The review was in response to a report by the Older People’s Commissioner for Wales, “A Place to Call Home”, published in 2014.
The aim of this review was to investigate:
- How Betsi Cadwaladr University Health Board (BCUHB) meets the healthcare needs of older people living in residential and nursing care homes, either directly through the provision of services, or through its contracting arrangements with primary care providers.
- The experience of Care Home Managers in accessing healthcare support for people from the NHS
- How Healthcare Inspectorate Wales (HIW) and Care Inspectorate Wales (CIW) can work in a more integrated way to improve outcomes for people living in care homes.
What we did
We looked at care homes delivered by the Betsi Cadwaladr University Health Board in six counties in North Wales: Anglesey, Gwynedd, Conwy, Denbighshire, Flintshire and Wrexham.
An advisory group was established to help shape and inform the review. This included representatives from providers, the health board, local authority commissioners, Older People’s Commissioner and policy colleagues from Welsh Government.
The review considered accessibility, timeliness and effectiveness of a range of healthcare support.
What we found
Feedback was variable across most of the service areas considered, but some common issues emerged which need to be addressed in order to provide seamless, good quality care, to individual residents and patients.
- Clear roles and responsibilities: the part that each organisation/ profession/ individual plays in the system of care and support needs to be clearly articulated and understood by all
- Training: training should be available to support everybody to play their part in the system effectively and every effort should be made to ensure that staff can be released to undertake that training
- Access routes: when additional advice or support is required in response to changing needs, access should be as easy as possible and it should be clear to whoever requests the support the response they should expect
- Feedback: processes should be in place to enable ongoing feedback on issues and concerns in order that patterns can be identified and matters resolved
- Collaboration and partnership: organisations should work together in the best interests of the populations they serve. When issues arise they should be tackled collaboratively to achieve a practical and sustainable solution.
Many of the issues highlighted in the report echo those found during the course of the Older People’s Commissioner’s review in 2014 and have a direct impact on the well-being of people living in care homes.
Our work indicated that:
- Support for care homes from out of hours GP services was mixed, and included reports that residents are sometimes unnecessarily transported to hospital because the out of hours GP was unable to visit for conditions which may, with appropriate support, have been managed in their own home.
- Support and practice in community nursing was variable across the region
- Individuals receive a positive experience from physiotherapy or occupational therapy services once their support has commenced, although there appears to be a lack of clarity around arrangements for accessing services as well as long waits for home visits and assessments.
- There appears to be a lack of awareness regarding the support, services and products available from the health board regarding continence.
- Waiting times for CPN support were generally considered to be a problem, although the standard of care when support was available was well regarded.
- Significant negative feedback was received regarding the practice of discharging patients to care homes in the North Wales area.
- Care homes were generally positive about the training provided and were able to provide many examples of further training that they would find valuable. It was therefore disappointing to note that less than half of the places on training courses made available by the health board during 2017 were taken up.
The report identifies 16 areas for improvement. HIW/ CIW will follow up on these as appropriate.
CIW will ensure access to healthcare support is embedded in the inspection frameworks currently under development and will raise issues with relevant health boards.