POLICY FOR THE SUSPENSION OF
COMMISSIONING OF PLACEMENTS IN
CARE HOMES AND CARE PACKAGES
Policy No.
Version:
CP33
V.1
Ratified by:
Basildon and Brentwood CCG
Board
28 January 2016
Date Ratified:
Name of Originator/Author:
Date Issued:
Stephen Mayo, Deputy Chief Nurse
Nikki Livermore, Senior Quality
Manager
Greer Phillips, Quality Manager
21 April 2016
Date Implemented:
21. April 2016
Next Review Date:
3 years post ratification
Target Audience:
BB CCG staff, Board members,
member practices, and Provider
Organisations commissioned by
the CCG
1
Policy Date: 17.11.2015
Review Date: 17.11.2018
CONTENTS
1.0
2.0
3.0
4.0
5.0
6.0
6.1
6.2
7.0
7.1
7.2
7.3
8.0
9.0
10.0
11.0
12.0
13.0
14.0
PAGE NO.
INTRODUCTION
3
PURPOSE
3
RESPONSIBILITIES
OF
BBCCG
IN
4
COMMISSIONING
PLACEMENTS
FOR
CONTINUING HEALTH CARE
ROLE OF BBCCG FOR PERSONAL HEALTH
5
BUDGETS/SELF-FUNDING RESIDENTS
MONITORING OF PROVIDERS
5
SUSPENSION OF COMMISSIONING OF
6
PLACEMENTS
CIRCUMSTANCES WHEN THE SUSPENSION
6
OF PLACEMENTS PROCESS WOULD BE
CONSIDERED
ACTION
REQUIRED
WHEN
SERIOUS
6
CONCERNS HAVE BEEN MADE
ROLE OF BBCCG IN SUSPENSION OF
7
COMMISSIONING OF PLACEMENTS
DECISION TO SUSPEND COMMISSIONING
7
COMMUNICATION WITH THE HOME/CARE
7
PROVIDER
MONITORING OF HOME/CARE PROVIDER
8
TIMESCALES FOR SUSPENSION
9
COMMUNICATION STRATEGY
9
TRANSFERRING RESIDENTS
9
RESUMING COMMISSIONS
10
BEST PRACTICE
10
ALL
CCG
STAFF
&
MEMBERS
11
RESPONSIBILITIES
REFERENCES
12
APPENDIX
:
FLOWCHART
SUSPENSION
PROCESS
13
2
Policy Date: 17.11.2015
Review Date: 17.11.2018
1.0
INTRODUCTION
This policy addresses the responsibilities of the Basildon and Brentwood
Clinical Commissioning Group (BBCCG) in the management of
suspending placements in care homes and/or commissioned domiciliary
care packages that are registered with the Care Quality Commission
(CQC) to provide nursing care to adults.
The Local Authority (LA) is responsible for leading the investigation of
concerns within care homes or home care providers situated within its
boundaries.
1.1
BBCCG fund Continuing Health Care (CHC) and Funded Nursing Care
(FNC) for its population in both local and out of borough care homes and
those receiving domiciliary care packages. The BBCCG is committed to
complying with its responsibilities to ensure that the care commissioned
for its population is consistently of a good quality, is safe and sustainable.
This includes residents in receipt of a personal health budget.
The CCG is required to comply with:
•
•
•
•
•
•
•
•
•
2.0
Mental Health Act 1983 and 2007 including section 117
NHS Act 2006
Section 57 of the Health and Social Care Act 2012
Mental Capacity Act 2005 and use the principle that people
have capacity unless otherwise proven
London Multi-Agency Safeguarding Adults Procedures (2011)
NHS Constitution
Statement of Government Policy on Safeguarding Vulnerable
Adults (2013)
NHS Commissioning Board and CCG (Responsibilities and
Standing Rules) Regulations 2012
National Framework for NHS Continuing Healthcare and NHSfunded Nursing Care November 2012
PURPOSE
The purpose of this policy is to clarify the role of BBCCG when there are
serious concerns regarding the quality and safety of the care provided to
residents within a care home or receiving a package of care within a
domiciliary setting.
3
Policy Date: 17.11.2015
Review Date: 17.11.2018
The policy sets out the responsibilities of BBCCG in relation to:
•
•
•
•
•
•
•
3.0
Ensuring the welfare of the residents of the home/those in
receipt of a care package remains the main priority
Working with the Local Authority to investigate concerns related
to quality and safety (encompassing safeguarding) within the
statutory framework
Commissioning services to assess the risk to the residents
placed in the home or in receipt of a care package
Taking action to mitigate the risks including, where necessary,
suspension of the commissioning of new placements in the home
and review of the care of all residents/care packages from a care
provider due to concerns related to quality and safety
Maintaining clear communication with all residents, relatives,
key external stakeholders and the home/domiciliary care
provider
Identifying any legal implications of actions by BBCCG
Ensure link with the NHS serious incident process
ROLES AND RESPONSIBILITIES
The Responsibilities of BBCCG in Commissioning
Placements for Continuing Health Care
BBCCG is committed to working with the LA and to ensure that the
systems in place for commissioning placements in care homes are in
line with the Safeguarding Adults Principles (HM Govt 2013 Statement
of Government Policy on Safeguarding Adults) and the legislative
framework underpinning these principles:
Empowerment - presumption of person led decisions and informed
consent
Prevention - it is better to take action before harm occurs
Proportionality – proportionate and least intrusive response
appropriate to the risk presented
Protection - support and representation for those in greatest need
Partnership - local solutions through services working with their
communities
Communities - have a part to play in preventing, detecting and
reporting neglect and abuse
Accountability - accountability and transparency in delivering
safeguarding
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Policy Date: 17.11.2015
Review Date: 17.11.2018
In order to implement best practice across the health economy and
drive continuous improvements in outcomes, the CCG will work with
the LA to develop:
o Clear service specifications and contracts for registered settings,
which set out the appropriate standards
o Mechanisms to link information from different sources (e.g. care
managers, nurse assessors, CQC compliance managers,
complaints officers and contract monitoring managers) with
agreed information exchange to maximise information about
quality and safety within registered settings
o Effective contract management incorporating regular quality
reviews to measure operational performance, activity and service
improvements
o Management of serious incident process to ensure learning for the
provider and across the sector
4.0
The Role of BBCCG for Personal Health Budgets/Self-Funding
Residents
Within BBCCG boundaries – BBCCG has responsibility for all residents
receiving care within the boundary, irrespective of the funding stream.
Therefore self-funded residents will have equitable access of clinical
reviews and support during any suspension of placements, although it
should be noted that the contractual relationship is between the
resident/funder and care home/provider. BBCCG will work with the LA
and the provider to offer advice to potential self-funders during
suspensions.
Outside of BBCCG boundaries – BBCCG will not have responsibility
for privately funded people placed outside its locality in homes where
BBCCG may have CHC funded residents.
Personal Health Budgets – BBCCG has responsibility for ensuring
that residents eligible for personal health budgets are supported
through appropriate governance arrangements to enable them to deal
with any quality of care related problems.
5.0
Monitoring of Providers
The NHS Act 2006 Section 14R places CCGs under a duty to ensure that
there is a continuous improvement in services and must act to ensure
continuous improvement in outcomes is secured. These outcomes
include the safety of the services.
5
Policy Date: 17.11.2015
Review Date: 17.11.2018
Providers will be monitored through contractual work and quality of care
received by individual residents. Areas of concern must be addressed
with the provider to ensure that an improvement plan is put in place that
addresses all areas of concern. This improvement plan may be required
when care management, contract monitoring, complaints monitoring
and/or other sources of information indicate a shortfall in the quality of
services provided and statutory agencies want to see improvements in
specific areas of quality, safety and practice.
Where incidents have occurred that have placed residents or service
users at risk, the BBCCG serious incident policy should be implemented
to complement the contractual work being undertaken.
6.0
Suspension of commissioning of placements
BBCCG will not act in isolation when there are concerns related to the
care and welfare of people that they fund the care for within a care
home/care provider.
When there are significant concerns related to the quality and safety
of care within a Care Home/Nursing Home or domestic setting, the
provider should be encouraged to place their own ‘suspension’ on all
new placements. If this does not occur, BBCCG may engage the
process to suspend all new health-funded placements in consultation
with the LA. In exceptional circumstances where BBCCG has
significant quality concerns and the LA have not placed a suspension
the Chief Nurse or Deputy Chief Nurse may choose to place a
suspension of locally funded nursing placement. This is to be
considered as an additional safety net to protect patients.
Under no circumstances will pressures e.g. financial, override this
suspension where quality and safety concerns have been identified.
6.1
Circumstances when the suspension of placements process
would be considered:



If at any stage there are strong indicators e.g. from the LA
safeguarding team or CQC, that there is a risk of significant harm to
service users receiving the services within a care home/from a care
provider and that this risk is continuing, sustained and not
manageable;
If a criminal investigation is underway;
If any other relevant and serious incident/concern/situation had
occurred;
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Policy Date: 17.11.2015
Review Date: 17.11.2018


6.2
If the Care Quality Commission (CQC) reports significant regulatory
concern; or
If there is failure to notify the appropriate authority within 24
hours of a serious incident/safeguarding concern.
In some circumstances the level of harm suspected of being caused to
residents could be sufficiently serious to warrant a consideration of a
suspension of new placements by BBCCG to the home.
Action required when serious concerns have been made
(Appendix 1 flow chart)
If concerns are raised about a care home/domiciliary care provider where
BBCCG has commissioned care, a joint investigation will be conducted
in partnership with the LA. The investigation should be undertaken in
a timely manner with the aim of protecting any service users from ongoing risk.
The flow chart in appendix 1 sets out the process to follow in the event of
serious concerns
•
•
•
•
•
It is imperative that BBCCG receives accurate and timely
information. This requires appropriate representation at LA
meetings to discuss establishment concerns. BBCCG Quality
Team will represent BBCCG and will report directly to the Chief
Nurse and Deputy Chief Nurse. All issues will be reported
through the Patient Safety and Quality Committee and then to
the CCG board
BBCCG serious incident policy will work in conjunction with the
investigation process
BBCCG will work collaboratively with the LA to evaluate
concerns and agree whether suspension is required
Any action should be proportionate to the risk posed
BBCCG should keep a record of the information received and
the decision making process
7.0
Role of BBCCG in suspensions of commissioning of placements
7.1
Decision to suspend commissioning
•
BBCCG Quality Team will work with the Continuing Healthcare
Lead and the LA Safeguarding and Quality Improvement Team to
assess the level of the concern. If of a serious nature, and there is
no other way to address the concern, then escalation to the Chief
Nurse and Deputy Chief Nurse is required
7
Policy Date: 17.11.2015
Review Date: 17.11.2018
•
•
•
7.2
Once alerted to a concern, BBCCG Chief Nurse and Deputy Chief
Nurse will consider the risk and formalise the decision to suspend
commissioning if the situation requires.
Oversight of the quality of care home provision within BBCCG will
be carried out jointly by the CHC team and the Quality team.
Specific concerns related to individual providers will be reported
into the respective BBCCG Quality and Patient Safety Committee,
with escalation to the Board if agreed by BBCCG Quality and
Patient Safety Committee
When there are serious concerns the CHC team will be expected to
confirm the clinical risk status for each CHC funded resident.
Communication with the Home/Care Provider
BBCCG is committed to improve the quality of care home
provision/care packages for its residents. As part of this there is an
expectation that the home/provider will be informed of any concerns
(unless not in the best interests of the residents or due to police
investigation) that arise. The CHC Lead and BBCCG Quality team will
undertake work in collaboration with the LA and the home/provider to
improve quality and identify any safeguarding issues that need
addressing.
In the event of escalating concerns, the Joint CHC Lead and BBCCG
Quality team will work with the home/provider to help inform the
seriousness of the concerns and ensure that the Registered Manager
is aware of the concerns.
When a decision is made to suspend commissioning of placements,
formal notification will be sent to the home owners by the LA Director
for Adult Social Care. The provider should be given the opportunity to
respond to the concerns and consideration should be given to any
mitigation plans the provider suggests which could safeguard residents.
If information is to be shared with residents/families/other CCGs/other
Local Authorities, prospective resident’s form of wording should be
agreed with the provider. If this is not possible, the wording will provide
a factual account e.g. “The CCG is not placing any new residents with
this provider at the current time but we would suggest you contact the
provider for further information” and refer the enquirer to the provider for
clarification.
The provider will be encouraged to establish a clear communication
strategy to enable all residents and relatives to be kept informed which
should include potential self-funders.
8
Policy Date: 17.11.2015
Review Date: 17.11.2018
7.3
Monitoring of Home or Care Provider
When the decision has been made to suspend the commissioning of
placements, BBCCG will:
• Ensure that no new placements are made in the home/care
provider for an agreed period of time.
• Work with the LA to ensure that there is a plan for communication
to all commissioning organisations.
• Work with the LA to complete the safeguarding investigation and
monitor the home action plan
• Undertake increased contract and quality management activities
within the provider which will include assurance by the provider
that no self-funders are admitted during the suspension
BBCCG Chief Nurse or Deputy Chief Nurse, along with the Quality team,
will work with the LA Lead Director to monitor the provider at a strategic
level. This is in addition to the meetings led by the LA safeguarding team
regarding establishment concerns.
An Improvement Plan will be required to ensure that there is no delay in
taking remedial action to safeguard the residents. This will be
monitored, in collaboration with the LA, to ensure that progress is being
delivered within agreed timescales.
8.0
CHC Out of Areas Checks and Assurances
All CHC and FNC placements have set criteria of assurance checks
undertaken by BBCCG prior to service user placement. Appendix 2 is
an example of the check list form which details how pre checks includes
intelligence gathering from local NHS CCG’s, local authorities, CQC etc.
Only if no concerns are identified then the placement can proceed. This
is followed up by BBCCG informing the relevant local authority and CCG
of the out of area placement.
On-going monitoring is also maintained by BBCCG as part of their
commissioning responsibilities which include.
 A standard contract signed by the providers including a
requirement to inform BBCCG of any incidents such as falls or
admissions to hospital.
 Regular CHC reviews by BBCCG nurses assessors
9.0
Timescales for suspension
9
Policy Date: 17.11.2015
Review Date: 17.11.2018
For the duration of the suspension, BBCCG Chief Nurse or Deputy Chief
Nurse will have monthly reviews to ensure that the CCG Board is kept
updated. A clear plan for decision making to either resume
commissioning or consider moving residents to another placement will
be in place with the LA.
In the event of suspected or known criminal offences, the timing and
conducting of the process will be subject to police advice.
10.0
Communication Strategy
Communication with relevant stakeholders will be considered on a
case by case basis taking into account patient safety, commercial
sensitivities impact on the local health economy and risk.
Key stakeholders:
•
•
•
•
•
•
Residents
Relatives/carers
Owner of home
GP practices providing primary care input to the home
The pharmacy used by the home
The community provider that delivers specialist nursing input
and allied health input to the home
• Continuing Health Care assessors
• Local Authority contracting and procurement
• Local Authority safeguarding team
• CQC
• Other CCGs
Please note the list is illustrative and not exhaustive.
11.0
Transferring Residents
The expectation is that suspensions will relate to all new placements but
that close monitoring of the home will be undertaken to support current
residents to remain in the home/care provider. Nevertheless, in the most
serious cases it may not be possible for this to happen. The transferring
of residents to another home should be one of the last resorts but if or
when necessary, BBCCG will commit to consider alternative placements
for all residents regardless of funding basis, working jointly with the LA.
The resident, relatives, carers and the home will be kept informed and
involved at every stage to enable the safe transfer of residents to reduce
10
Policy Date: 17.11.2015
Review Date: 17.11.2018
the risks to those with complex needs.
As part of the process for involving residents/relatives and carers,
BBCCG will, in partnership with the LA, liaise with them to find an
appropriate placement. However, BBCCG is responsible for the final
decision when responsible for funding.
N.B If a resident lacks capacity then a Best Interests Decision will be
required to inform BBCCG’s decision making if there is more than one
option identified by the CCG.
12.0
Resuming commissions
It is intended that suspensions will be lifted as soon as it is assessed as
safe to do so, but BBCCG will need to be satisfied that the home/care
provider has addressed the issues highlighted and that it meets with
contractual and regulatory requirements.



When considering lifting the suspension, the following actions must have
taken place:
There have been planned meetings between the CCG, LA and the senior
management for the company running the home throughout the period of
suspension, to monitor strategic improvements.
BBCCG Chief Nurse or Deputy Chief Nurse will require appropriate
evidence of service improvement and assurances from the LA and the
CQC regarding the status of the home/care provider.
Once assured, the Chief Nurse or Deputy Chief Nurse will endorse the
lifting of the CCG suspension.
When a suspension is lifted BBCCG will work in partnership with the
LA to monitor the on-going sustainability of the quality improvements
made. As part of the on-going monitoring BBCCG and the LA will
require the provider to have an improvement plan, which continues
once commissioning is resumed.
13.0
Best Practice
BBCCG will assess the potential impact of suspension of placements
on the business of the home and the future welfare of the residents
remaining in the home and prevent unwarranted financial loss to the
care home business.
BBCCG will ensure that, in consultation with the LA and the CQC, the
home owners and senior management, residents /carers or
11
Policy Date: 17.11.2015
Review Date: 17.11.2018
advocates are kept informed of the progress of the investigation.
14.0
All CCG Staff and Members
All members of staff have a responsibility to familiarise themselves with
the content of the ‘Suspension of Commissioning of Placements in Care
Homes and Care Packages Management Policy’.
All members of staff have a duty to work within the standards and
guidelines as specified in this Policy.
All members of staff have a duty to ensure that patients, their relatives
and carers are not discriminated against or treated in any way less
favourably when suspensions are reported and investigated.
15.0
REFERENCES
Department of Health (2013), the National Framework for NHS
Continuing Healthcare
NHS - Funded Nursing Care, Department of Health
Department of Health (2010), Who Pays? Establishing the Responsible
Commissioner, Department of Health December 2010
Department of Health’s (2010) Ordinary Residence: Guidance on the
identification of the
Social Care Institute for Excellence safeguarding and quality in
commissioning care homes
SCIE February 2012
Social Care Institute for Excellence, Protecting Adults at Risk: London
Multi Agency Policy and Procedures to Safeguard Adults from Abuse
2011.
Hounslow CCG Policy for the Suspension of Commissioning of
Placements in Care Homes and Care Packages
http://www.scie.org.uk/publications/guides/guide46/commonissues/index.asp
12
Policy Date: 17.11.2015
Review Date: 17.11.2018
APPENDICES:
Appendix 1: Suspension Process
BBCCG made aware of concerns from LA or other stakeholders
Concerns investigated the
LA, plus the CCG as
appropriate
Provider
places own
voluntary
suspension
Residents and families informed throug
Risk assessed by CN / DCN throughout the
No
further
action
LA places formal
suspension.
(BBCCG mirror the
decision to suspend)
Provider develops a service
improvement plan in
partnership with LA &
BBCCG
YES
Service improves suspension
13
lifted in agreement with LA.
BBCCG mirrors
Or
Service improves BBCCG lifts
its unilateral suspension
Monthly joint LA
& CCG reviews
undertaken during
suspension
BBCCG has exceptional
quality and safety
concerns. Unilaterally
BBCCG may place
admission suspension
No service
improvement LA
place
a formal
Policy
Date:
17.11.2015
Reviewsuspension
Date: 17.11.2018
Appendix 2: CHC new provider Check List
New Providers
Checklist 2015 - 16.docx
14
Policy Date: 17.11.2015
Review Date: 17.11.2018