Healthwatch Warrington Esstta Hayes – Community Engagement Officer Jonathon Woodruff – Communication and Intelligence Officer October 2017

What is Enter & View? An opportunity to gain a unique insight and provide additional information to Healthwatch on Adult Social Care and NHS care services by: Observing an agreed service as it is being provided Engaging with current service users/residents, their families, relatives & carers to see how they feel about the service they are receiving Talking to staff about how they view the service they provide Working in partnership with local service providers

What Enter & View is not! It’s not a formal inspection process. Inspections already exist in both the NHS and Adult Social Care services and is undertaken by the Care Quality Commission (CQC). It is not contract monitoring. This is undertaken by the Commissioner of each service. It’s not to ‘catch services out’. It’s about supporting local providers and working in partnership to improve care services for local people.

Commissioners/Contractors The ones who pay for services: The Council NHS England Clinical Commissioning Groups

Service Providers The ones who provide/operate/deliver your services: Local Council – HIV team, learning disability services, Local hospitals/national hospitals, Community Care NHS Trusts – school nursing, health visitors, Mental Health & Learning Disability Trusts, GP Practices, Dentists, Pharmacies – can vary according to need, Charities, voluntary sector or independent people using personalised budgets e.g. Icare Ltd – local meals on wheels, Independent companies who own care homes and nursing homes.

Who can conduct a visit? Certain individuals can be authorised by Healthwatch to enter, view and observe health and social care activities. The legislation is clear that ONLY ‘authorised representatives’ can enter and view premises. In order for an individual to be authorised Healthwatch must have agreed procedures about who can be an authorised individual.

Who can conduct a visit? Healthwatch’s regulations sets out the arrangements for ‘authorised individuals’, that state: A Disclosure and Barring Service (DBS) check must be completed with a certificate to verify it. A ‘nominated person’ from Healthwatch has considered the certificate and is satisfied that the person is suitable to carry out visits. Healthwatch must make a comprehensive up-to-date list of all its authorised representatives publicly available.

Carrying out visits A duty is imposed on providers of health and social care services (with certain exemptions) to allow authorised representatives from Healthwatch to enter premises that they own or control to observe the services that are being provided. Enshrined in law by the Local Government and Public Involvement in Health Act 2007 (and amended by the Health and Social Care Act 2012), Enter & View is the statutory power granted to every local Healthwatch.

Carrying out visits In addition, there are legally binding directions that place requirements on those who commission (buy) services from independent providers, to ensure contracts made after April 1st 2008 make provision for authorised representatives to enter and view. It is important to remember that Enter & View is an engagement tool, not an inspection. The aim of Enter & View is to put together a picture of what people think of the care they are receiving.

Values and Culture Values are core sets of beliefs or views that reflect a person’s sense of right and wrong and what is good or bad. Culture is the collection of practices and interactions that make up the work environment. As a Healthwatch, we have observed that when staff and organisations have shared values, not only is care experience for residents/patients of higher quality, visitors, carers, families and employees have a more positive overall experience too.

Best Practice Enter and View Visits Project Background Between September 2016 and December 2017, Healthwatch Warrington visited 8 local care homes, which at that time, were identified as demonstrating aspects of best practice Prior to these visits, good practice was indicated in a number of intelligence sources including Care Quality Commission inspections and Local Authority visits The intention was for our trained volunteers to visit these care homes, observe this good practice being delivered and share our findings so that other care establishments could learn from their approach and replicate it in their own settings The care homes visit were; Belong Care Village, Summerville Nursing Centre, Heath Lodge, Brookfield Care Home, Heathfield Ladies Residential Home, U&I Care, High Peak and Three Elms

Examples of Best Practice Observed (I) Activities, Entertainment and Facilities One home had a range of additional on-site facilities such as a Bistro, a hair and heauty Salon, exercise suite internet café and a purpose- built function room – some of which were open to the public, which allowed residents to better connect with the wider community, as well family and friends The home also offered comfortable lounge areas, a library and a spacious communal garden where residents could grow vegetables (which were then used in the kitchen) Person-Centred Care A local care home had implemented a ‘resident ambassador’ role within the home; a resident who is responsible for gathering other resident’s views and discussing these with management – followed up with a ‘You Said, We Did’ document, which demonstrated how the home had taken action in-line with this feedback

Examples of Best Practice Observed (II) Staff and Staff Attitudes In another care home, staff wore smart uniforms with embroided names (as name badges may feel too clinical) This home had also attained an ‘Investors in People’ award in recognition of management’s investment in staff development; such as a values- aligned recognition scheme The home also ensured that its approach to recruitment was heavily values orientated; with an emphasis on identifying and recruiting staff that had a genuine passion for delivering care to older people Throughout our reports, we discovered that it was the provider’s values that made all the difference – as values shape the culture of a care home (underpinning everything from staff recruitment through to the delivery of care)

Best Practice Project Outcomes As a result of our best practice Enter and View programme, we; Made 19 recommendations for sharing good practice and making service improvements Have now developed a specialist spotlight focus on ‘values’ as part of our Enter and View approach (included in our updated volunteer training programme) This means that we reflect on what a provider’s stated values are (for example, by reviewing material published on their website) and consider how each individual service should ‘feel’ and ‘look’ like according to these expected standards During each visit, our volunteers make observations and speak with staff, residents and carers to gain insights into whether the lived experience in a given care settings corresponds with the provider’s values For example, a provider may take particular pride in delivering high quality entertainment, so our team would look for supporting evidence such as a varied activities programme and positive resident feedback

Getting Involved We run regular Training Sessions on Enter and View, so you can become an Authorised Representative and undertake Enter and View Visits with our team. We currently have 27 active Authorised Representatives. To find out more, you can visit our website: https://www.healthwatchwarrington.co.uk/get-involved/volunteering/

Questions Esstta Hayes Community Engagement Officer 01925 246 894 esstta@healthwatchwarrington.co.uk Jonathon Woodruff Communication and Intelligence Officer 01925 246 893 Healthwatch Warrington The Gateway, 85 – 101 Sankey Street, Warrington, WA1 1SR Tel: 01925 246 893 Email: contact@healthwatchwarrington.co.uk Website: www.healthwatchwarrington.co.uk