

8.1 The Nurse Call and Management I.T. system will provide the essential I.T. functionality for the management of records, medication, and key aspects of Clinical Governance such as risk assessment and clinical audit.

8.2 The funding for the Nursing Management system was approved by the cabinet in December. Implementation is being phased with the contingency system in place for the first 3 homes.

8.3 The management IT system will provide:

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

8.3.2 More efficient processes and improved data accuracy;

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

8.4 Nurse Call System:

Vivatec has been awarded the contract for the Nurse Call and Resident monitoring system. This is installed in Hawthorne Court and Ticehurst and has been supported by a full training and implementation package. This technology is a nurse call system and also enables us to monitor the health, safety and well-being of residents. These 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 is vital in assisting staff in providing the highest level of care and safety of environment to the residents.

9 Operational Delivery

9.1 Site specific:

9.1.1 Hawthorne Court

The first residents have successfully been admitted to Hawthorne Court and we are now working towards the first 30 residents. An Open Day was held on 28 January, when the Leader, elected members of the County Council, and representatives from the Strategic Health Authority, Department of Social Services and the Design Team were given the opportunity to attend a preview of the new nursing care home.

The official opening was held on Wednesday 9^th March and was hosted by the Leader Ken Thornber with the Lord Lieutenant Mary Fagan J.P. performing the formal opening ceremony.

9.1.2 Ticehurst

The residents have successfully transferred from the residential accommodation and the refurbishment programme has commenced. Planning is now underway for admission of the first nursing care residents.

9.1.3 Oakridge House / Fleming House / Marlfield / Willow Court

These are reaching final stages prior to formal completion and handover. The staff group are receiving their induction and training programmes.

10 Diversity Statement

10.1 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.

11 Recommendations

The committee are asked to note the progress report and the recommendations that are for approval by the executive member for social care these being:-

11.1 The executive member is asked to approve the priority for admission of prospective residents and the eligibility criteria for the Hampshire County Council nursing home beds as set out in Section 2. of the report.

11.2 The executive member is asked to approve the initial charges that are detailed in Section 3. of the report.

11.3 The executive member is asked to receive the progress of the nursing care investment strategy which is on target for Phase One implementation.

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 or confidential information as defined in the Act.

NONE.

HOME	OPMH	GN	TOTAL No. BEDS	No. OF NURSING BEDS AVAILABLE DURING REFURB. (with date WHEN REFURB. STARTS)	No. BEDS FULL CAPACITY DATES	RESIDENTIAL CARE			TOTAL COMBINED BEDS
						CURRENT	REFURB	FINAL
TICEHURST	20	28	48	19 DE (E) APR 2005	NOV 2005	45	28 FEB 2005	38	86
HAWTHORNE COURT	50	30	80	MAR 2005 NURSING HOME READY	OCT 2005 Or earlier	-	-	-	80
OAKRIDGE	20	28	48	19 DE (E) JUN 2005	NOV 2005	38	28	34	82
WILLOW COURT	30	36	66	JUN 2005 NURSING HOME READY	DEC 2005	-	-	-	66
MARLFIELD	20	20	40	15 (GN) JUN 2005	JAN 2006	37	24	34	74
FLEMING HOUSE	30	-	30	No nursing beds MID MAY 2005	DEC 2005	29	25	25	55
BICKERLEY GREEN	-	30	30	No nursing beds OCT / NOV 2005	AUGUST 2006	42	23	30	60
WESTHOLME	30	-	30	No nursing beds APR 2006	OCTOBER 2006	41	29	38	68
EMSWORTH	28	20	48	19 ( ? ) APR 2006	OCTOBER 2006	36	28	31	79
TATCHBURY	40	40	80	-	MARCH 2006	-	-	-	80
TOTALS	268	232	500			268 __	Loss = 38	230 __