Residential and nursing care

Calderdale Council conducted a Fair Cost of Care exercise with providers of homecare and older peoples residential and nursing care. This was undertaken in 2022 and the results were submitted to The Department of Health and Social Care in October 2022.

The exercise took into account the cost pressures of providing social care. Through engagement with the local market, figures were produced showing the cost to deliver care in Calderdale. The results of this will be used to set future fees, along with other factors, such as inflation.

• Cost of Care report on 65+ care homes.(PDF 232KB)
• Cost of Care report on domiciliary/homecare(PDF 149KB)
• Calderdale Market Sustainability Plan March 2023(PDF 192KB)

Calderdale's younger adult's community had the chance to take part in their care home model. This model came into effect on 1st October 2022.

• Younger Adults Care Home Engagement Report 2022(PDF 258KB)

Engagement and participation is an integral part of commissioning work. Commissioners focus carefully on enabling people to play an active and influential part in the decision process.

The aim of this engagement was to make sure that stakeholders had the chance to take part in a meaningful way on Calderdale's older people's care home model. This will come into effect on the 1st October 2022. It will be designed around the needs of older people aged 65+ who live in a Calderdale residential or nursing home which:

• Provides safe and personalised care;
• promotes choice;
• dignity;
• control;
• and quality of life for all residents.

This report describes a process which was undertaken to engage people who live, work, are a relative/friend or are a health and social care professional, connected to an older people's care home. Everyone's opinions, personal experiences, thoughts and feelings have been collated under the findings section and will inform a joint Calderdale Council and NHS Calderdale CCG older people's care home strategy and service specification.

This piece of engagement was led by Calderdale Councils Commissioning Engagement Officer, in partnership with the NHS CCG Senior Engagement Manager.

In October 2021, when this piece of work began there were 552 residents permanently living in 29 Calderdale older people's residential / nursing care homes, which are supported under contractual arrangements with both Calderdale Council and NHS Calderdale CCG.

What we set out to achieve

• To give people who live, work, are a relative/friend or a HSC professional connected to a care home the chance to;
  • Help influence how care home provision and services are shaped.
  • Through learning and listening to their views and experiences.
  • So that we understand what really matters to them.
• To communicate clear and simple messages in an accessible format using 'Think Local Act Personal (TLAP)' appropriate engagement approaches to engage all stakeholders.
• To reach our diverse communities and protected groups.
• To hear the voice from those who may have had a disproportionate and serious impact from COVID-19.
• To have a coordinated approach to engagement across care home provision.
• To ensure communications are timely, consistent and coordinated.
• To make good use of what we already know through conversations that have already taken place.
• To ensure the engagement is captured accurately to use the intelligence to inform future care home provision and models of care.
• To ensure any engagement and equality is delivered in line with current legislation.
• To feedback to people the outcome of this engagement activity.

What we achieved

We heard the views and opinions from:

• 16 Residents.
• 17 Health and Social Care professionals.
• 73 Relatives/Friends.
• 78 Care Home Staff.

Participants were given the option to name the care home, they were speaking about or to not use the name for those participants preferring not to say. The name of the care homes that have been identified as part of this piece of engagement were:

Show care homes

We gave people who live, work, are a relative/friend, or are a health and social care professional connected to a care home a platform and opportunity to help influence how care home provision and services are locally shaped. The main approach was by working in partnership with existing services and using current mechanisms which enabled us to reach the agreed target audiences (residents, staff members/Health and Social Care professionals and relatives/friends). This approach was agreed by Calderdale's Care Homes Commissioning Workstream as the main facilitator with help and support from all partners which included the NHS CCG, Local Authority and the Voluntary and Community Sector.

Due to the nature of this piece of engagement, it felt that talking to those who live in an older person's care home needed a face-to-face conversation. Asking questions about someone’s home is potentially a sensitive subject. It needs to be handled with care and diplomacy by trusted people who know the person and understand them and their needs. So, we asked for support with this part of the engagement exercise from care home staff, relatives and friends, social workers and/or other professionals who visit the residents in their homes.

We had a limited scope to engage with people using face-to-face methods. This was due to restrictions around the ways, we could work during this period of the pandemic. Although we used a range of methods to collect feedback, we recognise and acknowledge the challenges and barriers of reaching people. Every effort was made to make sure we engaged with all our communities, which made sure we got a wide range of views.

Four individual surveys were co-produced with experts by experience. This included five relatives of people who live in a care home, an experienced Social Worker and two members of recently retired Care Home staff with years of experience in local care homes across Calderdale.

Clear communication channels were formed through simple, accessible messages using a variety of approaches. These approaches included: emails, phone calls, social media posts for the use of multi social media channels, publicity for service bulletins and newsletters and attendance from the Commissioning Engagement Officer to online team meetings and Care Home Managers forums. An offer to hold separate digital or face to face focus groups for all four targeted audiences was also given but was not taken up during the period of time when the engagement was live.

• The surveys were hosted on a platform called 'You Can Say'.
• They were also shared on our consultation database 'Engage'. This is where information on projects is registered and uploaded to both the Internet and Intranet for Council staff and public with an active interest to be notified and given the chance to take part.

Council, NHS CCG and Voluntary/Community Sector colleagues all reached out to many of our diverse communities and protected groups. This was by:

• Promoting the consultation at Multi agency partnership meetings;
• through existing distribution lists;
• and extensive communication channels.

A joint engagement plan was agreed and signed off at the Care Homes Commissioning Workstream, which provided a coordinated approach to this piece of engagement across care home provision. The engagement plan included a timeline which ensured that all the communications were timely, consistent and coordinated. There was a scoping exercise, where recent intelligence on care home provision was gathered from various organisations. This was used as knowledge and baseline evidence on what conversations had already taken place in this area of work.

Through robust analysis all the engagement has been captured accurately. The intelligence, as raw data has been given to the lead Commissioner who will use this to inform the future provision and model of care homes going forward.

Findings

We received 100% of equality monitoring across each of the target audiences. We also made sure that the engagement and equality being delivered was in line with current laws.

Due to the size of the four questionnaires, the lead Commissioner agreed that this report would highlight the key findings. We use the CQC 5 key standards as headings, which are: Safe, Effective, Caring, Responsive and Well-led.

Safe

• 100% (residents) said they strongly agree or agree they felt safe in their home.
• 89% (relatives/friends) said that they strongly agree or agree that their relative or friend is safe.
• 96% (care home staff) said they strongly agree or agree that they support the residents to feel safe.

Effective

• 94% (residents) said they strongly agree or agree they feel as independent as they can be.
• 53% (residents) said they strongly agree or agree they spend their time doing the things that they enjoy.
• 94% (residents) said they strongly agree or agree that the staff support them to be active.
• 81% (relatives/friends) said that they strongly agree or agree that their relative/friend receives the support from staff to be as independent as they can be.
• 58% (relatives/friends) said that they strongly agree or agree that their relative/friend spends time doing the things that they enjoy.
• 74% (relatives/friends) said that they strongly agree or agree that the staff support their relative/friend to keep as active as they can.
• 96% (care home staff) said they strongly agree or agree that they encourage and motivate residents to be independent.
• 94% (care home staff) said they strongly agree or agree that they encourage residents to spend time doing what they enjoy.
• 95% (care home staff) said they strongly agree or agree that they encourage residents to be active and move more.
• 63% (HSC professionals) said they strongly agree or agree that in the main residents are motivated to be independent as much they can.
• 31% (HSC professionals) said they strongly agree or agree that in the main residents are encouraged to spend time doing what they enjoy.
• 31% (HSC professionals) said they strongly agree or agree that in the main residents are encouraged to be active and keep moving.

Caring

• 88% (residents) said they strongly agree or agree they feel valued.
• 94% (residents) said they strongly agree or agree they feel they are respected.
• 94% (residents) said they strongly agree or agree their support and care needs are being met.
• 79% (relatives/friends) said that they strongly agree or agree that their relative/friend are valued.
• 79% (relatives/friends) said that they strongly agree or agree that their relative/friend are respected.
• 90% (relatives/friends) said that they strongly agree or agree that they felt their relative/friends support and care needs are met.
• 100% (care home staff) said they strongly agree or agree that they show dignity and respect to residents.
• 79% (care home staff) said they strongly agree or agree that they have the time to meet the resident's individual needs.
• 100% (care home staff) said they strongly agree or agree that they go the extra mile to make the residents feel worthy and important.
• 69% (HSC professionals) said they strongly agree or agree that in the main residents are valued.
• 81% (HSC professionals) said they strongly agree or agree that in the main residents are shown dignity and respect.
• 81% (HSC professionals) said they strongly agree or agree that in the main residents' individual needs are met.

Responsive

• 71% (residents) said they strongly agree or agree they know who to speak to if they have a concern and know that it will get dealt with appropriately.
• 65% (residents) feel involved in decisions about their life.
• 88% (residents) said they strongly agree or agree the staff know them well.
• 79% (relatives/friends) said that they strongly agree or agree that they know who to speak to if they have a concern and that it will get are dealt with appropriately.
• 63% (relatives/friends) said that they strongly agree or agree that their relative/friend is involved in decisions about their life.
• 85% (relatives/friends) said that they strongly agree or agree that the staff support my relative/friend to keep well.
• 95% (care home staff) said they strongly agree or agree that they know who to speak to if they have a personal concern and that it will be dealt with appropriately and in a timely manner.
• 88% (care home staff) said they strongly agree or agree that they involve residents in decisions being made about their lives.
• 87% (care home staff) said they strongly agree or agree that they ensure they keep relatives informed of any changes or incidents that have occurred.
• 94% (HSC professionals) professionals said they strongly agree or agree that they know who to speak to if they have a concern about a resident and that it will be dealt with appropriately and in a timely manner.
• 75% (HSC professionals) said they strongly agree or agree that where appropriate, they involve relatives/friends in decisions about resident's care and support.
• 69% (HSC professionals) said they strongly agree or agree that in the main they feel residents are involved in decisions being made about their own life as much they can be.

Well-led

• 94% (residents) said they strongly agree or agree they are not discriminated against in any way because of my gender, ethnicity, religion, sexual orientation, age or disability.
• 88% (residents) said they strongly agree or agree that the staff know them well.
• 90% (relatives/friends) said that they strongly agree or agree that they felt their relative/friend is not discriminated against in any way because of gender, ethnicity, religion, sexual orientation, age or disability.
• 92% (relatives/friends) said that they strongly agree or agree that the staff are approachable.
• 82% (relatives/friends) said that they strongly agree or agree that the management are approachable.
• 79% (relatives/friends) said that they strongly agree or agree that they are kept informed of any changes or incidents that happen.
• 97% (care home staff) said they strongly agree or agree that they are not discriminated against in any way because of my gender, ethnicity, religion, sexual orientation, age or disability.
• 88% (care home staff) said they strongly agree or agree that they contribute to decisions in work.
• 99% (care home staff) said they strongly agree or agree that they have received sufficient training to fulfil their role.
• 100% (HSC professionals) said they strongly agree or agree that they as professionals visiting the care homes are not discriminated against in any way because of their gender, ethnicity, religion, sexual orientation, age, or disability.
• 68% (HSC professionals) said they strongly agree or agree to their knowledge residents are not discriminated against in any way because of their gender, ethnicity, religion, sexual orientation, age or disability.
• 88% (HSC professionals) said they strongly agree or agree they have good relationships with staff.
• 94% (HSC professionals) said they strongly agree or agree they a good relationship with the manager.

Conclusion

It is important to note that when this consultation was carried out, there were national and local restrictions in place.

• The advice was that people work from home, where necessary;
• and only meet face-to-face with vulnerable people if it was essential.

Due to these restrictions, we had to rely on social media platforms, Council/NHS colleagues and the Voluntary/Community Sector to:

• Help distribute the survey link;
• and communications virtually to those who they were in contact with.

We feel that without face-to-face guidance and a full explanation on why people were being asked to take part in this survey the overall reach and number of responses we received has been negatively impacted.

It is vital that residents in care homes, feel that they are safe, secure and their needs are being met. The feedback was:

• 82% were happy where they live.
• 100% felt safe.
• 94% said their support and care needs are being met.

It is also important how relatives/friends feel about their loved ones being safe, secure and their individual needs being met. The feedback was:

• 89% felt that their relative/friend was safe.
• 82% felt that their relative/friend is happy where they are.
• 90% felt their relative/friends' support and care needs are being met.

It is important that the care home staff feel supported, valued and recognised for the care work they give to the residents. The feedback was:

• 92% feel supported by their management.
• 88% feel they contribute to decisions in work.
• 92% have job satisfaction.

These report findings highlighted improvements are needed in the choice of activity being provided to residents.

• Only 53% of residents felt they spend their time doing things they enjoy.
• 59% of residents saying the choice of activity interests them. This mirrored how relatives/friends felt with 58% saying they felt their relative/friend spends time doing things they enjoy.

Next Steps

• This report will be shared with the Care Homes Commissioning Workstream and Care Homes Programme Board and distributed across all Calderdale older people's care homes and Health and Social Care staff. As part of the engagement process, it is paramount that the people who have engaged in this process are provided with the overall feedback and outcomes of the engagement activity.

Recommendations

• All the raw data provided, to be looked at and responded to by:
  • The Care Homes Commissioning Workstream;
  • Integrated Commissioning;
  • Contracts and Quality;
  • Quality Team;
  • and Business Relationship Managers.

    (This includes all written comments made by residents, relatives/friends, health and social care professionals and care home staff.)

• Via the Care Homes Commissioning Workstream. To establish a small task and finish group to look at key themes and develop an action plan to address the areas raised.
• For the Care Homes Commissioning Workstream. To make sure that feedback is represented within the development of the Older People's Care Homes Specification.

Thank you for having your say on Calderdale's older people's care homes.

Your views, opinions and comments have been read and taken seriously by Calderdale Council and NHS, Clinical Commissioning Group.

We want you to be confident that the care and support people receive is of high quality. Also, that every person is safe and treated with dignity and respect.

Key findings

Residents told us:

• 100% - feel safe.
• 82% - feel happy where they live.
• 94% - get their support and care needs met.
• 53% - spend their time doing things they enjoy.
• 65% - feel involved in decisions about their life.

Relatives and friends told us they feel that their relative/friend(s):

• 89% - is safe.
• 82% - is happy where they live.
• 90% - support and care needs are met.
• 58% - spends time doing the things that they enjoy.
• 63% - is involved in decisions about their life.

Care home staff told us they feel that they:

• 92% - are supported by their management.
• 88% - contribute to decisions in work.
• 92% - have job satisfaction.
• 94% - encourage residents to spend time doing what they enjoy.
• 100% - go the extra mile to make the residents feel worthy and important.

Health and social care staff told us they felt that:

• 31% - in the main residents are encouraged to be active and keep moving.
• 94% - they have a good relationship with the manager.
• 81% - in the main residents' individual needs are met.
• 31% - in the main residents are encouraged to spend time doing what they enjoy.
• 69% - in the main residents are involved in decisions being made about their own life as much they can be.

What happens next

What the Council and NHS Clinical Commissioning Group are doing with what you told us:

• A report that is available to you, has been written which includes further findings from the surveys. See: Older People’s Care Home Engagement Report 2022.
• A meeting with different professionals has been organised to look at key themes from the survey feedback.
• Focussed feedback sessions will be arranged with care homes to share and learn from the feedback shared with us.
• Key findings have been considered and improvements made where needed to the older people's care homes service specification. This will be part of the contract's terms and conditions, that care home providers have to meet in the future.