Agenda item

Report of the Assistant Director for Commissioning. To be introduced by the Cabinet Member for Adults and Health.

 

Report setting out the options for future use of the Osborne Grove Nursing Home site, and seeking approval of the preferred option.

Deputation 2 - Michelle Rodda - Osborne Grove – Agenda Item 11.

 

Michelle Rodda addressed the Cabinet on behalf of the residents, relatives and community participants in the co-design group on Osborne Grove. The report and recommendations were not endorsed. The deputation was concerned that the option preferred by the co – design group had already been discounted in the report.

 

The deputation continued to make the following requests:

 

• A feasibility study that includes a revised option 3 for Osborne Grove to have a 32-bed home with a combined use of long term and intermediate care funded by the CCG to alleviate bed blocking.

 

• Re—establishment of the joint improvement steering group, including CCG membership, to support Osborne Grove achieving a ‘good’ CQC rating this would enable the embargo to be lifted.

 

• Amendment of the recommendations to include feasibility report on revised option 3 which includes keeping the 7 residents in situ and improving standards, lifting the embargo and working with the CCG to provide intermediate care and explore other options.

 

The deputation contested the content of the report and outlined the following:

 

• The future of the 7 residents that were remaining on site was not fully set out.
• Potential privatisation of the enlarged site
• Reference to paragraph 7.20, which advises that the direct provision is not sustainable.

 

The deputation had visited an ‘outstanding’ care home to understand the difference between the provision at Osborne Grove. The physical features of the home had been very similar and the main difference was the better governance procedures in place.

The joint improvement steering group was set up in early 2017 following the CQC inspection and now required a new task. This group could analyse the criticisms from the CQC report to understand the actions that were required to move the home from “requires improvement” to a “good” rating. There was expertise to call on and the deputation felt that, with 3 months of concerted work, this could be achieved. In addition, the Council could seek funding from the CCG to support the improvements.

The deputation recommended the Council wait a further 5 years before expanding the provision at Osborne Grove. The deputation suggested initially running a pilot scheme for the Nursing home to allow focus on quality before expansion.

The deputation advised that Homes with nursing beds above 32 had issues; therefore, it was prudent to initially take a smaller scale provision forward before expanding.

The deputation opposed the discounting of option 3 as although the feasibility may suggest a smaller number of beds, this option was favoured by the co –design group and should be added to the options.

The deputation concluded by urging Cabinet to listen to what the community wants and revise the recommendations to include option 3 without amendment. They advised moving the 7 residents to a wing, to allow negotiation on the site.

The deputation group welcomed their membership of the co – design group but the option that was omitted was useful for nursing care continuing. They felt that the first priority order should be service design and design of the building be a secondary factor. They recommended that option 3, in the alternative options considered section of the report, having a feasibility study completed and questioned how the Council can run 64 beds, if a 32-bed pilot could not be agreed.

The Cabinet Member for Adults and Health responded to the deputation and emphasised that the co -design process was a genuine process and establishing the group was part of building that trust. There had only been an opportunity to hold one meeting of the co-design group before Cabinet due to the need to address the outstanding decision on closure of the Home.

The three main key points of the report were: Home will be retained for the current residents there, the site would be retained for nursing care and there was no outsourcing to the private sector.

The Cabinet Member provided assurances that the co-design group would be meeting on a monthly basis. This was a broad group with a number of stakeholders. The Council would continue the conversation and report back in the autumn with a preferred option.

All the options contained in the report were for the seven residents to remain in the home with appropriate safeguards in place. The Council had an intermediate care offer and the key capacity gap for Haringey and across North Central London was nursing care, particularly for people with dementia. The Council need to increase the availability of nursing care beds not reduce them, over the medium term.

 

The Cabinet Member expressed that, in the scenario where the Council were able at worst to maintain the current number of nursing care beds and at best to increase them, it would consider models where some units in an expanded OGNH would be available for intermediate or rehabilitative care. The Cabinet Member agreed that this was a strong model but only where it did not compromise the number of nursing care beds available for local residents.

 

The Cabinet Member further outlined that the Council was required to have a wider consideration of all residents of all its residents in the round, both presently and into the future. There was a rare opportunity to expand and improve the offer at OGNH, without detriment to the existing residents. The Council had not ruled out any configurations within the Home which was why it had commissioning a feasibility study of what is possible on the site, which this will include the options for nursing care, intermediate/rehabilitative care and day care on the site. However, these options could not be considered unless an agreement was reached to consider an expanded Home, as they were not possible without expanding the footprint of the current building on the site.

 

The Council had agreed to consult formally on any emerging preferred option after the period of feasibility had been concluded.

 

The Director for Adults and Health advised that the Joint Improvement Board had responded in taking forward the closure process, but there had been no reduction in efforts and intensity to improve quality issues at the Home. The CCG continued to support staff at Osborne Grove. Quality assurance nurses worked alongside staff and external audits were in place. Therefore, in no way had the emphasis on improvement been reduced since December.

The Assistant Director for Commissioning added that the options appraisal was drawing from a range of factors including premises design, quality and service model design, and demand capacity, to meet the requirements of co design. The co – design group would contribute to a range of feasibility options that will be looked at, and this was not a decision but a launch of those feasibility processes which was a positive development.

The Cabinet Member commented that the previous co – design group meeting had discussed health representation, and they have been invited with officers also taking forward ongoing discussions with the CCG on nursing care.

The Leader thanked the deputation for putting forward their views and asked the Cabinet Member for Adults and Health to introduce the report.

 

The Cabinet Member for Adults and Health introduced the report, which set out the future of Osborne Grove Nursing Home. The report was proposing to retain and expand the Home to meet the needs of older people in the borough, exploring in depth two high-level options through detailed feasibility studies. The Council were committed to continuing to work closely with partners and stakeholders through a co-design process to develop an approach, which is affordable, sustainable and flexible enough to address current and future capacity challenges.

 

The Cabinet Member advised that a meeting had taken place of the co- design group and the Council were taking engagement with this group seriously. The existing residents would remain on the site and the Council would continue to develop a high quality provision.

Cabinet placed on record their appreciation to the families and campaigners who had campaigned to keep this facility open. It was important to note that the Council would be developing the facility and not taking forward closure.

Clarification was provided in relation to paragraphs 7.6 and 7.10 and the meeting was advised that the trade unions were in favour of this provision continuing with a direct delivery .The Cabinet Member for Corporate Services and Insourcing welcomed the proposed direct delivery with public sector partners and examining if other local authorities can run this facility with the Council.

The Cabinet Member for Environment commented that it was very helpful to involve the public sector as their ideologies meet the Council’s aspirations. The options further allowed families to participate in complex plans. Clarification was sought on whether the provision could be smaller.

Cabinet Member responded to questions and provided the following information:

• Clarification that delivery of the services would not be in the private sector and the Trade Unions were part of the co-design group and will attend the meetings.

 

• The Cabinet Member agreed to add in more opportunities for families do attend the co- design group meetings.

 

 

• The Cabinet Member welcomed advice from the Cabinet Member for Environment on the appropriate voluntary sector partner groups to include in the co-design meetings and further advised that an open care model was being explored.

 

 

• With regards to the placement of the 7 residents, as outlined in the Cabinet paper, their ability to remain in the Home will be subject to risk assessments to ensure that this continues to be in their best interest and will support their continued wellbeing during the course of any work.

 

 

• The Assistant Director for Commissioning advised Cllr Morris, that a range of costs had been looked at according to potential future running costs. The increase in running costs were because these would involve providing super numeri staff.

 

• In terms of future provision, the services were analysing the needs of different client groups and working with North Central boroughs on examining data trends with needs analysis a constant theme across that. It was currently noted that nursing care specifically related to dementia had more demand. However, other areas of demand were also recognised and would be considered i.e. prevalence of people with learning disabilities that are living longer that need specific support.

 

 

• Initial discussion with CQC was based on risk assessment and any decision on the Home would be based on best interest of the residents, and based on the scenarios in front of them at the time.

 

RESOLVED

 

1. To retain ownership of the OGNH site;

 

2. For the site be used for the provision of residential and nursing care;

 

3. The draft design principles on the future development of the site at paragraph 7.2 be adopted;

 

4. Options 1b (resident in situ and new build of 70 bedded unit) and 2b (resident in situ and expansion/rebuild to a 64 bedded unit) be taken forward as set out in paragraph 3.1.7 below;

 

5. The establishment of the OGNH Co-Design Reference Group be confirmed and to act in an advisory and consultative role on the future of the Home and as set out in paragraph 6.7. The Group to be Chaired by the Lead Member for Adult and Health and the membership to include Ward Councillors, family members of residents, Haringey HealthWatch, Chair of the Older People’s Reference Group, Trade Union representatives, the Clinical Commissioning Group and Council officers.

 

6. That a design partner on the future residential and nursing care provision be procured;

 

7. Following procurement of the design partner, detailed design and feasibility work be undertaken with the active engagement of a range of stakeholders including the OGNH Co-Design Steering Group, partners, nursing care providers and officers, on Options 1b and 2b as set out at paragraph 7.5.1:

 

Option 1b: Maintaining a reduced-capacity service at Osborne Grove to allow the current residents (7) to remain and building a new 70-bed Nursing Home on site following demolition of the existing building; and

 

Option 2b: Maintaining a reduced-capacity service at Osborne Grove to allow the current residents (7) to remain and building an expanded 64-bed Nursing Home on site with the existing residents in situ.

 

The feasibility work to include the construction works to be undertaken, whether this can be undertaken with residents in situ, the risk to and likely impact on residents and whether and how residents can be safeguarded;

 

8. That the outcome of the detailed design and feasibility work (referred to in paragraph 3.1.7) be brought to Cabinet for a decision on the preferred option for consultation with residents and other stakeholders;

 

9. That the current provision at OGNH to remain open to existing residents only and who choose to remain; and

 

10. That officer’s work proactively with partners in the NHS, with the care sector and with neighbouring local authorities to develop a sustainable partnership approach to future delivery of care at Osborne Grove.

 

Reasons for decision

 

Osborne Grove Nursing Home is a 32-bedded nursing unit, with a day centre space, run directly by the Council. It is located on a site, owned by the Council, in Stroud Green, which has a sizeable garden and a large car park.

 

On 12^th December 2017, the Cabinet made a decision to close the Home, following an extended period of consultation with residents, users, carers and other stakeholders. This was in the context of the seriousness of care quality issues raised through internal and external audits and inspections including those carried out by the Care Quality Commission, staff from the Brokerage and Quality Assurance Service of the Council and the Safeguarding and Quality Assurance function of the Clinical Commissioning Group (the CCG). An embargo, which can be placed on any care provider where there are concerns about the quality of care and it is not considered safe to place new residents, has been in existence since August 2016. This embargo on any new placements meant that numbers of residents in the Home have been falling since then and at the time of the December Cabinet paper there were only 17 residents in the Home. Following implementation of the closure decision and the planned and careful transfer of residents to new care homes, there are now only 7 residents living in the Home (down from 32 at full occupancy). In order for the Council to maintain its focus on quality of care, there are no plans to increase the number of residents or for the current embargo to be lifted.

 

A recent review of activity and demand in Haringey and across North Central London has confirmed the need for increased nursing bed capacity in the area. The site, owned by the Council, offers considerable potential for expansion of nursing care capacity, which would help to meet the increased demand for nursing care both in the borough and in the wider sub-region. In the context of established and increasing demand, there is a pressing need to grow capacity across the whole of North Central London and capitalise on opportunities to do this wherever they appear. No longer can Haringey rely on excess capacity in NCL to meet its demand as the number of nursing home beds continues to fall and all boroughs in NCL are experiencing higher demand. Out of NCL, there is increasing cross-authority competition for beds, which creates on upward pressure on prices.

 

The options appraisal has been pursued in order to consider whether and how this potential should best be delivered. The decision to explore further two options is being presented following an options appraisal which has already taken into account the range of factors set out in section 6 and which has considered a number of options for the future of the site. This options appraisal is set out in section 7 of this report.

 

The proposed approach aims to develop a high quality provision to improve outcomes for residents through a model of nursing care, which is responsive to need. The existing site is demonstrably not fit for purpose with a number of design issues making the provision of high quality care particularly challenging for an increasingly frail resident population. The approach to quality will be developed to better address future demand, whilst also mitigating the quality of care issues that led to the previous decision to close the home under current management by the local authority.

 

The proposal to retain those of the current 7 residents who wish to remain in situ to do so reflects the current wishes of a number of stakeholders. Their ability to remain in the Home will be subject to risk assessments to ensure that this continues to be in their best interests and will support their continued wellbeing during the course of any works. The Care Quality Commission in their continued regular inspections of the Home will consider these risk assessments. Further consultation has been highlighted as necessary in light of the fact that the options currently being presented for further work are fundamentally different from the proposals initially consulted upon. It has therefore been considered fair that the residents and stakeholders be consulted on the preferred option following the outcome of the detailed design and feasibility work and before a final decision was made by Cabinet. Following the final decision on the preferred option, full consultation will be held with all residents and we will make clear through risk assessments that any decision will be made in the best interests of residents.

 

Alternative options considered

 

The option to close the Home and not to revisit an options appraisal for future use of the site was identified but discarded early on as the Home is an asset of great value to local residents and to the Council.

 

A full options appraisal was considered to be the most effective way to explore all viable options in relation to the home post-closure and to seek Cabinet approval to start the next phase of implementing the preferred option.