Quality & Sustainability in Care Homes: A One City Approach As a key person in health and social care quality improvement you are invited to this important event aimed at shaping and improving the quality of the older people’s care home market in Leeds. #qualitycarehomes

Councillor Rebecca Charlwood Executive Member for Health, Wellbeing and Adults

Councillor Peter Gruen Leeds City Council Scrutiny Perspective Councillor Peter Gruen Chair of the Scrutiny Board (Adult Social Services, Public Health & NHS)

Quality & Sustainability in Care Homes: A One City Approach Councillor Peter Gruen Chair of the Scrutiny Board (Adult Social Services, Public Health & NHS)

Background Chair of Scrutiny Board – May 2015 Fresh eyes: New perspective CQC inspection outcomes not routinely considered Established a system to consider published reports, month-by-month Pattern of performance soon emerged Approx. 50% of Care Homes in Leeds require improvement / inadequate

Scrutiny Aims Best services for people of Leeds Health and well-being of all service users & families Focus on service quality across health and social care Increasing transparency and robustness of decisions What gets measured gets managed What gets managed gets done

Scrutiny Perspective Significant variation in quality across the Health and Social Care Sector Primary Care – 90%+ good or outstanding Social Care – 50% (approx.) good with very few outstanding Safety remains a particular concern Can you picture similar ‘failing’ standards with schools? Is the diversity in providing Social Care part of the problem or part of the solution?

Changing the focus Independent OR Council provided services we need to find a way to: Set a city standard Raise the bar – collectively and collaboratively What do providers NEED in order to perform better? How do commissioners, regulators and providers WORK TOGETHER to: Raise and maintain quality standards? Improve the lives of our older and vulnerable people?

CQC Position & Future Developments Debbie Westhead Deputy Chief Inspector of Adult Social Care, North Region, Care Quality Commission

Quality & Sustainability in Adult Social Care Copyright: Community Care Debbie Westhead, Deputy Chief Inspector Adult Social Care 7 April 2017 10 10

Our purpose The Care Quality Commission is the independent regulator of health and adult social care in England. We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Strategy Slides - 24 May 2016 - MASTER

The Mum (or anyone you love) Test Is it responsive to people’s needs? Is it good enough for my Mum? Is it effective? Is it safe? Is it well-led? Is it caring?

Overall ratings: England NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding Source: Ratings data extracted 24/03/2017

Overall ratings: Yorkshire and The Humber NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding Source: Ratings data extracted 24/03/2017

Overall ratings: Leeds NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding Source: Ratings data extracted 24/03/2017

Ratings by service type: England

Ratings by service type: Leeds NB. Hospices are not included in this chart – Leeds' only outstanding rated location is St Gemma's Hospice Source: Ratings data extracted 24/03/2017

Ratings by size: England NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding. Small = 1-10 beds, Medium = 11-49 beds, Large = 50+ beds Source: Ratings data extracted 24/03/2017.

Ratings by size: Leeds NB. Figures in the charts above are in percentages and may not add up to 100% due to rounding. Small = 1-10 beds, Medium = 11-49 beds, Large = 50+ beds Source: Ratings data extracted 24/03/2017.

ASC Re-inspections: Leeds The chart illustrates the proportion of re-inspected locations in Leeds that have changed ratings between their first and most recent inspection. The majority of re-inspected locations (59) were of those that were first rated requires improvement, almost half of which (49%) remained unchanged. Of the four good locations that were re-inspected, one was re-rated as inadequate. More than 73% of the 15 inadequate locations that were re-inspected improved, 20% to good. Source: Ratings data extracted 24/03/2017.

Outstanding characteristics People are at the centre and staff want to them to have a life not just a service Good leadership extends beyond the manager and values are shared to inspire staff Transparent, open culture with people who use services, staff, families, carers and partners Strong links with local community Creative and innovative A can do, will do attitude – staff dedication Safe care actively promoted Always looking to improve Focus is on people not the regulator!

State of Care 2016: Adult social care The good news Many services are providing good quality care – over 70% More than three-quarters of re-inspected inadequate locations improved 84% of community social care locations, including 92% Shared Lives services, Good or Outstanding Caring achieves highest scores – 90% Good, 2% Outstanding

State of Care 2016: Adult social care The worrying news 26% services Require Improvement and 2% are Inadequate Poorer performance for safety and leadership Nearly a quarter of re-inspected inadequate services did not improve Half of services rated requires improvement did not improve on re-inspection – 8% became inadequate Services for older people fare worse than those for people with a learning disability

State of Care 2016: approaching a tipping point? Age UK estimated in 2015 over a million older people have unmet social care needs, up 800,000 from 2010 26% fewer older people receive LA funded care – 81% of councils reduced spending on social care Five-year increase in nursing home beds now stalled Improvements are becoming harder to make Some providers resigning contracts, councils warn of more Source: CQC – State of Care 2015/16

State of Care 2016: system failing the Mum Test Causes of delayed transfers of care April 2012 to July 2016 Home care package Nursing home Residential home

Quality matters: a collective effort The public – people who use services, families and carers Staff – capable, confident and supported Providers – culture, organisation, expectations Commissioners and funders – expectations of quality Regulators – monitor, inspect, rate, take action, celebrate

What is Quality Matters? A document that sets out: a single shared vision of what quality is for adult social care why the sector and people who use services, their families and carers need to come together to improve quality a shared set of (initial) priorities to tackle the quality gap. More than a document: a broad coalition of partners coming together to take concrete action on quality, built around a shared view of what quality is. CQC, providers, commissioners, SCIE, Skills for Care, Local Government Ombudsman, Healthwatch and more involved. Minister supports the direction of this work.

We’re promoting a shared view of quality that aligns across health and social care Person-centred high quality care for all Safe Effective Caring & Responsive (positive experience) Sustainable use of resources Well-led

Our next phase of regulation We plan to update our approach and assessment framework to reflect the changing provider landscape Two consultations on these changes: December 2016/17 (now closed) and May 2017 more integrated approach that enables us to be flexible and responsive to changes in care provision more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication 29

Consultation 2: adult social care inspection methodology Our next consultation will cover a range of areas, including the end to end process for inspecting adult social care services Specific focus on how we will encourage improvement in services that are repeatedly at requires improvement Improved processes for inspecting services providing care to people in their own homes Our effectiveness and consistency of how we use our enforcement powers 30

Deputy Chief Inspector of Adult Social Care Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Debbie Westhead Deputy Chief Inspector of Adult Social Care Deborah.westhead@cqc.org.uk 31

A Provider Perspective Peter Hodkinson Chair of Leeds Care Association and Managing Director of Westward Care Ltd

A Commissioning Perspective Mark Phillott Jo Harding Head of Commissioning, Adults & Health Director of Nursing and Quality, Leeds West Clinical Commissioning Group

City Bed Overview City-wide Bed Provision Older people – 92 Homes in the independent Sector with approx. 4084 beds. Since 2008, there have been 1,184 new beds in the independent sector and 311 beds removed through Home closures. The market continues to attract investment with 3 new Homes opened in 2016/17 and a further 3 new homes to open in 17/18.

Examples of Current Issues Facing Sector – Older People Market Shaping Tensions – Nursing EMI Provision Workforce Issues Hospital Admission/Discharge Local Authority Budgets Provision of Equipment Medication Errors Raising the quality of services

Started the re-commissioning of independent sector care homes in the City Review of the Quality Standards We want to try to incentivise quality services How best the authority can support the sector to achieve the best quality services for residents

Director of Nursing and Quality Role of the Leeds CCGs in Care Home Quality, Safety, Contracting and Performance Jo Harding Director of Nursing and Quality

Leeds CCGs contract with approximately 38 care homes with nursing as part of our continuing care responsibilities. We commission continuing care placements and community intermediate care beds NHS Leeds South and East CCG is the lead commissioning CCG The collaborative team for community services leads on contract and performance management for CHC and CIC beds – as part of a wider portfolio of community services. Quality in care homes is primarily monitored by collaborative team with input from a range of professionals including the main CCG Quality team, CCG Medicines Management team, Infection Control team and Continuing Care nurses Quality information and performance is reviewed at the CHC Contract Management Group and the Community Provider Management Group. Key issues and concerns are reported into the CCG Quality and Safety committee/Assurance Committees

Where concerns are identified the continuing health care team works with the home to develop and monitor a remedial action plan Partnership working with local authority colleagues from Adult Social Care includes joint meetings (Care Homes Provider Group, Care Homes Quality forum), sharing of information, joint quality assurance visits Further developments being progressed in joint monitoring of homes where CQC has rated ‘inadequate’ and there are significant quality concerns requiring enhanced surveillance and targeted work. Joint meetings with care home, joint quality review visits, joint reports. NHS England expects CCGs to have oversight of quality in all care homes, including those without nursing. This presents a challenge for the CCG. Homes without nursing are also discussed at the bi-monthly CQC meeting attended by the CCG and LA, and CCG is also copied into suspension notices from the Local Authority so has some oversight of issues in care homes without nursing

NHS Initiatives/Direct Support to Care Homes Alison Gordon Julie Budd Clinical Operations Manager, Dementia & Specialised Citywide Community Teams, Leeds & York Partnership Foundation Trust (LYPFT) Clinical Team Manager for the LYPFT Care Homes Team

LYPFT Citywide Care Homes Team April 2017 Become a Dementia Friend today and make a real difference to someone’s life. Join Dementia Friends and we’ll help you understand a bit more about dementia, and the little ways you can help. https://www.dementiafriends.org.uk/  Mental health information   for everyone in Leeds www.mindwell-leeds.org.uk   Mental health information   for everyone in Leeds www.mindwell-leeds.org.uk

Who we are A team of professionals including: Nurses Occupational Therapists Pharmacist Psychologist with access to psychiatrists With access to medical staff and other relevant professionals

What we do We provide secondary mental health services to people residing in 24hr care This includes assessment, treatment and non-pharmacological approaches to care We also provide advice, support and education to care home staff

General Information On average the team receive 900 referrals per year. Our response to referrals are for the person to be seen within 5 working days We aim to reduce unnecessary hospital admissions and prevent a step up in care

What the teams thinks is good quality care Person centred “All about me” Involving carers/relatives Mental Capacity Act Back to basics Meal times (protected time) Distressed behaviour (management and advice of ) Medication regular review

What the teams thinks is good quality care The environment and Meaningful activity Monitoring impact of interventions Supporting staff Outcome measures Celebrating successes

Challenges ahead National political climate and impact on all public services Local (Yorkshire/Leeds)services changes Partnership working LYPFT OPS redesign model

Thank you Any Questions

A Resident’s Perspective Betty Smithson Resident’s Representative from Healthwatch Leeds

Please move to your allocated table after refreshments. Workshop What practical solutions can Leeds put in place to deliver high quality care in older people’s care homes? What practical solutions can Leeds put in place to ensure a sustainable high quality care home market in Leeds? How do we work together to achieve them? Please move to your allocated table after refreshments.

Adults & Health Perspective Cath Roff Director Adults & Health

Plenary Questions and answers to speaker panel

Next Steps and Event Close Thank you