Secondment & Strategic review of care home sector update Rosamunde Willis-Read CQC/NCC 11 September 2014 Nottinghamshire County Council

Secondment from CQC Aims: to improve ways of working across CQC & the Council through the development and embedding of partnership working with key stakeholder agencies understand respective roles & remits

Secondment outcomes Completion of strategic review of care home sector Develop a changing approach to quality - refine & focus quality monitoring - OUTCOMES Develop a risk tool Escalation process Develop proactive & responsive approach Dementia quality mark audit & award

Why a strategic review? Local & national media interest Financial collapse of Southern Cross Winterbourne View Own intelligence about poor quality care CQC intelligence Dovetail with initiatives via board; Care Act

Who were the strategic board members? Nottinghamshire County Council, Nottingham City Council, Newark & Sherwood Clinical CCG, Mansfield & Ashfield CCG, Nottingham North & East Nottingham West CCG, Rushcliffe CCG, Nottingham City CCG, Nottingham City & Nottinghamshire County Healthwatch Community Programme Chaired By Allan Breeton, Independent chair of Nottinghamshire Safeguarding Adults board 1] Healthwatch is the independent champion for health and social care in England: www.healthwatch.co.uk [2] The Community Programme was launched in July 2011 to identify issues between primary and secondary care to improve the patient, carer and clinical experience and has developed 10 projects to deliver this. www.nuh.nhs.uk/community programme

Who weren’t as involved? Nottinghamshire Care Association Care Quality Commission

What did we look at & why? (ToR) 1 Processes to measure quality (CQC, the County and City Councils & CCGs) State of current care home sector Identified areas of overlap by agencies

What did we look at & why? (ToR) 2 Gaps in the sector Challenges for providers Compliance and regulation Dementia Quality Mark Quality Monitoring Current methods used to address poor quality in care homes

Conclusion Steady stream of issues with some care home quality Commissioning messages not being ‘heard’ Not using ‘good quality’ providers enough Understand impact of, measure, then inform & refine support to care homes

Recommendations Share findings with CQC to inform methodology Enhance audit through outcome focus* Adopt targeted approach to commissioning Increase engagement with providers Launch commissioning strategy publicly Coordination of inspections, visits, audits Provide partnership improvement suggestions to CQC Highlight nursing shortage nationally Targeted approach to leadership & quality deficits in care homes – task force

Recommendations continued.. Evaluate effectiveness of existing clinical and specialist support to care homes Use quality monitoring information to inform opportunities for sector led support Consider CCG and Council alignment re QM Include Healthwatch in information sharing Agencies to report regularly re quality to NSAB

Next steps for strategic review Submit to governance Organise working group to plan implementation Extend CQC Inspection Manager secondment to support Develop media strategy Implement recommendations Monitor progress formally

Secondment achievements Refined & outcome focused quality audit process Risk management approach - - information sharing - internal & external escalation procedure proactive & responsive work approach swifter reporting to provider & public involvement of residents & relatives

Dementia Quality Mark (DQM) Initial round of Dementia Quality Audits completed by independent organisation Outcome 136 homes dementia care specialists; 34 achieved DQM Applications to apply reduced from 105 in 2013-14 to 82 in 2014-15. Second round of audits currently under way Any questions?

Media V Quality Close working with CQC & CCG resulted in closure by providers of 3 care homes Information shared with CQC re financial viability lead to CQC urgent location removal Council terminated contract with 4 care home providers Number of contract suspensions have reduced significantly

Thanks for listening Any questions?