Mr Anthony Middleton, Chief Operating Officer Wirral University Teaching Hospital NHS Foundation Trust introduced his report that set out details on the arrangements for provision of a managed service contract to run a 30 bed Transfer to Assess Unit sited at Clatterbridge Hospital. The report summarised the process and activities undertaken to identify a supplier to provide a managed service contract for the provision of T2A services to the Trust. The report further detailed the major milestones in the tender process and the key factors that led the project group to recommend the award of the contract to Cedar Court (Tamaris Healthcare - Four Seasons Group Holdings Ltd).

Mr Middleton informed that in Wirral there were a total of 102 ‘Transfer to Assess’ (T2A) beds across 7 sites. The purpose of the beds being to provide assessment and therapy services for those patients who may require longer term support upon leaving hospital. The beds were also a step up provision for the community to avoid unnecessary hospital admissions. He further informed that it is highly frustrating both for patients and the clinical teams employed at Wirral University Teaching Hospitals that at any one point in time there were over 100 patients who had been medically assessed and therefore able to be discharged from an acute medical bed, but due to capacity constraints elsewhere these patients remained in hospital. He added that although unacceptable, this was not disproportionate and similar to nationally reported figures, but placed severe pressures and logistical challenges for staff.

Mr Middleton explained that Wirral Hospitals had determined that the model for the 48 bed requirement would be one of additional provision of acute medical and surgical capacity to the tune of 18 beds as well as a new model for 30 beds to allow a clinical staffing solution matched to the patients. The latter would operate along similar lines to that of care homes provision but with additional therapy, GP and community geriatrician input. This would therefore not require hospital consultant medical staff, nor registered acute nursing staff - needed for those patients with the most acute needs. 

The Overview and Scrutiny Committee was apprised that a formal tendering process was undertaken to identify potential suppliers for the provision of  T2A Services in the Summer of 2018. Six suppliers had participated in a pre-market engagement session and the OJEU contract notice was published on 4th August 2018 via the Trust’s tender management portal Pro-Contract. 2 suppliers submitted tender bids and on the basis of the tender analysis and evaluation process, the Trust board of directors awarded the contract to Cedar Court (Tamaris Healthcare - Four Seasons Group Holdings Ltd).

Members questioned Mr Middleton on aspects of the tendering processing with particular focus and concern regarding the contract award criteria and weightings (60% specification compliance and 40% cost). Mr Middleton explained that these aspects of the contract tender had been worked up by a project group and panel to ensure the most appropriate service outcomes.

In response to a question from a Member on the matter of staffing levels, the Committee was informed that this too formed part of the overall tender documentation.

The Committee expressed some concern regarding the appointment of a provider who had received less than satisfactory Care Quality Commission (CQC) ratings at some of its operations. Members were informed that at the time of the contract tendering and evaluation process no individual homes under the management of tender bidders had been rated as inadequate.

Members quizzed Mr Middleton on the nurse / patient ratios and sought clarity on the numbers for trained, registered nurses and untrained staff. The Committee was informed that nursing cover for the provision of T2A Services covered 24 hours, seven days a week, with a nurse to patient ratio of 1:8, compared to 1:6 for Acute Wards elsewhere in the Hospital.

Further discussion took place on matters relating to CQC visits, reassurance on care provision, a sustainability plan, discharge handling, respect for patients, readmissions, and staff terms and conditions.

In response to a question on CQC inspections, the Overview and Scrutiny Committee noted that an unannounced CQC visit had taken place just prior to Christmas and that, as with all CQC inspections, results would be published online in due course.

The Chair thanked Mr Middleton for his attendance and report.

Resolved – That the report be noted.