Short-notice care home closures

Capacity and resources: Further information

• Stepping-in rightsOpen

  In negotiation with providers, contract clauses can allow for 'stepping-in' rights at times of crisis, for instance, when a service can no longer be run by the existing management or other circumstances arise whereby the home cannot be fully staffed. Stepping-in rights allows the commissioner to provide additional staffing capacity for an agreed duration and with explicit understanding about who bears the costs of such an arrangement.

  Naturally, some providers may not welcome such a provision, particularly in geographical areas where the local authority is a minor purchaser, but agreement can and must be reached on defining the sort of crisis when this contractual provision may reasonably be invoked, for the benefit of existing residents, to support the staff and for business continuity.

Resources required

• Directing the processOpen

  • A project lead with responsibility for coordinating the relocation of residents should be appointed at the earliest opportunity.
  • The project lead should manage a project team which will primarily include care managers, commissioning staff, finance and human resources (HR) from all relevant agencies. 
  • The head of safeguarding will need to coordinate safeguarding issues.
  • All normal staff duties may have to be 'back-filled' while they are engaged in managing the closure, and this will have resource implications.

• Reassessment and care planningOpen

  • Commissioning authorities must reassess all publicly funded residents before a move - this service should also be offered to self-funding residents. 
  • Where the person is funded through NHS continuing care resources, the relevant health community will need to take the lead on assessing the patients who are fully funded by NHS funds.
  • All residents (and their families) should be allocated a key worker - this will have resource implications for assessment and care management capacity within the system.
  • Where people are judged to lack mental capacity, the provision of an independent mental capacity advocate (IMCA) will be required so that a 'best interest' decision can be arrived at for the individual.

• Alternative placementsOpen

  • Local authorities must ensure that the person's assessed need is the key determinant in selecting and/or funding a care placement.
  • Residents should not be placed in a setting which is not able to meet their assessed need, just because there is a vacancy.
  • Choice of accommodation regulations still apply. This means that local authorities can limit the cost of new placements to what 'local agencies would reasonably expect to pay to meet similar levels of assessed need'.

• TransportOpen

  • Helping people move to a new home will require transport, including in some cases an ambulance.

• Supporting existing care staffOpen

  • Local authorities need to provide support to existing care staff in order to maintain mental capacity and continuity of care. This means being open with information about the impact that change may have for their clients but for themselves. Local authorities need to encourage the employer also to share human resources information in a timely and sensitive manner.
  • Staff will have many employment queries and local authorities will need to arrange the input of people with human resources expertise as well as general people management skills.

• Impacts on other parts of the systemOpen

  • Acute and mental health trusts and NHS commissioners need to be kept informed about the possible 'knock on' effects of demand for staff (for assessment and care management) and alternative placements, as there may be an impact on hospital discharge flows.

• Communications and pressOpen

  • Councils will need to secure capacity to ensure the timely and sensitive communication of information to residents and family.
  • The project lead will need to develop a communication plan, including the resources to deliver it.
  • Councils will need to ensure that they have the resources to manage the message with press, and this will require the involvement of corporate communications teams.