Agenda item

The Cabinet Member(s) will update the Panel on any relevant issues. Panel members may ask questions on the update provided.

Councillor Alison Born, Cabinet Member for Adult Services addressed the Panel and highlighted the following areas from her update report. A copy of the update will be attached as an online appendix to these minutes.

Death Rate in Local Care Homes

Figures published on the second wave of Covid infections showed B&NES to be an outlier in that a high proportion of local Covid deaths occurred in care homes with a low proportion occurring in hospital. This was investigated by Public Health and Prevention who identified:

·  During the second wave, B&NES had a lower rate of cases of COVID-19 and a lower death rate than the England average

·  Nearly all deaths from COVID-19 in B&NES during the second wave occurred in either a care home or hospital, with a small number occurring at home. 

·  The rate of deaths in local care homes was higher than the England average

·  The rate of deaths at the Royal United Hospital was lower than the England average

For some years B&NES has been ahead of many other areas in ensuring that care homes are well supported by a dedicated GP service and that proactive work is done with care home residents, to plan choices for care and treatment in the event of a future severe illness. This has enabled more people who chose to, to have a dignified death at homeand has reduced the number of admissions to hospital where treatment is unlikely to affect the outcome.

This resulted in emergency admission rates from care homes to hospital being much lower in B&NES than in neighbouring areas for a number of years prior to the pandemic and that continued during the pandemic.

The above information confirms that the overall death rate from COVID in B&NES has been lower than average.

To supplement this analysis, the public health team also commissioned an independent Applied Research Collaboration, ARC West to undertake additional research in local care homes to identify any factors that were associated with COVID-19 cases and deaths.

The findings of the ARC research have been delayed to allow for further staff interviews to take place, in the meantime, an interim report is available on the B&NES Strategic Evidence Base Document Library.

B&NES Managed Care Homes

There is a comprehensive action plan to address the concerns identified by the CQC relating to Charlton House and good progress is being made but I thought it would be useful to share some of the issues identified in a recent report by Care and Support South West which summarised the challenges that providers across the South West (and indeed, the rest of the country) are facing. These include:

• Problems recruiting and retaining staff with local turnover rates far exceeding the national average of 15%. This is a particular problem for management and clinical lead roles.

• Over reliance on agency staff, with agencies filling shifts for many providers on a daily basis. This is very costly and impacts on continuity, reducing the quality of the services provided

• Managers having to cover shifts so not having the time to manage services effectively. This reduces their ability to embed effective systems and to improve services.

• Services reducing or closing, with knock on effects for those with care needs their families and for other health and care services

Staff in the Care sector work with these challenges on a daily basis and the shortage of people available to work in leadership roles played a significant part in the problems experienced in Charlton House.

A major factor in the progress we are making at Charlton House is that we have been able to recruit an experienced manager who came into post just before the January meeting of this group. We were still struggling to recruit to clinical leadership roles and were reliant on agency nurses until the RUH agreed to second one of their senior nursing staff across to us. She also came into post in January and she and the new registered manager are working together to address the long standing structural issues at Charlton house.

The new leadership has also helped attract more staff into the service which is key to sustained improvement. However, we cannot under-estimate the scale of the ongoing challenge in providing high quality care services. The new Panel, under the next administration may wish to receive regular updates on this subject.

Councillor Liz Hardman asked if there were known to be any particular reasons for the high percentage of staff turnover and was it related to pay.

Councillor Born replied that this had been something that they had been assessing and said that staff were now receiving an extra £2 per hour. She added that it was felt that the rates paid now were favourable in comparison to the rest of the sector.

Councillor Joanna Wright asked what the data was for people who have died at home within B&NES.

The Associate Director for Public Health replied that very few deaths occur at home, around 4%.

Kevin Burnett said that it was good to see that the Clinical Lead role was making an impact and asked if any thoughts have given to the overall structure of the service.

Councillor Born replied that there is a CRC Manager in place with an overall Operational Manager working above them. She added that each home has its own individual manager. She said that it was possible that a new model may be devised in the future following further clinical input.

Kevin Burnett asked if the ICB had a role in this area of work.

Councillor Alison Born replied that they have more of a commissioning role.

Laura Ambler, BSW ICB Director of Place Bath and North East Somerset added that they are working with both the Council and the RUH in terms of sharing resources and upskilling of staff.

Councillor Andy Wait asked what the next stage in the process would be for the CQC to return to Charlton House.

Councillor Born replied that they are expected to make a return visit and would do so whenever they want to.

The Chairman asked if the voluntary sector were being required to re-tender for all their current contracts. He believed that there were around 100.

Councillor Born replied that this was part of changes being made to the Community Health and Care Service, although these had not taken place yet. She added that discussions have been held with representatives of the voluntary sector regarding the potential that further tendering would be required.

The Chairman explained that although Councillor Dine Romero, Cabinet Member for Children and Young People, Communities was unable to attend she had submitted a written update and asked if the Panel had any questions.

Councillor Liz Hardman referred to Secondary School Admissions and asked what happens if a child is not allocated a school place.

The Director of Education & Safeguarding replied that should they wish to the parents can make an appeal to get a place at their preferred school. He added that through the allocation process this year no child is without a school place.

Kevin Burnett asked if there were any other areas of service that could benefit from following the path that Youth Connect South West has taken.

The Chairman asked for Councillor Romero to respond in due course.

Councillor Gerry Curran addressed the Panel regarding Bath Opportunity Playgroup (BOP) and its proposed move from Odd Down, Bath to Broadlands School in Keynsham. He explained that BOP was founded 30 years ago to support local families and that he was aware that some staff and families using the service were unhappy about the move.

The Director of Education & Safeguarding replied that BOP is a service that supports families within the whole of B&NES and that he was aware that the commissioner has been meeting with parents. He added that as part of the proposed move an extra 30 spaces will be able to be provided at Three Ways School.

Councillor Curran said that he remains disappointed and would welcome the Panel input on such a decision. He added that he was concerned that Bath families would be losing access to such experienced staff. He asked if it was an option to use the Culverhay site for this service.

Councillor Andy Wait referred to plans for a future Special School in Keynsham and said that he was not a fan of the bidding process involved. He asked if it was known what money could be drawn down from Government for this project.

The Director of Education & Safeguarding replied that the opportunity to run the school would be listed on the Create:Schools website. He said that any contribution from the Local Authority would only be required for excessive costs, for example, if any new roads were required.

He said that a final decision regarding the Special School was likely to be made by DfE, but he hoped that the Council would be able to have some input. He added that this stage he did not know of a defined amount of money for the project.

Councillor Andy Wait asked if he knew of a timeframe for the project.

The Director of Education & Safeguarding replied that this was dependant on elements such as Land Searches and Planning. He said that as provisional date the school might be open by September 2025.

The Chairman thanked the Cabinet Members for their updates on behalf of the Panel.