Report of the Clinical Commissioning Groups (CCGs)
The Executive Director Nursing Staffordshire & Stoke on Trent 6 CCGs outlined the approach to quality assurance of key Mental Health and Learning Disability Independent Hospitals and described the mechanisms in place to ensure that patients in Staffordshire and in external provision were safe and receiving the best possible care.
Host commissioner guidance came into effect in January 2021 to oversee systems and quality and to demonstrate they met the criteria outlined.
A CQC review in March 2021 alerted the host commissioner of issues at Eldertree Lodge in Staffordshire, which resulted in management of the situation and closure of the premises. All patients were relocated within timelines and had settled well into new accommodation.
Following this, a gap analysis of processes was undertaken and working arrangements had been strengthened in Staffordshire, in line with the host commissioner guidance to include: patient monitoring every 6-8 weeks; link with placing commissioners; a provider failure operational process as part of the toolkit; face to face site visits to other providers; and a proactive programme of visits regularly taking place across the system. There was acute mental health provider support with specialist mental health patients and good connections with Safeguarding Children and Adults Boards. Some of the processes developed through lessons learned were being shared locally and nationally.
In terms of mental health provision 84 patients were in placement, half in area half out, 21 out of 26 of providers were rated as good by CQC but 2 independent providers were of concern and assurance was given that commissioners were working with them and all 3 patients in placement had received satisfactory safe and well checks.
· following a Covid outbreak at John Munroe Group in Leek, other concerns were identified and CQC carried out a routine visit. An improvement plan has been put in place with regular monitoring visits. CQC had re-visited and John Munroe Group which was subject to further improvements.
· During the pandemic commissioners working from home were not able to carry out face to face visits unless there were specific circumstances. Since Eldertree Lodge failure, face to face visits have been carried out where there was the slightest concern.
· CCG was working on a document with NHS England to capture all lessons learned from Eldertree Lodge failure, highlighting how to manage the situation and to deal with challenges of relocating high level of high-risk individuals.
· Providers were independent providers and it was important to maintain quality and standards, and to ensurepatients who were amongst the most vulnerable residents in Staffordshire had a voice.
· As placing commissioners of a learning disability or autism package of care out of County there was a responsibility to check the individual in placement on a minimum of eight weekly basis.
· Host commissioner guidance placed the responsibility on each of the host commissioners to make sure the organisation was safe, to advise the placing commissioner of any issues and to meet to source alternative placement for individuals, where necessary.
· In terms of mental health facilities out of County, there were regular in person reviews and a blend of working with host commissioners and providers remotely and at least one review in personto ensure safety.
· There was a national scheme for relatives to claim back travel expenses and families could be helped in advance of travel, where possible placement distance was kept to a minimum.
· Staffordshire and Stoke on Trent beds were commissioned from NHS providers where possible; it was considered that there was an over dependence on Independent Mental Health Hospitals in the County and the aim was to reduce in-placement levels and to consider housing association providers in the County.
· Members were assured that positive behaviour support was availablein the community, to train and support the independent sector providers, to bridge between independent hospitals and community placements and to provide a blend of roles and expertise to support individuals.
· For face to face meetings the ‘care programme approach’ and ‘care and treatment reviews’ were used. Service user, provider, family members and carers were all involved. This approach had a support network for individuals and a contract with the provider.
The Chairman thanked presenters for a clear presentation and report.