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Schedule 2
SERVICE SPECIFICATION
Service
ENHANCED NURSING HOME BEDS
Commissioner Lead
Stephanie Lawrence
Provider Lead
Konrad Czajka
Period
1st April 2013 – 31st March 2014
1. Purpose
1.1 Aims
To commission intermediate care beds in a care home facility with appropriate care and nursing support.
 targeted at people who would otherwise face unnecessarily prolonged hospital stays or inappropriate
admission to acute in-patient care, long term residential care, or continuing NHS in-patient care;
 provided on the basis of a comprehensive assessment, resulting in a structured individual care plan that
involves active therapy, treatment or opportunity for recovery;
 has a planned outcome of maximising independence and enabling the client to resume to living at home;
 Is time-limited, normally no longer that 2 weeks or 4 weeks dependent on which bed the patient is
admitted to.
involves cross-professional working, within a unified assessment framework, single professional records, shared
protocols and accessed via a single point of access.
1.2 Evidence Base
The multi-disciplinary Airedale Collaborate Care Team will utilise these beds to reduce the requirement for the
Airedale Intermediate Care Ward as part of the Intermediate Care system redesign within Airedale and
Wharfedale and Craven area.
1.3 General Overview
To provide a community bed-base to facilitate “step up” and “step down” bed base in the community.
1.4 Objectives
To facilitate the transition to functional independence so that the client may return to their usual place of
residence within a pre-defined period of time.
1.5 Expected Outcomes
Avoidance of unnecessary admission to hospital
Support for the transition from hospital to home
Avoidance of preventable or premature admission to long term residential or nursing home care
Programme of residential rehabilitation
2. Scope
2.1 Service Description
Provision of 10 enhanced nursing home beds;
The beds will be accessed only via the Airedale Collaborative Care Team ** (the Airedale Wharfedale and
Craven CCG’s single point of access for all intermediate care services) by hospital and community based
professionals across health and social care, adhering to the admission criteria for the service. Medical/Nursing
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Schedule 2
admission criteria found in the Operational Policy – available in Schedule 2 The Services G. Other locally
agreed policies and procedures.
It is a requirement that the beds will be provided from a registered nursing home and have current QS3 (VTE
Prevention) accreditation with a verification visit undertaken this year.
** The Airedale Collaborative Care Team is a multi-disciplinary team, comprising:
Hospital consultant, GP, specialist nurses, community matrons, therapists, support workers, social and
care workers
2.
Service Overview
The beds will be required to facilitate two functions:
1) Beds to prevent admission into hospital.
2) Beds to primarily facilitate discharge from hospital.
There will be some flexibility on how many beds will provide each function and this will be agreed with the
individual care home and the Airedale Collaborative care Team
This will be a short stay facility (maximum of 2 weeks for the function to prevent admission to hospital and a
maximum of 4 weeks for the function to facilitate discharge, longer in exceptional circumstances following review
through the Collaborative care Team).
The Service Provider will nominate a number of dedicated staff to promote a rehabilitation focus and ensure
continuity of care. This will foster good working relationships and increase communication pathways with the
dedicated nursing home staff and multi-disciplinary intermediate care team visiting the home.
The Service Provider will provide a co-ordinator to oversee the management and use of the designated beds and
liaise with relevant health and social care professionals, who will work with patients who are admitted to these
beds, for example physiotherapists, occupational therapists, GPs, social workers, consultant geriatricians
Their medical care will be monitored by the patient’s General Practitioner or temporary General Practitioner
(where applicable) in collaboration with the hospital outreach team.
The Service Provider will receive support from the Airedale Collaborative Support Team consisting of a multidisciplinary team of nurses, therapists, rehabilitation assistants and social worker input, together with consultant
geriatrician input, to ensure appropriate case management and discharge arrangements either back home or to
an alternative setting.
The care provided and facilities within the home must meet the National Minimum Standards and requirements
set out in the ‘Care Homes for Older People – National Minimum Standards – Care Home Regulations 2001’ (3rd
Edition, DH, 2001) and in line with the principles and standards outlined in the National Service Framework for
Older People (DH, March 2001), and meet the requirements for the National Service Framework for NHS
Continuing Healthcare and NHS Funded Nursing Care (DH 2007).
2.2 Accessibility/acceptability
Medical/Nursing admission criteria found in the Operational Policy – Schedule 2 , G. Other Policies locally
agreed
2.3 Whole System Relationships
The aim of the service is to commission intermediate care beds in a care home facility with appropriate care and
nursing support that will be available for use by the Commissioner. Following assessment by the Airedale
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Schedule 2
Collaborative care Team and the named nurse from the home, patients whose intermediate care needs can be
met by the hospital outreach team and/or Collaborative care Team can be transferred into this facility. The
admission will be jointly coordinated by the Collaborative care Team and the home.
2.4 Interdependencies
The Airedale Collaborative care Team is a multi-disciplinary team, comprising:
Hospital consultant, GP, specialist nurses, community matrons, therapists, support workers, social and care
workers.
2.5 Relevant networks and screening programmes
2.6 Sub-contractors
3. Service Delivery
3.1 Service model
The beds will be required to facilitate two functions:
3) Beds to prevent admission into hospital.
4) Beds to primarily facilitate discharge from hospital.
There will be some flexibility on how many beds will provide each function and this will be agreed with the care
home and the Airedale Collaborative Care Team
This will be a short stay facility (maximum of 2 weeks for the function 1 beds to prevent admission to hospital and
a maximum of 4 weeks for the function 2 beds primarily to facilitate discharge, longer in exceptional
circumstances following review through the Airedale Collaborative Care Team). It is expected that the home will
nominate a number of dedicated staff to promote a rehabilitation focus and ensure continuity of care. This will
foster good working relationships and increase communication pathways with the dedicated nursing home staff
and multi-disciplinary intermediate care team visiting the home.
There is a requirement for the Service Provider to provide a co-ordinator to oversee the management and use of
the designated beds and liaise with relevant health and social care professionals, who will work with patients who
are admitted to these beds, for example physiotherapists, occupational therapists, GPs, social workers,
consultant geriatricians
Their medical care will be monitored by the patient’s General Practitioner or temporary General Practitioner
(where applicable) in collaboration with the hospital outreach team.
The Service Provider will receive support from the Airedale Collaborative Care Team consisting of a multidisciplinary team of nurses, therapists, rehabilitation assistants and social worker input, together with consultant
geriatrician input, to ensure appropriate case management and discharge arrangements either back home or to
an alternative setting.
The care provided and facilities within the home must meet the National Minimum Standards and requirements
set out in the ‘Care Homes for Older People – National Minimum Standards – Care Home Regulations 2001’ (3rd
Edition, DH, 2001) and in line with the principles and standards outlined in the National Service Framework for
Older People (DH, March 2001), and meet the requirements for the National Service Framework for NHS
Continuing Healthcare and NHS Funded Nursing Care (DH 2007).
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4. Referral, Access and Acceptance Criteria
4.1 Geographic coverage/boundaries
Scheme available to patients registered with an Airedale / Wharfedale or Craven GP
4.2 Location(s) of Service Delivery
Currergate Nursing Home
4.3 Days/Hours of operation
4.4 Referral criteria & sources
See Operational Policy – Schedule 2 , G. Other Policies locally agreed
4.5 Referral route
See Operational Policy – Schedule 2 , G. Other Policies locally agreed
4.6 Exclusion criteria
See Operational Policy – Schedule 2 , G. Other Policies locally agreed
4.7 Response time & detail and prioritisation
See Operational Policy – Schedule 2 , G. Other Policies locally agreed
5. Discharge Criteria & Planning including End of Contract “Phase out” plan
See Operational Policy – Schedule 2 , G. Other Policies locally agreed
6. Information Reporting
The Provider will submit to the CCGs Contracting Team the following information on a monthly basis to facilitate
payment:1) Occupancy Tracking Sheet
2) Copies of Patient Questionnaires completed
The Commissioner may from time to time notify the Provider of what further information it may
reasonably require in order to monitor the Provider’s performance of this Agreement, and in particular
the Provider’s compliance with Quality Standards, and the Provider shall supply such information.
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Quality Performance
Indicator
Threshold
Method of
measurement
Infection Control
Service User Experience
Improving Service Users &
Carers Experience
Unplanned admissions
Reducing Inequalities
Reducing Barriers
Improving Productivity
Access
Care Management
Outcomes
Additional Measures for
Block Contracts:Staff turnover rates
Sickness levels
Agency and bank spend
Contacts per FTE
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Consequence of
breach
Report Due
Schedule 2
8. Activity
9. Continual Service Improvement Plan
10. Prices & Costs
10.1 Price
Basis of Contract
Unit of
Measurement
Price
Cost per bed per
week
Vacant bed
£700.00
Cost per bed per
week
Occupied bed
£749.00
Maximum 10 Beds
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Schedule 2
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