Working together to deliver quality, person centred care James Frewin, Head of Inspection, London London Care and Support Forum, Croydon 28 March 2018 1 Generic ASC deck (June Final) 1

Our purpose and role We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Register Monitor and inspect Use legal powers Speak independently Encourage improvement People have a right to expect safe, good care from their health and social care services Strategy Slides - 24 May 2016 - MASTER

Regulation to inspire improvement What we do: Set clear expectations Monitor and inspect Publish and rate Celebrate success Tackle failure Signpost help Influence debate Work in partnership Generic ASC deck (June Final)

Four priorities to achieve our strategic ambition Our ambition for the next five years: A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care Encourage improvement, innovation and sustainability in care Deliver an intelligence-driven approach to regulation Promote a single shared view of quality Improve our efficiency and effectiveness

The landscape of care GP practices 58.9 m registered with a GP Care homes 460,000 beds 223,000 Nursing home beds 237,000 Residential home beds NHS hospitals 93.9 million outpatient appointments / year 12.6 million inpatient episodes / year 23.7 million A&E attendances / year 636,000 baby deliveries / year England 55.3 m (45.2m adults) Dentists 22 million adults seen by NHS every 2 years 6.8 million children per year Ambulances 6.9m calls receiving a face to face response 10 NHS trusts 251 independent ambulance providers Health & social care staff 1.2m NHS staff 1.58m in adult social care Private hospitals Over 1,200 private hospitals and clinics Home-care 500,000 + people receiving home-care support at any one time

Adult social care: stats and facts Older people and people living with dementia, long term physical conditions, mental health needs, physical and learning disabilities Diverse needs £20 billion contribution to economy 1.4 million staff Public, private and voluntary providers Significant Sector 16,000 locations caring for c.460,000 people in care homes, nursing homes and specialist colleges Residential Care 8,500 community services providing personal care for 500,000+ people at home or Shared Lives schemes, supported living and extra care housing Community Care

Are adult social care services closer to the tipping point?

Variation and the tipping point Source: CQC ratings data, 31 July 2017 Some areas closer to the tipping point, others further away Factors affecting the tipping point vary geographically – ratings variation is one aspect ADULT SOCIAL CARE RATINGS BY LOCAL AUTHORITY Percentage of good and outstanding Top 20% Upper 20-40% Middle 20% Lower 20-40% Bottom 20%

Adult social care ratings CQC ratings data – 2 March 2018

Ratings by service type CQC ratings data – 2 March 2018

Ratings by key question CQC ratings data – 2 March 2018

Adult social care findings High-performing services have strong leaders – innovative registered managers known to staff, people using the service, carers and families had a positive impact High-quality services are person-centred – staff get to know people as people, understanding their interests, likes and dislikes Most enforcement for poor care relates to governance, safety, staffing and person-centred care

Quality matters

Quality Matters: what people told us they wanted Click for each of the four photos

Quality matters - joint commitment to improve adult social care Agreed priorities to improve quality No single person or organisation can improve the quality of adult social care on their own Everyone who uses, provides, commissions, oversees or supports care and support services has a part to play

Promote quality through everything we do Quality matters - principles Promote quality through everything we do Support and encourage improvement Coordinate action

What does quality mean to people? By following these principles and encouraging others to do the same, we enable people using services to say: “I have considerate support delivered by competent staff” “I am in control of my support, in my own way” “I feel in control and safe” “I can decide the kind of support I need” “I have the information I need when I need it” “I have access to a range of support that helps me live my life”

Quality matters – action plan Acting on feedback, concerns and compliments Measuring, collecting and using data more effectively Commissioning for better outcomes Better support for improvement Shared focus areas for improvement Improving the profile of adult social care

Quality matters: in the future Person centred, co-ordinated care True partnerships Meaningful choice Great staff 19

Local system reviews How well do people move through the health and social care system, with a particular focus on the interface between the two, and what improvements could be made?

Local system reviews CQC is reviewing health and social care systems in 20 local areas to find out how services are working together to care for people aged 65 and older at different places within the system.

Key messages from our interim report Without good relationships and a shared, agreed vision between system partners, achieving positive outcomes is significantly compromised More focused action is need on keeping people well, with joined up processes to identify and support people to stay safe and well in their usual place of residence The focus on individual organisational outcomes is distracting from the needs of the wider system to work effectively for the people it serves. Focusing on DToC in isolation will not resolve the problems that local systems are facing. Final report due out: 3 July

How systems work together Interim report : Key findings 1 How systems work together We found a strong commitment and enthusiasm from organisations and staff working across health and social care services to meet the needs of people who use services, their families and carers. However for systems to work appropriately there has to be effective relationships and leadership accountability.

How systems work together Areas for priority action for system leaders Develop a shared vision and system-wide strategy agreed by system leaders Invest time in positive and productive system relationships Agree and define cross-system leadership accountability

Managing capacity, market supply and workforce Interim Report: Key findings 2 Managing capacity, market supply and workforce People’s choice about their health and social care is limited in many of the systems we reviewed due to a shortage of capacity and range of options.

Managing capacity, market supply and workforce Areas for priority action for system leaders Ensure ‘choice’ criteria for people moving between health and social care services Agree the high impact changes and prioritise implementation in accordance to the level of need Establish risk sharing agreements Develop clear and longer term arrangements with VCSE sector providers

Moving beyond delayed transfers of care Key findings 3 Moving beyond delayed transfers of care We have seen examples of where a focus on delayed transfers of care (DToC) has improved the speed at which people are moving between services, however, this can divert attention from other important issues

Areas for priority action for system leaders Moving beyond DToC Areas for priority action for system leaders Ensure timely access to data Systems should access and apply national guidance and support available

Local system reviews - areas for priority focus We encourage national leaders to: Enable and encourage health and social care partners to establish aligned objectives, processes and accountabilities. Address the risks in the social care market as a matter of priority and ensure that there is a national focus on joint health and social care workforce strategies. Enable local systems to invest in out of hospital services to keep populations well through preventative support. Although we are reporting at an early stage of the review programme and have only published reviews of systems in six local authority areas, common themes are emerging that we believe should be addressed at a national level. We will continue to keep these under review throughout the remainder of the review programme and make comment in our final report in summer 2018.

Shared vision and strong leadership Local collaboration and joined up care Golden thread connecting vision to delivery through different organisations Shared vision and strong leadership All staff to share that vision and deliver to action Work together as part of a system

high quality care for all All we want is….. Person-centred co-ordinated high quality care for all 31

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