By working in partnership with the Local Authority, Community Integrated Care and Halton CCG have transformed a previously failing care home into a genuine centre of excellence for dementia care. Find out how!

1. Failing Care Homes to Success
Stories
Health + Care Conference 2015
Catherine Murray-Howard
Deputy Chief Executive
@CathMHCIC

2. This is a story about different groups
coming together to change lives.
About how NHS Halton CCG, Halton
Council worked with us Community
Integrated Care to transform a failing
dementia care home into a Centre of
Excellence…

3. Background to St Luke’s
• Successful home for many years
• Recent years began to experience occupancy issues.
• Hands-off relationship between the home and the Local
Authority
• Losses for many years, becoming untenable…
• Proposal to close was taken to the commissioner

4. All too often the reasons why a
home fails are complex and
linked…

5. Poor
Management

6. Poor
Management
Major
safeguarding
event

7. Poor
Management
Major
safeguarding
event
Reputational
damage

8. Poor
Management
Major
safeguarding
event
Reputational
damageReferrals stop
– very low
occupancy

9. Poor
Management
Major
safeguarding
event
Reputational
damageReferrals stop
– very low
occupancy
Losing money

10. Poor
Management
Major
safeguarding
event
Reputational
damage
Referrals stop
– very low
occupancy
Losing money
No investment
in
environment

11. Poor
Management
Major
safeguarding
event
Reputational
damage
Referrals stop
– very low
occupancy
Losing money
No investment
in
environment
Failing
Care
Home

12. So we needed to decide what to
do…and this isn’t a story of…

14. It’s a story of great partnerships…

16. …Maybe not…

17. The reason the partnership works so well
is there was a common purpose and
absolute trust…

18. So let’s go back to the late 90’s –
early ‘noughties’
…here’s how the relationship often worked

19. THE COMMISSIONER
“All Powerful”, scary

20. THE COMMISSIONER
“All Powerful”, scary
PROVIDER
“Acquiescent”, no power

21. …and then in 2012
• NHS reforms – introduction of the CCG and integration
• Established an agreement to work together in partnership to turn
it round
• Worked together to create a true Centre of Excellence
• Dr David Lyon, CCG Clinical Lead and specialists became involved
• NHS Halton CCG Clinical Specialists work in the service providing
true relationship-centred care - delivered by highly trained staff.

22. Aims of the partnership…

23. To maintain the only specialist
residential/nursing dementia service in
Runcorn by…
(oh and what would 56 extremely unwell people
in Runcorn do for specialist dementia support?)

24. Doing this…
• Improving reputation of St Luke’s
• Getting the service onto a better financial footing
• Creating a wonderful living environment turning it
into a centre of excellence for dementia
• Forging a unique and ambitious vision

25. Step one
Improving the reputation

26. Bringing in Clinical Specialists to the service,
transforming staff skills and forging an
ambitious vision.

27. Here’s what we did
• Appointed a new ‘visionary’ manager – someone who just
understands dementia
• Brought in Clinical Specialists to the service, transforming
staff skills and forging an ambitious vision.
• Close working with GP’s – weekly visits
• Special support – visit by psychiatrist fortnightly

28. Step 2
Better financial footing

29. Risk taken by CCG and Local Authority –
block funding until the service was full…
This gave us the confidence to invest in
staff teams and specialist training

30. Step 3
Improve the environment

31. There were some hard-nosed financial
discussions…Capital investment was provided
by NHS Halton CCG
Risk share…
£100k from CCG and matched by Community
Integrated Care

32. So, what to do with that investment?

33. Well we…
• Completely gutted and refurbished half of the bedrooms
• Created two new high tech ‘wet rooms’
• Replaced four domestic kitchens
• Gutted and replaced the reception area and front of the
service

35. And we really wanted to create a
dementia centre of excellence…
So we did so much more…

36. “Sitting on the back row of the
movies…”

38. “Oh I do like to be by the
seaside…”

40. “In an English Country Garden…”

42. “Fancy a pint?...”

44. Memories and Activities room
for the local community too…

46. And the result?...

47. There are tangible and measurable
outcomes?

48. We have seen a major increase in
people and carers/family opting to
spend their last years with us.

49. For people it can sometimes feel
a little like this?…

51. A busy Hospital can be a very scary experience
for the frail or people with dementia.
Our priority is clinical and social quality approach
with our partners has meant a significant
reduction in Hospital admissions

52. Result?
Able to support people with acute needs
and reduce hospital interventions in the
borough.

53.  Fewer people going into Hospital
 More people choosing to die at St Luke’s
0
10
20
30
40
50
60
2012 2013 2014
Hospital Admission and End of Life care at St Luke’s
Hospital Admission Deaths

54. Which means…

55. By keeping people in a care home rather than
Hospital, even when they are critically ill, does three
key things…
1. Saves beds in the local hard pressed Hospital
2. Saves money from the NHS and reassures the people of
Halton that we are spending their hard-earned money
wisely
3. More importantly is the right thing to do, people just want
to live and die with dignity somewhere where they and
their families are comfortable.

56. Recipe for Success?...

57. The Recipe for Success
Decision
Makers
Real
conversations
Be honest
Cut through
the ….

58. And the Recipe for Disaster?…
Brace yourself…some of this may
shock…

59. NO…. KPI’s….

60. NO….
NO….
KPI’s….
Action Plans….

61. NO….
NO….
KPI’s….
Action Plans….
NO…. Tenders….

62. And now?…

63. £££ - now financially
sustainable…no threat of closure

64. The home is the a true centre of
excellence…

65. GP feedback is superb…

66. National Care Awards – Care Manager
Award – Sue Ashcroft – shortlisted
National Care Awards – Care Housekeeper
Award – Monika Golenska – shortlisted
Great North West Care Awards – Dignity In
Care Award – Adrienne Ratcliffe – won!
Great British Care Awards – Dignity In Care
Award – Adrienne Ratcliffe – won!

67. More importantly…

71. When you work together and
share a vision, amazing things
can happen….

72. Thank you
Any questions?
cath.murray-howard@c-i-c.co.uk
Please just get in touch!