George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 1

Diabetes Sans Frontiers! Meeting 26 th March 2014 Residential Care Quality Kite-Mark (QKM) The story so far in Devon… How to start a movement and its application to diabetes in residential care George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 2

A few slide about the Devon Residential Care Quality Kite Mark George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 3

Quality Kite Mark in Residential Care Settings in Devon The story so far…… priority focus on dementia care Commissioned in July 2012 by Devon PEN Dementia Task and Finish Group Core group focus – 6 members – all opted in Scoping the priorities – early meetings Sept- Oct 2012 ‘product development - construction’ work Project plan for priority workshops x3 -Nov- Jan Manageable wider engagement – ‘guest observers’ Introduction of monthly peer review – April ongoing – monthly programme QKM – ‘owner/ manager’ master class 3 day training – 2x annually The programme’s USP is ‘by providers for providers’ George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 4

Quality Kite Mark in Residential Care Settings in Devon Introduction, context and background Care competencies in care homes are very variable – this work seeks to ‘level up’ care standards in residential care settings Developing a skilled and able workforce related to care in residential settings across Devon is the main objective Providing ‘Reputation Enhancement’ for providers of the best care in residential settings Devon wide ‘product development, construction work and roll out’ Developing and promoting a consistency in approach and methods George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 5

Quality Kite Mark in Residential Care Settings in Devon Principles and Values Like mindedness ‘Person Centred Care’ focus Ensuring we remain ‘agenda central’ – risk of marginalisation and exclusivity Peer review and support as key components Developing a ‘consensus statement’ on what we stand for Evidence based – inc 5 core influences (1), SW Dementia Partnership and ‘Progress for Providers’ guidance toolkit A phased approach Making sure we are part of the solution !! including … …..KPOOH and GPOOH Keeping and Getting People Out Of Hospital ( 1) Rogers, Kitwood, Nolan, Sheard, Robbins George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 6

Quality Kite Mark in Residential Care Settings in Devon The Phased Approach 1.Scoping and initial construction work -Sept - October Skills based workshops – Nov- Jan Introduction of monthly peer reviews – Apr- ongoing 4.Master-class ‘owner / manager’ QKM training –May - 1 st cohort 5.Wider engagement, consultation and recruitment meetings –June 2013 ongoing 6.2 nd Wave of ‘owner / manager QKM training in the Autumn and twice yearly – next intake April / May Variable added ‘products’ - manager mentoring, safeguarding avoidance and mgt support, consortia purchasing via preferred provider, website -Ongoing monthly steering group meetings and peer reviews -Discussions with senior managers in social care re links with in house service -Further presentations recently in Glasgow, Belfast, CQC Executives, today at the Care Show in Bournemouth! -A product specifically for Nursing Homes – work underway -Potential for a product for Domiciliary Care George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 7

Quality Kite Mark in Residential Care Settings in Devon Peer Review timetable April – December 2013 care planning,training and education, activities, environment and atmosphere, medication management and administration, basic care – nutrition, hydration and personal care, long term condition management – (including diabetes), pain management, end of life care 2014 schedule Person centred care plans, safeguarding processes and strategies, managing challenging behaviour, Lewy Bodies Dementia, end of life care, skin care and pressure sore mgt, mood disorders inc depression, dental and sight care, fall prevention, night time lives issues, CVD inc stroke and renal care, medication management George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 8

Quality Kite Mark in Residential Care Settings in Devon Peer Review – 2 reviewers (owner and manager) reviewing a 3 rd member home – Appreciative inquiry format – Evidence based via ‘progress for providers’ tool – Intention to ‘ask not tell’ and share to learn – ‘observational best practice reports’ – done quarterly and shared with the steering group George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 9

Quality Kite Mark in Residential Care Settings in Devon Master Class - Owner / Manager Training 3 days spread over 3 consecutive weeks – Day 1- Leadership and Management – Day 2- Staff Development – Day 3- ‘Living well with Dementia’ – Day 4- 3 months later – 3 themes – service improvement initiative progress, ‘how to be a peer reviewer’ and follow up evaluation Theory vignettes and participative workshop based Workbook focused with homework and presentations fully evaluated in 3 parts 3 rd Cohort master class programme – 17 attendees booked – Apr/ May George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 10

Quality Kite Mark in Residential Care Settings in Devon External and Wider Interest SW Dementia Partnership, South Devon and Torbay CCG (various projects), ‘NEW Devon CCG’ as a dementia aware organisation links IDOP- Institute of Diabetes in Older People Skills for Health and Skills for Care, local AgeUK Bristol commissioner QKM scoping meeting Eastern Devon Locality Clinical Executive, Local MH Trust and acute FT (RDE) Gloucester commissioners and follow up events, Various pharmaceutical organisations, Local MPs – Anne Marie Morris and Dr Sarah Wollaston CQC Executives – David Prior and Andrea Sutcliffe Local MP interest – Norman Lamb recommended meeting with Martin Green, ECCA George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 11

What options and thoughts on adapting the model for the Diabetes Stakeholder Network and population ? George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 12

Quality Kite Mark in Residential Care Settings in Devon facts and stats about diabetes in hospitals and care homes 15% of OBDs 630,000 admissions in November – 10% diabetics – 63,000 people Average age 75yrs 50% of newly diagnosed already have complications 10% of the NHS total care budget Source - H&SCIC 1:4 residents in care homes 23% screened on placement 28% annually reviewed Little structured training for care staff in care homes Every 25mins a care home resident with diabetes has an unplanned admission to hospital Source Diabetes UK ‘Diabetes in Care Homes’ George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 13

Quality Kite Mark in Residential Care Settings in Devon The West Berkshire – QKM diabetes scoping meeting Why care homes ? - facts and stats Cross over for care homes – dementia model used for diabetes A ‘virtual network’ of likemindedness The ‘Devon model of initiation’ -identifying your 2.5% (1) 1. Everett Rogers (1962) – “ Diffusion of Innovation”– 2.5% innovators, 13.5% early adopters, 34% early adopters, 34% late adopters, 16% laggards George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 14

Quality Kite Mark in Residential Care Settings in Devon But how portable is the model to diabetes? 1.IDOP interest in a national programme 2.The principles are transferable 3.‘Share to learn’ – promoting and celebrating best practice 4.Things in common between dementia and diabetes – Both are LTCs, both see huge increases in older age, both see lots of avoidable admissions, both very common in care homes. George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 15

Quality Kite Mark in Residential Care Settings in Devon What will encourage care homes to get involved? – Building Trust and Transparency across the sector – ‘WIIT’ factor linked to ‘WIIFM’ – Reward for being proactive – reputation enhancement and occupancy impact – Producing a means for greater consistency of best care – offering better likelihood of excellent CQC inspection outcomes – Cooperation can coexist with Competition George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 16

Quality Kite Mark in Residential Care Settings in Devon But what’s important? ‘Embedding the approach in a residential care culture shift’ – Trust and Transparency, Being Proactive and Imaginative, Happy residents and Kind staff – Greater consistency of best care – offering: better likelihood of excellent CQC inspection outcomes, reducing safeguarding problems and, keeping beds filled !! – Choice, Safe and Fun, Best Value residential care for people with diabetes – ‘Aspiring to be Better’ – Links, partnerships and collaboration - including risk sharing George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group

Devon Quality Kite Mark in the Care of Older People with Dementia Lobby Certificate for participant homes We are one of the coalition of residential and nursing homes in Devon who are aspiring to provide the best possible care for people with dementia. The values and principles we are developing are based on: openness continual internal review and improvement peer review and support using best evidence for the care we offer to our residents Owner and Manager specialist masterclass training graduates The principle of sharing to learn George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 18

Quality Kite Mark in Residential Care Settings in Devon Options for next steps considered other independent residential homes in Devon domiciliary care -this was part of the original brief specific module for nursing homes specific clinical themes related to residential care inc diabetes, fall prevention, skins care and pressure area management, end of life care specific localities in Devon eg Eastern Locality of NEW Devon are interested in work with their 46 care homes, 16 Brixham care homes looking at diabetes as a focus external organisations and bodies accreditation, validation and gaining endorsement for the work a commissioning tool to support improved care and recognition for providers. Growth and expansion add on products for members George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 19

Quality Kite Mark in Residential Care Settings in Devon So….. How to do it 1.Convene a ‘best care home diabetes SIG’ 2.Identify your ‘hero innovator’ care homes 3.Convene a steering group 4.Agree best practice principles 5.Apply the Devon model of peer review and support the work with positive endorsement 6.Involve me in some form supported by Gary and MSD ?! George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 20

George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 21

Quality Kite Mark in Residential Care Settings in Devon Key Themes Partnership and collaboration Meaningful engagement with people receiving care and their significant others Outcomes and positive impact focused evidence based approach Peer review and support To maximise certainty regarding CQC compliance and support ‘Consensus statement’ regarding values and principles of best care Local and independent validation - various options under consideration To help inform the commissioning of the best care possible for residential care for people with Dementia Having a consistent high standard of care George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 22

Quality Kite Mark in Residential Care Settings in Devon Consensus Statement 1.the overall aim is to drive up quality of care and support to people with dementia and their families 2.the QKM will focus on a philosophy of sharing and learning from one another 3.those involved in the QKM work and development will adhere to greater partnership working across health and social care systems 4.we are committed to sharing risk in how we enable people to receive the best care and support including how we work together to keep people out of hospital where this is safe and appropriate particularly avoiding emergency admissions through proactive working 5.we will give priority to embedding person centredness for people including those using services and those providing services alike 6.we will provide a strong emphasis on peer review and support between and across provider organisations 7.we will use, and be guided by, the best and most up to date evidence and local demographic data available George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 23

Quality Kite Mark in Residential Care Settings in Devon Immersion, Embeddedness and Culture shift What does the culture shift look like? How to create an ‘appreciative inquiry model’ without colluding, being defensive or defending inadequate care providers and poor practice What the QKM advocates in terms of every day lives – Person centredness – A ‘culture of improvement’ - it’s about aspiring to be better – Promoting ‘Good Care Habits – Being proud of what we do – Staff being kind – Residents being happy George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 24

Quality Kite Mark in Residential Care Settings in Devon Eligibility Criteria 1.adherence to the QKM consensus statement 2.engagement in the process and be part of the QKM journey 3.attend 4 Devon Care Quality Forum events per year 4.attend at least 2 PEN meetings including the DCT annual training conference – Sept 2 nd this year Owner and / or Home Manager must attend the 3 day master class QKM training programme 6.must participate in the peer review and support programme 7.all members must join the Devon Dementia Care and Support Partnership 8. manager’s attending 1/2 of the 10 Manager Forums per year George Coxon, Director CCH Devon Chair of the Devon Dementia QKM steering group 25