Oral Care in Care Homes

This week Care Quality Commission (CQC) published its latest report on oral care health in care homes.

Their findings reflect what people have been telling Healthwatch nationally, including the problems people face in accessing dentists.

Key findings from CQC

  • People who live in care homes do not always get the support they need to maintain good oral health.
  • 52% of care homes have no policy in place to support resident’s oral health. This could mean care home staff are not aware of the need to support people with daily mouth care, like brushing their teeth.
  • Many residents are not able to access oral health products like toothbrushes as care homes would not provide them, as they are seen as a cosmetic product, not a health care one.
  • One third of care homes said they had had difficulty accessing routine NHS dentistry services. Some managers reported that domiciliary dentists refused to visit care homes.

In response to the publication of the report, Healthwatch England Chair, Sir Robert Francis QC, said:

“Healthwatch has investigated the lack of oral healthcare in care homes for a number of years, and it is encouraging that this issue is now being addressed. Daily oral health support, which includes simple things like the daily brushing of teeth, is important to maintaining people’s overall health and it needs to be taken seriously.

“I am pleased that we have been able to work with the CQC to raise the profile of this issue and it is encouraging to see that practices are beginning to change. We want people to have the confidence to know that if they speak up to Healthwatch, action will be taken.

“What we learnt from this report is that we must improve oral healthcare training for care workers. It can make a big difference to the health and wellbeing of people living in care homes when care workers have a better understanding of what is good practice in oral healthcare and how they can support people to maintain good oral health.

“This report makes it clear that this issue is about more than just about access to dentists in care homes. The lack of availability of dentists is an growing issue that needs immediate attention. There is an increasing number of people who struggle to access high street dentists, and we urgently need to look at how we can successfully address this issue.”

Emergency Ambulance

Ambulance Services to Care Homes in Northumberland

Across its operational area in 2015/16 North East Ambulance Service (NEAS) attended 14,484 emergency incidents with the location flagged as being a care home.  During the first six months of the year, there was an average of 38 incidents per day, rising to an average of 41 per day in the latter half of the year. There were 30 care homes that NEAS were called upon to attend on 90 or more occasions in 2015/16.  Of those, ten accounted for over 9% of the total care home activity that year. One care home in Northumberland made this list.

While this showed that Northumberland based care homes made only a small call on NEAS emergency services, from feedback we understood that some care homes were concerned about the length of time they have had to wait for an emergency ambulance to attend for their residents.

Between September 2016 and January 2017, Healthwatch Northumberland took a closer look at the issue. We specifically wanted to know the extent of the issues and understand what the ramifications could be for residents and the operation of the care homes.

Read the full report.

AGM: Questions and Answers

The Healthwatch Northumberland AGM took place in October at Stannington Village Hall. At the end of the meeting the panel took some pre-submitted questions from the attendees.

Panel members:

Ray Burns – Operations Manager (North East Ambulance Service)

John Young -Head of Service, Care Management (Northumbria Healthcare)

Jane Weatherstone –Associate Medical Director (Northumbria Healthcare)

Caroline McGarry –Patient & Public Involvement Co-ordinator (Newcastle Hospitals)

Sally Ridley –Corporate Matron (Newcastle Hospitals)

John Lawlor –Chief Executive (Northumberland, Tyne & Wear NHS Foundation Trust)

Julie Ross –Chief Operating Officer (Northumberland Clinical Commissioning Group)

Ann Marshall- Acting Group Nurse Director for Community Services (NTW)

Liz Prudhoe –Strategic Lead (Healthwatch Northumberland/Adapt North East)

Cynthia Atkin –Chair (Healthwatch Northumberland)


Q1: What are the CCG’s intentions regarding the commissioning of couples therapy for depression counselling within IAPT?

A: Julie Ross: The CCG has a contract with Talking Matters Northumberland dedicated to couples therapies.

A: John Lawlor: Complex needs are signposted to Northumberland, Tyne & Wear NHS Foundation Trust.


Q2: With the Government only providing the Tees area a proportion of the monies from the Mental Health Fund, will it have a detrimental effect on NTW’s operational strategy within Northumberland?

A: John Lawlor: The NHS has been receiving the lowest increase in resources. The concern is how do we make sure we don’t go backwards on mental health and learning disabilities services. The big challenge is to continue what we do, making sure it’s within the resources.


Q3: A series of recent sector training events have raised awareness of the needs of people living with Parkinson’s Disease, what are the CCG/NHCT future plans to support the quality of life needs of carers and affected loved ones coping in their own homes and to raise their profile and public awareness to the same level as that of dementia?

A: Jane Weatherstone: As a health body the CCG and Northumbria don’t have a plan for Parkinson’s disease. We know that Parkinson’s disease is becoming more prevalent due to an aging population. What that pathway would look like we will put into educational events for GPs. We work with our nurses to keep them up skilled and to help people in their own homes to keep them independent. There are no great plans for Parkinson’s disease as such.

Question from the floor: Why can’t they bring the community surgeries back to the communities, to aim to make GP practices a hub. From speaking to other people it has been found that sometimes whenpeople go onto websites the information is out of date.

Helen Williams (Alzheimer’s Society) and Hanna Whincup (Ageing Well) have provided excellent support, it’s really important that the voluntary sector is part of that model for the hubs

A: Julie Ross: The ACO strategy create hubs where community services can work together i.e . mental health, physical care professionals. It’s about getting them together to see the whole picture as one.

A: John Lawlor: At Northumberland, Tyne and Wear NHS Foundation Trust we provide much more specialist services. We have a number of locations of where our staff are based and the large majority of interactions happen in people’s houses. We have found it to be very effective working with third sector organisations. It’s hard to stretch our resources across Northumberland.


Q4: Can you share some thoughts on the best community based models that would fit Northumberland for supporting people with mental health issues out in the community to regain skills, reduce isolation and build confidence and self-esteem? What support and input are NTW offering in terms of the establishment of Recovery Colleges across the whole of Northumberland?

A: Ann Marshall: Across all our localities our ideas are growing. Recovery colleges are a model about helping people to manage their own strengths. This is a very new way of working for us and there are challenging times for us around resources.

How do we provide a service for people who come together to share their experiences? We are really grateful of the work that has been done with Healthwatch Northumberland. We offer our expertise and knowledge of highly skilled clinicians to work with the wider community and providing access to facilities. Joint work is still ongoing with a single point of access and bringing together nurses and other types of nursing which is still in discussions.


Q5: How can better communications improve cancer services locally?

A: Julie Ross: Newcastle is our main provider of cancer services. The role of the voluntarysector is something we know we need to maximise on and making sure of patient input is key. Within the ACO it is getting a central computerised system as it’s also about us joining up.

A: Jane Weatherstone:It’s about the pathways everyone needs to have input as to what a pathway could and should look like. What comes up is x- results are not being read in a timely way. The clinical policy group is where all of the heads of services come together, to have systems in place that work, making sure there are lots of safety nets and pathways in place in the first place.

A: Sally Ridley: In urology we are working really hard to work through that pathway. Joint working in partnership about making a seamless transition i.e. if an element of care is in one Trust and another is in another Trust, it isimportant we work in partnership with Northumberland.


Q6: What does the future hold for Healthwatch Northumberland?

A: Cynthia Atkin: Healthwatch Northumberland is currently is a statutory function funded by a local authority. The contract ends in March 2017, however it will be going out to tender. The board members will be standing down.


Q7: There appears to be conflict when the Acute Trusts are being asked to increase their activity, yet the CCG’s don’t have funding to do this. How are you managing this as partners working together?

A: Julie Ross: The Acute Trusts see who turns up at their door; the more people they see the more they get paid. For Northumberland, Tyne & Wear NHS Foundation Trust the more they see the less money they get. Now it’s looking at putting all the money into one pot and the ACO will have to move off payment by results. We are trying to work together; over the next six months, the ACO will balance the system.

Question from the floor: Shouldn’t there be a strategy on how that money is going to be spent?

A: Julie Ross: A clinical strategy is in place of what is going to be delivered and what the outcomes are.

Question from the floor: Where does health promotion come in on this?

A: Julie Ross: As of April next year we will be working with the Local Authority to invest in prevention and to reduce demand, looking at what can we do to stop people getting ill.

A: John Lawlor: From the North East Authority Health and Social Care Commission one of the pieces of work is to publish a health and wellbeing strategy. Looking atthe current health of Northumberland, Tyne & Wear and Durham and also looking at the health gap, the care gap and the financial gap.

Question from the floor: Many CCG’s are in deficit and have a recovery plan, what happens in the new financial year?

A: Julie Ross: How we manage the money going forward, our contracts exceed our income. It’s not sorted yet but we will have to create a financial fix.


Q8: Can you describe what happens when a patient is due to be discharged from a Newcastle hospital back home to Northumberland?

A: Caroline McGarry: Working closely with our discharge team, ward staff contact discharge nurses in the area. Initial assessment would go to a Northumberland social worker for the patient to get a short term care package. Long term they would be allocated to a care worker. We are working together to try to get the patient out of hospital safely and in the best way.


Q9: What targets are GP practices given, if any, to record patients as carers or recognise them as such. How many Carer Champions have been recruited by GP practices and is there any financial incentive to do so?

A: Julie Ross: 44 practices each have a carers champion within the practice who is a GP. On doctors desks there is a carers prescription pad for care and support. This is £6.75 per head which is monitored by audits, random checks and feedback.

A: Sally Ridley: Identifying and acknowledging carers i.e. ‘John’s campaign’ the care he received in hospital was very good but he was socially isolated because his carer couldn’t spend time with him. We recognised carers can be invaluable to us in supporting patients while in hospital. It’s very clear from some carers it is an opportunity to have respite also. Packs for carers and cards within the packs help carers to visit at different times. There are also meals for carers, it’s about choice and negotiation. Also within that to identify younger carers as well working with organisations for that.

Liz Prudhoe: At a Northumbria Healthcare listening event a carer mentioned that when visiting the Freeman Hospital they were given a carers pack and food menu.


Q10: What procedure is in place when integrating services between Newcastle and Northumberland?

A: John Young: Transfer from Newcastle to Northumberland we get a referral from a Newcastle Social worker we generally accept that referral. If someone needs residential care or social care or step down care we do that. A social worker couldn’t arrange that in Rothbury.

A: Julie Ross: They are costed very differently i.e. RVI is on a tariff basis and i.e. Rothbury is on a block contract.

Question from the floor: What about support to go home i.e. from an acute specialist setting?

A: John Young: A discharge nurse specialist looks at step down facilities and what’s right for the patient at that time.

Question from the floor: Will there be enough home care in place i.e. for Rothbury?

A: John Young: This would be subcontracted to another care agency directly.


Q11: How do you feel Healthwatch Northumberland could work more closely with Newcastle Hospitals to ensure patient’s voices are heard? After all we access the good quality services provided from Newcastle?

A: Caroline McGarry: We are keen to work closely with Healthwatch Northumberland and would be more than willing to meet up and discuss any feedback that you receive about the Trust.

Cynthia Atkin: Asked if Healthwatch Northumberland could be provided with the protocols in place on discharge.


Q12:Patients have said that palliative care or lack of it is a problem for Northumberland. What can we do to ensure we have palliative beds when required?

A: Jane Weatherstone: We are very proud of the palliative care we provide. In Northumberland it is a community based service. The service we provide endeavours we keep people where they want to be. We have a partnership with both Macmillan and Marie Curie. We know that people access beds for the last few days of their lives and we have services that provide carers with respite.


Q13: Patients with mental health problems are presenting themselves at hospitals via A&E. How do the trusts work together on ensuring good quality service for patients is in place and patients know where they go for help?

Example from the audience: A lady’s brother was suffering from psychotic episode and had to travel in an ambulance from one hospital to another, as his carer she was allowed to go with him and security people also went along in the ambulance to provide support. Having that support and familiarity helped her brother.

A: Anne Marsh: It is the people who have gone the extra mile to help with care. Recognising the value that someone who is familiar can help. It is the Triangle of Care between the carer, the professional and the patient with the partnerships and services in local communities to help people better understand. Patients have extended families and extended networks, we are signposting and working in collaboration with GPs.

Cynthia Atkin: The majority of feedback comments we get back from patients are compliments rather than complaints.

Q: What about travel needs in Northumberland – a friend who has cerebral palsy was taken in an ambulance from Hexham to Wansbeck A&E. It was then down to him to get himself back home. He is 80 years old and he did not have enough money on him for a taxi.

A: Jane Weatherstone: For Northumbria Trust we wouldn’t be able to get an ambulance at that time of night but we would endeavour to get that taxi service for him. We would like your friend to contact us at Northumbria Healthcare about this.

Q: What about access to GP surgeries?

A: Julie Ross: Surgeries are not bursting at the seams; there are no practices that are in breach. They are all open. GP surgeries access quite a lot of funding through the Vanguard programme. In Northumberland it will guarantee same day demand; this will then be spread out with GPs monitoring people who are coming back time and time again.

Liz Prudhoe: A lot of work has been done on access to GP surgeries and there is a report on the Healthwatch Northumberland website.

Q: There are some issues arising around Patient Transport.

A: Liz Prudhoe: It has been a continuing challenge in Northumberland, the decision for whether someone is eligible for Patient Transport is initially through a questionnaire by NEAS. Numbers going through on appeal are very high. We’re working with NEAS on this as well with Mark Johns and Mark Cotton.

Q: How does the ambulance service meet the needs of Mental Health patients?

A: John Lawlor: For those with physical health issues there are no problems. 97% of our patients are living in support in the community. For the 3 % who are not living in support in the community the ambulance service works pretty well in the time it takes to transfer patients; we work with the police, the street triage service and the community psychiatric nurses. In Cramlington for example, doctors and nurses are able to make assessments. The numbers involved are small.

A: Ray Burns: Work is done in collaboration with the North East Ambulance Service and Northumberland, Tyne & Wear NHS Foundation Trust – these are really small numbers.