Agenda item

This report provides members with an update on how the service has performed since transfer in April 2017 and its progress towards delivering the transformation that was part of the Your Care Your Way procurement.

Kirsty Matthews, Managing Director – Bath and North East Somerset,

Virgin Care Services Limited introduced this report to the Panel and highlighted the following areas from within it.

She stated that she had been in her role for two years and said that she was proud of all her colleagues within Virgin Care who work very hard.

She explained that the Bath and North East Somerset Community Health and Care Services, provided by Virgin Care, went live on 1 April 2017. The contract brings together community health and care services to deliver the objectives of Your Care, Your Way (YCYW), a document which was compiled by the Council and NHS Bath and North East Somerset Clinical Commissioning Group (CCG) over the previous two years through consultation with local people.

Under the contract, Virgin Care is responsible for the direct delivery and sub-contracted delivery for approximately 200 community services.

She said that overall, the service is performing well against both local contractual and national indicators, with significant performance improvements noted in a number of areas. Performance of the service is monitored at both local and national level, as well as by commissioners at the Council and CCG.

She informed the Panel that there have been a number of significant improvements in service performance since the transfer in April 2017, including:

·  The average length of stay on rehabilitation wards at Paulton and St Martin’s Hospital has reduced from 36 days at point of transfer to 28 in 19/20, despite increased complexity of the patients admitted. This length of stay is now in line with the national average for these types of services and brings significant benefits for patients by enabling them to return home, with support, and live as independently as possible.

·  Safeguarding performance has significantly improved. Decisions taken within 4 days has increased from 48% in 17/18 to 88% in 18/19. Planning meetings being held within 10 days has increased from 32% in 17/18 to 77% in 18/19

·  Continuing Health Care assessments completed within 28 days has risen from an average of 23% completion in 2017 when Virgin Care took on the contract to an average of 73% this year, and 100% in August 2019.

·  Virgin Care has worked with Royal United Hospitals, Wiltshire Health and Care and Somerset Partnership Foundation Trust and commissioners to deliver the Home First pathway. This was recognised with a Parliamentary award for Excellence in Urgent and Emergency Care in 2018.

·  A new service was developed with the Royal United Hospitals and South West Ambulance Service, a ‘falls pick up service‘ which provides an early response to people who have had a fall within their own home and avoids them having to go to hospital. Initial outcomes from this service show that 70% of people who were supported in this service were able to be instead managed in an outpatient setting

·  Bath and North East Somerset is now among the top performers for delivery of the Healthy Child Programme. This has improved from 82% compliance with national standards for 14-day visits at the point of transfer, to 94% in 19/20.

·  As of August 2019 the overall staff sickness rate is 2.76% which compares well to the average NHS staff sickness rate of 4.51% (February 2019 data).

·  Our staff turnover data is 12.68% on a monthly average rolling year to date basis, this figure includes retirees

She stated that IT services are essential to the ongoing positive performance of health and social care services. Virgin Care mobilised a new network and equipment following the transfer of services from Sirona and while the fast rollout of the system caused widely reported issues these were resolved during the first year of the contract (17-18).

There are number of areas of the transformation programme that technology continues to support to meet the Your Care Your Way objectives of joining up the information and these include; a new referral management solution, the deployment of an integrated care record and the provision of mobile working.

She said that Children’s Services delivered as part of the contract are consistently high performing, both against national benchmarks and the Key Performance Indicators set by the Council and NHS.

Virgin Care, through its learning and development arm, The Learning Enterprise – an Ofsted registered apprenticeship provider with the Skills for Health Quality Mark – will launch four new Social Work apprenticeship roles in October. These degree-level programmes will allow Bath and North East Somerset to “grow its own”, provide career development opportunities, helping to secure the future of a stable adult social work service into the future.

The performance of the service is significantly improved since it transferred to Virgin Care in 2017 and continues to be on a trajectory of further improvement. At the time of transfer, 72 needs assessments per month were taking longer than 28 days. At the time of writing, just 3 per month take longer than 28 days. 

Virgin Care provides a number of services to support health and wellbeing in Bath and North East Somerset.  This is both by directly providing the services and through sub-commissioning with a large number of third sector providers across Bath and North East Somerset.

She explained that with the introduction of Primary Care Networks, Virgin Care are working with primary care, with Developing Health and Independence (DHI) and Village Agents, amongst many others, to develop the local offer for social prescribing. This will be launched this winter and will form part of Wellbeing Bath and North East Somerset. It supports a key principle for Your Care Your Way of living and staying well and delivering care closer to the community.

Virgin Care are proactive partners with the third sector in Bath and North East Somerset. This has enabled volunteering services to continue and which is now being directly provided. Virgin Care work closely with Third Sector Groups, 3SG, partners and is supporting Bath Mind to develop a Safe Haven for Mental Health services locally.

She said that recruitment remains a key issue across all services leading to high agency usage in some areas. This is reflected in the national position for all providers of healthcare services. During the summer, Virgin Care held two recruitment open days and these were popular, leading to the recruitment of both new colleagues and additional members of the bank.

She informed the Panel that the Supported Living Services teams in Bath and North East Somerset were inspected by the CQC in 2018, after the transfer to Virgin Care Services Limited. The CQC awarded a “good” rating to the services following this inspection.

No quality performance notices have been served on Virgin Care in the past 12 months. The quality of services has remained of a high standard, and this is reflected in the quality indicators including:

·  Maintaining the proportion of service users receiving ‘harm free’ care as measured by the national Safety Thermometer audit (94.2% in 2018/19 compared to 94.2% in 2016/17)

·  No MRSA Bacteraemia infections in Community Hospitals since 2014

·  An ongoing reduction in the number of acquired pressure ulcers from 281 in 2017/18 to 187 in 2018/19.

·  The number of falls reported in community hospital wards is reducing over time, as a result of proactive work to reduce risk. The reduction has been from 104 between April – August 2018 to 88 between April – August 2019.

Virgin Care established its Citizens’ Panel engagement network during its first year of the contract and has continued to engage with local people through this panel, while also seeking to grow membership which, at time of writing, stands at just over 100 active members. This group of users engages with service change programmes and supports Virgin Care to ensure proposals for change work to the advantage of service users and meet local people’s needs.

2019-20 is year 3 of the contract, and as such the transformation programmes have gathered pace and are now substantially progressed.

Care co-ordination (CCC) – The delivery of a care co-ordination centre which works across Bath and North East Somerset, and conducts many of the administrative functions previously carried out within each individual service, is an essential enabler of providing joined-up and resilient services. The service is now in phase 2 of its deployment with wellbeing services co-located alongside some social care colleagues and adults health professionals as well as administrative support.

Mobile working – Alongside the care co-ordination centre, mobile working allows us to maximise the time teams have to be with service users directly by cutting down on travel and duplicated note-taking. Virgin Care has deployed over 400 devices to enable colleagues to work closer to people’s homes and spend as much time face to face with people as possible. In some teams this has resulted in an increase of over 20% time spent with the people they support.

Virgin Care is working with key partners across Bath and North East Somerset to introduce an Integrated Care Record (ICR) within the area and more widely.

The ICR will collate information on an individual’s health and care record into a single view, enabling appropriate sharing of information across organisations to support decisions regarding care and serve to ensure that people do not have to repeat their story and history to each care provider they see.

The ICR will be used to share information between Royal United Hospitals Bath NHS Foundation Trust, Bath and North East Somerset Council, Avon & Wiltshire Mental Health Partnership NHS Trust, Virgin Care’s Bath and North East Somerset Community Health and Care Services, Dorothy House Hospice and up to 30 GPs.  Each organisation will have access to a single record that can be viewed independently or from within an existing system.

The programme to integrate records from various systems is well established and the technical implementation has been successful both for community health records and social care. The programme is working towards full systems implementation by the end of the calendar year.

Access to the system will be released in October and the first teams to access will be the colleagues who support frailty within Virgin Care and RUH Emergency Department.

Colleague engagement and morale is always impacted by significant change and, following the transfer of employer in 2017, the significant, lengthy and ongoing change programmes have reduced engagement and morale across some services.  Virgin Care has, and is, committed to taking steps to improve. This is measured through the annual Have Your Say staff survey, which mirrors some questions from the NHS National Staff Survey.

During 19/20, Virgin Care is also reviewing its staff engagement programmes. The Partnership Forum will be repurposed, increasing its effectiveness as a colleague consultation forum; managers will continue to be supported and trained to ensure they are as effective as possible. Kirsty Matthews and the Senior Leadership Team will hold a series of listening groups across the service, to hear from the frontline. Virgin Care will also focus on improving the quality of conversations at appraisals.

Virgin Care increased recruitment activity during 18-19 and continues to do so during the current year. This work is focused on reducing the use of agency staffing in wards, which not only increases cost but can also reduce the overall quality of services, and on increasing staffing of the “bank” of flexible workers.

She explained that the contract between the Council and NHS CCG with Virgin Care Services Limited runs over the course of seven years with the option to extend to a maximum of ten years. The contract requires a 9% cash saving over the course of the 7-year contract, and the provider’s income is partially dependent on the satisfactory performance of the service.

In 2018/19 after the direct costs of delivery, such as the wages of colleagues and premises, payment of sub-contractors for services commissioned by Virgin Care and a £600,000 contribution towards the costs of centrally provided services (shared back office functions such as payroll and IT), the contract generated an overall loss of £1.4m for Virgin Care.

While transformation is ongoing, in 2019-20 the services are making good progress towards financial sustainability as the benefits of investments made in future years begin to materialise. These investments include the development of the care co-ordination centre, remote working by community teams and other programmes which have supported efficiencies and increased productivity.

Councillor Liz Hardman asked if the recruitment open days that were held were successful and what impact does the use of agency staff have on costs.

Kirsty Matthews replied that the open days were held at St Martins and Paulton for potential staff to visit and see the facilities available within the wards. She added that the conversion rate from those that attended to gaining employment was good. She said that they also actively recruit through NHS Jobs and adverts in professional journals.

Councillor Liz Hardman asked what impact staff morale is having on the recruitment and retention of staff.

Kirsty Matthews replied that change has been the major factor in morale amongst staff with many having been in their role for a number of years. She said that she always enjoyed receiving direct feedback from staff. She added that a lot of changes have taken place, with some still ongoing and that after Year 3 there would be more of a focus on service delivery.

Councillor Liz Hardman asked what is the expected impact of Brexit on recruitment.

Kirsty Matthews replied that she believed that Brexit will affect health care staff both nationally and locally. She said that Virgin Care has a robust plan in place and that a risk register has been produced as part of the plan. She added that an Emergency Planning Lead Officer has been appointed to oversee this work.

The Chairman commented that there were encouraging aspects within the report and that he was pleased to see the profile of Social Workers to be increased. He asked how confident she was on delivering the 9% savings agreed when the contract was awarded given that in Year 2 there was a deficit of £1.4m.

Kirsty Matthews replied that the deficit was due to initial delays in the transformation programme, but said that the delivery of a care co-ordination centre, enhancements in mobile working and staff co-location would lead to savings and that she was confident they could deliver the savings as agreed.

Councillor Jess David asked when the transformation programme was due to be complete.

Kirsty Matthews replied that it is scheduled for the end of Year 3 of the contract.

Dr Ian Orpen, Clinical Chair, BaNES CCG commented that the morale, wellbeing and recruitment of staff within the NHS is a high priority. He added that when in place the Integrated Care Record (ICR) will be a great benefit to both professionals and the public.

Councillor Andrew Wait asked if Virgin Care would be able to achieve a balanced budget for this financial year.

Kirsty Matthews replied that she believed they would.

Councillor Mark Roper asked what were the figures for the previous year in relation to the Have Your Say survey given that his year it is rated at 64%.

Kirsty Matthews replied that the figure the previous year had been 60%.

The Chairman thanked her on behalf of the Panel and said that she could expect to be invited back in 12 months’ time to give a further progress update.