Minutes:
Appendix A
Written questions for the Heath and Wellbeing Board meeting on 28th November 2014
Three questions from Mrs Tricia Choppin for Written Responses:
During the Public Questions section of the Clinical Commissioners meeting last week I asked a question and I also submitted a series of further questions all regarding the same subject matter and all have yet to be answered, however, I will receive a written response in due course. The subject matter was the decision by Bromley CCG and Kings to open a Clinical Decisions Unit in A&E at the PRUH and, after a maximum stay of 48 hours, discharge some (although the Dir of Soc Services did write ‘many’ in his comments to the Care Services ODS) elderly patients from A&E to care/residential homes. I have attached a copy of my questions to the CCG for information. The attachment marked extra question is the question I asked at the meeting itself.
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Response from Bromley CCG:
The answer to Qs 1 and 2 is amalgamated.
The intention of a Clinical Decision Unit is to allow for short term assessment of patients, which allows for the most appropriate onward referral to an acute ward, intermediate care, or discharge to a care setting, or to home. It will manage adult patients of all ages. It is not intended to change the appropriateness of referral to a care/residential home, or the assessment and selection process for accessing this option. We expect that all patients, whatever their age and condition, are treated with dignity and due care, whether their inpatient stay is on a ward or the CDU or both.
Q3 relates to the financial responsibilities of LBB, and should be properly answered by them.
-----------------------------------------------------
Two questions from Mr Stuart Choppin:
Response from Bromley CCG
The place of discharge for A+E attendances is recorded, including those to care/residential home, though in practice this relates to patients already located in that setting, rather than to new referrals to care/residential home. We are not aware that these numbers are routinely published, at hospital level, but they do inform national and local understanding of the management of urgent care services.
The CCG strongly discourages late discharge of patients from hospital, especially where patients are older and have complex conditions . We recognise that some patients, for example those who are in hospital for day case procedures and short stays, may be discharged later in the day. Sometimes these late discharges are expected and have been planned for. Occasionally, patients are discharged later in the day to ensure that beds are available for a patient with more urgent needs. We will continue to work with Kings College Hospital to minimise the number of these instances, and to ensure that appropriate arrangements are in place for the safety, support and comfort of patients where a late discharge is required.
--------------------------------------------
Three Questions from Susan Sulis
Secretary, Community Care Protection Group
Neither LBB or BCCG have published the name; location; or the management company running the private nursing home for the provision of the new Intermediate Care Beds.
(a) Why will the CS PDS Committee not receive a report to enable scrutiny of how this complex joint service with many partners, will work?
In June 2013, Lauriston House was breaking Regulations 10, 11 and 18, and failed to meet 3 of the 5 Standards inspected, including “safeguarding people who use the service from abuse”; “consent to care and treatment”; and “assessing and monitoring the quality of service provision”.
(a) How does its selection satisfy the requirement for “Quality Commissioning?”
3. LAURISTON HOUSE NURSING HOME: HISTORY OF FAILURES BY ADIEMUS CARE LTD.
Lauriston has, in recent years, had a high turnover of management, (including Southern Cross). This April, a careworker was jailed for assaulting, abusing and neglecting 3 patients, following CQC warnings that the home could be closed.
(a) Were any patients placed by Bromley during this period?
(b) What investigations took place?
(a) Response from Bromley CCG
Bromley CCG reported the award of preferred bidder status for the integrated Step Down service to Bromley Healthcare, following an open procurement process. This service provides integrated home based and bed based support for patients requiring rehabilitation following discharge from an acute hospital. Bromley Healthcare will be responsible for delivery of the complete service, although it is jointly funded by the CCG and LBB. The new service replaces existing intermediate care beds at Orpington Hospital and Elmwood, the CARTs home based service and PACE team.
The service will be known as Bromley Healthcare Rehabilitation Service, and is due to start on 12 December. The service will have up to 42 beds, which will be located at Lauriston House. The beds will be operated by Bromley Healthcare who will hold the CQC registration and be responsible for all aspects of clinical care and management. The Bromley Healthcare beds are located in dedicated ward space, which has now been significantly upgraded to meet the clinical standards of this service.
Following the allegations about the care worker, Bromley CCG placed no patients in Lauriston House while investigations were conducted.
(b) Response from Bromley
A police investigation into allegations was carried out by Bromley Metropolitan Police Service.
A safeguarding investigation was carried out under the procedure; Protecting Adults at Risk London multi-agency policy and procedures to safeguard adults from abuse published 2011.
CQC conducted at least three unannounced inspections of the registered site.