How does the current service work?
The Lighthouse is commissioned by Derbyshire CCGs and Derby City Council. The health part of the service is currently being provided by Derbyshire Healthcare NHS Foundation Trust (DHCFT) which has given notice effective as at the end of May 2019. The CCG, Derby City Council and DHCFT are working hard to ensure the service continues for children and young people currently using it.
What are the plans for the future?
At this stage we need your input and help to understand what isn’t working but more importantly what is. This is why we are holding meetings with parents and carers to ensure you have your say and so we can fully explain our current situation. The online questionnaire is open until 7 January and after that we will review the findings and work with all relevant colleagues to put a timeline together of next steps. As our priority is to ensure service continuation, we may need to start some preparatory work on developing solutions and ask for your opinions on this before that date.
Are you able to reassure parents the services for their children and young people will not be cancelled or stopped whilst changes to health provider are established?
We will work with both the existing health care provider (DHcFT) and future providers and social care to ensure a smooth transition. Whilst we can’t guarantee that every child and young person’s care will be delivered as it is now during the transition, we will do our upmost to minimise impact on families. We are open to suggestions of different ways of providing care to ensure the needs of all children are met. Our priority is to ensure that children and young people have the right care that is safe. We will pursue all options to maintain the service through any change over and ensure the needs of all children are met.
Is the Derbyshire Healthcare NHS Foundation Trust contracted to provide the current service until the spring of 2019? If so does this mean the nurses are also contracted to work at the Light House until spring 2019?
Following recent conversations with Derbyshire Healthcare, a notice period effective as at the end of May 2019 has been agreed. We will expect DHCFT to deliver the current service for the length they are contracted for. However we appreciate potential difficulty with staffing towards the end of any contracting arrangement. All parties will do their best to continue to deliver services.
Is any of the funding for the Lighthouse residential service being reduced?
There is increasing demand on the service, and there continues to be a waiting list for services. If we are to ensure that we can continue to offer this service to all those that need it, then we have to review how we deliver it. The current way of delivering this service is unique as a model and it is more costly than other similar models locally. The service model is currently being reviewed and it may look different in the future. Safety and experience will always remain our priority. Most services that are commissioned have a finite budget as with ours. It is important to get the most for the money without compromising on service quality or children’s safety.
Are you able to reassure parents the services for their children and young people will not be cancelled or stopped whilst changes to health provider are established?
The existing health provider DHCFT are contracted to deliver to the end of May 2019. It will be their responsibility to ensure there is adequate and appropriately qualified staff to ensure the service continues to be delivered safely until the contract ends. However, as outlined in the question above, it is possible that the Trust may experience difficulty in maintaining staffing during this interim period.
If non-nursing staff are trained to administer procedures will they be able to administer oxygen, C pap – nebulising, peg feeding, tracheostomy care, dispensing medicine via peg, urgent epilepsy care - using sats monitors-suction machines?
We understand from discussions with the current provider the range of needs and clinical dependency levels of children and young people using the service.
However, we appreciate that there are a small number within our group of service users which have very complex needs that will need some specialist provision. We are keen to hear from parents and carers about the reassurance that they need and also what works in other settings. Our priority is that services are safe and meet need.
If council staff are going to administer this specialist intervention who will provide professional governance and how will the training be funded? Keeping the children safe - health care plans - who will be managing all the paper work for Ofsted? Who will manage the medicine dispense cards - this is a highly skilled role - the children’s medicine constantly changes you have to pass exams to enable you to take this role.
Whatever the model is staff will be trained, competent and supervised and working to robust clinical and operational policies and procedures, within an effective governance process. We expect there will be an ongoing role for a health provider to support the service with aspects of care and governance.
Are all of the beds on the Sun unit occupied every day or could the same level of service be delivered over fewer nights by the same health provider at a lower cost?
We have been and continuing to look at all options and want to hear the views from parents, carers children and young people. We want you to have your say and fill out the survey and attend any future engagement events.
Is there a significant difference in the salaries and terms and conditions between social care and health staff?
There will always be a difference in salaries and terms and conditions between different organisations, which are reflective of the roles, responsibilities and pay structures of the host organisations.
Have the council as yet met any service providers they are keen to employ or if not, when and will parents be involved in this?
No, commissioners have not yet met with any potential service providers at time of writing but have arranged to meet potential providers in January. We would expect that parents and carers would have a role in any procurement processes for both the short and medium term provision of the service.
Would it be an option for families to be given more health hours and their child attend the Light House with their own package of care? Using the same worker as they do in the home?
We have an open mind on what the future service may look like and are keen to learn from parents and carers what would work best for them.
However, as you would expect, we have been starting to explore options, and this is one solution we have been considering in order to meet the needs of children and young people with more complex needs. Please fill out the survey as we find your ideas really helpful.
All of the children accessing a residential service at the Lighthouse have significant needs. However, the parents of the children with very complex health needs are very worried their needs will not be met and this will put the family under immense pressure. Nationally we know there is a shortage of nurses and we are worried the current staff will apply for new positions before the spring.
If this is the case what contingency plan has been put in place to cope with potential nurse shortages in 2019 and how can you assure families their much needed respite provision will not be affected?
We will endeavour to provide care for all children and young people during the transition period. However, care can only be provided if it is safe to do so. In any circumstances where staffing ratios are not safe, care will unfortunately need to be cancelled on a temporary basis. However we are working to look at alternative arrangements to minimise this risk.
Do you plan to employ agency nurses? Parents know first-hand how difficult this was when this happened in schools – leaving many children out of school when a flu epidemic affected Ivy House School. If so how will that work with the continuity of the very complex children?
We have to provide a service that is clinically safe and to do this we need to employ staff with the right skills to meet the needs of children and young people. However, options are being explored to enable staff known to this group of children and young people to work on a ‘bank’ basis.
Keeping the children safe - health care plans - who will be managing all the paper work for Ofsted?
The CCG and LA are working closely with DHcFT to ensure processes, including relevant paperwork for Ofsted and/or Care Quality Commission (CQC), is completed and compliant with the regulations.
Who will manage the medicine dispense cards - this is a highly skilled role - the children’s medicine constantly changes you have to pass exams to enable you to take this role?
There is very clear guidance from Ofsted, Royal College of Nursing and CQC which clearly defines roles and responsibilities for qualified and non-qualified staff and what specific training is required to undertake tasks. Any new model would be consistent with the guidance.
How many families do you expect to be affected once the nurses start to leave (which won’t be long) as we understand they are looking for new jobs?
Derbyshire Healthcare NHS Foundation Trust has started a staff consultation given their contract to provide health services at the Lighthouse will cease in May 2019. Given this, it is difficult to predict the numbers of nursing staff who may successfully gain new employment before the end of the notice period. We will endeavour to provide care for all children and young people during the transition period. The service has to remain clinically safe and if there is any concern regarding staffing then this will managed by DHcFT and the staff at Light House.
What has been happening since our last letter to you December 2018
Derbyshire CCGs and Derby City Council have been working hard and have carried out a full assessment of each child’s health needs, understanding the outcomes from the surveys, engagement event with potential providers and progressing with plans from 1st June 2019.
How do you know what health needs my child needs?
The current provider Derbyshire Healthcare NHS FT was asked to carry out a full health assessment with each service user and their parent/carers. To help us understand the needs of all children using the Light House and plan safe care, we’ve written to all parents and carers to ask for consent to share individual identifiable medical and clinical information, as needed, between health and social care providers and commissioners
For those children and young people with complex physical health needs, we have also asked for consent for a health care professional to meet with you and your child so you are assured that commissioners have a clear and accurate understanding of your child’s health care needs and care plan.
We have learnt from this the physical health needs of the children fall into three broad groups
Children who need only oral medication (or no medications) some of whom have epilepsy that’s well controlled. These are mainly on Star Unit although there are some on Sun Unit who have a learning disability and a physical disability e.g. cerebral palsy
Children who are Sun Unit with additional physical health care needs e.g. gastrostomy feeds, nasogastric feed PEG fed, some of whom also have epilepsy
Children with higher/multiple complex physical health needs on Sun Unit e.g. those who have respiratory conditions, ventilators, tracheostomy in addition to gastrostomies and epilepsy.
What was the feedback from the survey that we were asked to complete?
The survey asked three key questions:
Feedback on current service
Themes from the survey to each question:
What do you think about The Light House and the way it works now?
- The Light House works well for families - a lifeline for parent and carers
- Staff know our children well and are dedicated
- Children who visit have complex needs
Is there anything that you think should be changed?
- The service is operating a good service, don’t change itDo you have any ideas for the future?
- The Light House is a lifeline so please continue to have a respite service
- Keep nurses who are suitably trained to run the service
- A better service between The Light House and the adult services
- Ensuring that health and social care are working together on this service.
What happened at the engagement event with potential providers in January 2019?
An open invitation went to providers 10th January 2019 and was attended by a range of providers including local NHS organisations, Community and Voluntary Sector and the commercial health sector. A parent of a service user from The Light House contributed. The purpose of the market engagement event was to help commissioners shape both the long term model for the service and the provision to continue to deliver the service in the short term. The CCG and DCC shared with providers the:
details of the service;
range of needs of the children and young people that use the service;
challenges of the service;
initial feedback we’d received through engaging with from parents and carers
During the engagement event the CCG and DCC ensured they shared the following commitments to the providers:
continue to deliver the short breaks service on a residential basis from the Light House;
maintain the service as open to children and young people with the same broad range of needs as the existing service.
We had a very helpful and informative discussion about different types of service models elsewhere and how those could be modified to take into account the higher levels of dependency and physical healthcare needs of some of the young people using the service at The Light House.
What is the deadline for providers to register their interest for the short term?
The commissioning team colleagues have asked for expressions of interest from all interested providers to submit an application of interest via the relevant procurement system. Once the application process has closed, each submission will be reviewed by commissioning colleagues at the CCG and DCC. We also told parents and carers when we met in February that we had approached the market for potential health providers to help to provide health services in the short term. This was not successful due to the short notice.
Derby City Council and the Derby and Derbyshire Clinical Commissioning Group have recently received a letter from Derbyshire Healthcare NHS Foundation Trust that provide the nursing service telling us that due to staffing difficulties they cannot provide a full safe nursing service in May. We also told you when we met in February that we had approached the market for potential health providers to help to provide health services in the short term. This was not successful due to the short notice. This means that to provide a safe service we can only open the Light House for 3 nights a week in May rather than the normal 6 nights. Unfortunately this means that we can only offer half the amount of respite nights for families in May
From 1 June 2019
From understanding the needs of children, listening to parents and carers and the market we are taking three approaches.
The short term
To keep the service safe, the care staff will continue to provide the care to each child.
Group 1 Children who need oral medication (or no medication ) some of whom have epilepsy that’s well controlled mainly on Star unit and some on Sun Unit who have a physical disability e.g. cerebral palsy - We plan to do this by training care staff in giving oral medication and epilepsy training.
A staff consultation has just commenced therefore we unable to give details but we will ensure that relevant training would be given along with checking competency and all relevant policies.
Group 2 Children who are Sun Unit with physical health care needs e.g. gastro feeds, Naso gastric feeds ,PEG fed, epilepsy
Group 3 Children with higher /multiple complex physical health needs on Sun Unit - We plan to do this by providing care packages through child specific packages based on individual needs.
We are therefore looking for a provider or providers that can provide health training and governance help us keep the service safe and to provide direct care that is able meet the health needs for children in group 2. From our discussions with the market we know that different providers provide different services and we may not be able to get what we need from the same provider.
The interim model – isn’t that going to cost both organisations more money?
We are aware that having an interim model may cost more than keeping the same provider but we want to ensure whichever model we do is with the intention of meeting the needs of the individual young person and is safe.
Long term provision early 2020 onwards
As part of the design of the long term model we need to go through a formal procurement process. This is being led by the Derby City Council and has already started. It can take about a year from beginning to end. More information will be provided at the engagement events, via the FAQs page and if necessary we will write to you.
Update since July engagement session
What has been happening since May 2019?
- Derbyshire Health Care FT nurses stopped providing a nursing service at the end of May 2019. Social care staff who are employed by Derby City Council are continuing to work at the Light House. The staff consultation has finished and you will see that them take on additional responsibilities as part of their role.
- The name of our interim specialist health care provider is Nurture Care, they are a non NHS organisation. They are rated Outstanding in Care and Good in all the other areas (safety, effectiveness, responsiveness, leadership). They are providing a mixture of training to care staff and direct nursing care with nursing cover for 3 nights a week from mid-June to December. There will be a small team of qualified nurses (around 5) working at the Light House so that they get to know the children and provide consistency. There is a lead nurse in charge. This will be in addition to ‘social care only’ nights whilst staff are trained and competent.
- There is a dedicated trainer for care staff who will assess and sign off competencies. Training will be practical and adapted to the needs of the children using the service.
- From the beginning of June we have started to train social care staff in the skills that they can be trained. The Nurture Care nurses will ensure that social care staff will get good quality ‘on the job’ supervision when they are practising new skills.
What slots will be available from June with the interim provider?
When Nurture Care started we set up some introduction sessions for you to meet the new team. We have agreed a 4 week rota for nursing cover from w/c 17 June
- Week one Tues, Wed, Thurs
- Week two Thurs, Fri, Sat
- Week three Thurs, Fri, Sat
- Week Four Tues, Wed, Thurs
We are not in a position where we can offer 5 nights at the moment and will be reviewing this with the staff at the Light House. We are very mindful of the need to offer more nights as we currently have families breaking down. If we are able to offer additional nights we will.
How will the social care staff have an impact on the new arrangements?
The new arrangements mean significant change for social care staff. Alongside nursing support, the senior social care team have started to develop the infrastructure of a care led model so that care is safe. Setting up new arrangements has provided an opportunity to do a ‘stock take’ on training so ensure everyone is up to date and understands new arrangements including roles and responsibilities. This includes
- Getting to know the new nursing team
- Training social care staff and training assessors (managers Sam, Neil and Sandra)
- Assessing staff so that they are competent and safe
- Safe individual care planning
- Putting policies in place
- Extending the social care team - recruiting to new roles and responsibilities eg senior care staff (level 3), senior night care staff
Since the beginning of June most care staff have been trained in
- Given oral medication
- How to identify an unwell child?
- Seizure management and administration of emergency medication
- Moving and handling
- Play training
Is all the training completed? If it hasn’t, what is still outstanding?
Not all the training is complete. There are still some gaps which include:
· In July Gastro/PEG feeding training will start
For children with the most complex needs for the foreseeable future we will continue to have a qualified nurse on shifts so that care is safe and parents are assured.
Has all the social care team staff been recruited?
The staff consultation is finished and response from staff has been very positive. Some new roles that need recruiting:
- Level 3 staff 3 out of 8 have been recruited.
- Senior night carers 2 out of 4 have been recruited
· We need to go out to external advert to recruit then training