QUALITY PROJECTS Adult Joint Commissioning Unit Market Development & Care Standards Team 11 October 2013 Nottinghamshire County Council

Why look at quality now? 2012 – number of care homes failing 5 key CQC areas Changes to CQC Inspection processes Increase in Council suspensions & repeats National & local media attention Increase in referrals of concern Dementia care quality Partner’s organisational changes

Why look at quality now? Difficulties quickly analysing information e.g. to respond to Members queries High vacancy levels – sustainability? OPPORTUNITY! Senior leadership support for 1 year secondment swap CQC CM joins NCC NCC MDO joins CQC

Secondment outcomes strategic review of care home sector develop a consistent approach to all provider quality monitoring refine & focus more on OUTCOMES develop & implement a risk tool review risk & escalation process develop proactive & responsive approach inter agency & public information sharing dementia quality mark audit & award Strategic review; look at whether we have sufficient and appropriate mechanisms in place to manage risk in CRHs. Identify themes and trends and refine the work programmed to support the council position.

Starting point - Council position on quality Who is responsible for provider quality? Understanding what the council position is on quality. What is acceptable and what is not? Care home bandings for OP CRH. 5 bandings for OP, 3 for YAs. Standard met, nearly met, almost completely met, met but could further improve…etc. Why do we place in band 1 & 2 homes? Is this ok? Should we have band 1 & 2 homes if we only want to commission ‘good’ quality care?

Who is responsible for provider quality? CQC? Commissioners? Contracts Officers (MDOs/QDOs)? Managers/owners of the service? Operational staff/reviewing officers? Families/carers? Individuals themselves? All the above? The Health & Social Care Act 2008 says the provider and the commissioners are responsible, therefore the MD team must audit quality effectively.

Sector position; improving quality – an example Older person’s care homes 2008/09 10/11 12/13 Band 5 2 34 30 Band 4 22 28 36 Band 3 57 46 45 Band 2 Band 1 39 25 166 170 172 Fair Price for Care and Quality Banding Other LA’s and their approaches Presented nationally – acclaimed approach This shows positive improvement in quality but is it consistent with CQC findings and if not why not? Nottinghamshire County Council

But ? Increasing safeguarding referrals – MASH Quality referrals in older person’s homes Consistent levels of non-compliance with CQC Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar 26 24 27 23 35 40 30 51 25 Increasing reactive role Changing role of reviewing officers? Differing roles across YA and OP Currently averaging out approximately 50 quality referrals per month to the market development team.

Strategic review of care home sector Purpose Review of care home provision across Nottinghamshire County & Nottingham City Local Authorities & CCGs, to identify & agree measures which, identify & manage risks promote & support diverse & robust care provision of high quality outcomes for people using services

Strategic review- progress & next steps Revised the risk and escalation procedures in partnership with CQC – final draft Gathered information about current support & input for care homes Agreed intelligence multi-agency provided data set & commenced analysis for completion by mid November 2013 Refined NCC internal processes for consistency & produced staff guidance – final draft

Consistent approach to monitoring quality - progress Reviewed NCC system in relation to H& SCA 2008 responsibilities and outcome focus Redesigned audit tool, descriptors & methodology for use in 2014/15 – future proof! – CQC 5 domains Developed supporting training package for NCC staff for implementation, including report writing for public sharing

Changing approach to quality Developed, agreed & implemented & a ‘risk tool’ Incorporating CQC inspection outcomes Market development team quality audits and referrals Safeguarding referrals & outcomes Electronic monitoring outcomes Provider financial viability Operational staff feedback Stakeholder feedback Health monitoring feedback Aims & use of risk tool Indicator of input needed from MDT to improve outcomes or inform restrictive actions Improve internal NCC knowledge about providers/managers & quality of care Improve quality of information shared between partners Increased co-ordination of actions relating to escalating concerns, for example…………

Risk tool – progress & next steps Continued basis for multi-agency information sharing Embed ownership with QDO as part of portfolio management Risk panel – critical friend/peer challenge – consistent/ proportionate approach across team

Dementia Quality Mark – driving improvement in dementia care DQM audit tool & methodology developed Independent auditors secured Audits completed in July & August 2013 DQM to be awarded to services assessed as delivering high quality dementia care Beacon status homes Share results with providers October 2013 Enhanced payments begin November 2013 Audit outcomes to be mainstreamed within annual quality audits for 2014/15

Overall project learning points & benefits True understanding of respective organisations map of the health & social care market Roles, responsibilities, powers, duties & restrictions/barriers Differences, similarities: national & local politics Co-ordinated and complementing SMART working – team structure, roles, line management, information sharing

Overall project learning points & benefits Improved early warning to issues with quality of care at individual & provider level Swifter action to encourage improvement in outcomes for people; quicker realisation of positive outcomes Improved public accountability Improved resource management for council work enabling balance between responsive and encouraging work

Overall project learning points & benefits Sign up across health & social care quality monitoring; clarity for agencies & providers alike Reduction of potential duplication in agency input – singing from the same hymn sheet! Increased confidence in partner agencies & support

Overall project learning points & benefits Reduced impact/burden of monitoring for providers Safeguarding or quality? Challenges of communication via different organisational structures & processes Confidence in judgements about services– safe, responsive, caring, effective, well-led

Thanks for listening Any questions?

Contact details Sue Batty – Group Manager, Joint Commissioning Unit, NCC Sue.Batty@nottscc.gov.uk Rosamunde Willis-Read – Project Manager, Strategic Quality & Risk, NCC (CQC) Rosamunde.Willis-Read@nottscc.gov.uk