Innovation in the care sector Debbie Ivanova Deputy Chief Inspector of Adult Social Care Care Managers Network, 12 September 2019 1

Our role and 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

Current ratings for the South West Region Source: CQC ratings at 31 July 2019. Numbers on bars are percentages. Numbers in brackets are total active locations rated.

Human rights based approach to care Human rights are a legal requirement Providers should promote non-discrimination and equality Empowerment of people who use care services

Leadership and culture, go hand in hand Involving staff, people who use services and their families, giving them a voice Shaping the culture of the organisation Staff feeling valued and given a voice Develop good teams to be even better, valuing training and development Empowering staff to ‘steer the ship’ “There’s a saying that to be a good leader you’ve got to have good followers. No. To be a leader you’ve got to breed more leaders.” Jamie Stubbs, Senior General Manager Ottley House Nursing Home

Consistent, compassionate workforce “Having the same staff means that they know the little things that make a difference to Jean, like making sure she has a tissue in her sleeve, or seeing if she’d like to spray some of her favourite perfume” David Eadie, whose wife uses the service Consistency of staffing makes a big difference Limited or structured use of agency staff Empowered staff willing to speak out and suggest changes No blame culture, learning culture Taking people on the improvement journey Regular supervision and training Robust recruitment and induction process, management providing bespoke training

Person centered care The Butterfly project – people and staff were wearing items to provoke conversation and memory. For example, one resident wore a uniform and this provoked conversation about their time in the armed forces. Stiperstones, Chobham, Surrey Broadwater Lodge, Godalming, Surrey

Are you confident with difference? People who use services will receive better quality care because services that are confident with difference are more able to meet their needs. Our aims for 2019–2021 Our regulation assures more people using services that they will experience frontline care delivery that is confident with difference. We ensure that CQC colleagues are confident with difference so that they can play their part in delivering this objective. We use the evidence we gather on this topic in our national reports and information to encourage improvement beyond the regulation of individual services.

CQC’s study into oral health Oral health is key to overall health, wellbeing and nutrition Site visits to 100 care homes External Advisory Group including commissioners, and representatives from the dental and social care - collaboration Focus on: Awareness and implementation of NICE Guideline NG48 Access to dental care (NHS and private) for people living in care homes 

What did we find? 73% of care plans only partly covered or did not cover oral health at all – Homes looking after people with dementia being the most likely to have no plan in place The majority (52%) of care homes visited had no policy to promote and protect people’s oral health Less than half (47%) of care homes providing specific staff training to support people’s daily mouth care

Thematic review of prolonged seclusion, segregation and restraint Number of people subject to restrictive interventions in these settings Pathway that the person has followed to end up in segregation and/or prolonged seclusion Quality of care and of the physical environment Safeguards in place to protect the person’s rights and to protect the person from abuse Impact of segregation and/or prolonged seclusion on people who are subject to it and on their families Impact on other patients/residents and staff The role of the wider system Quality of leadership and the culture

Interim recommendations 1/2 Independent review of every person in long-term segregation identified on a learning disability or children and young people’s mental health ward Convene an expert group, that includes clinicians, people with lived experience and academics, to look at what a better system looks like

Interim recommendations 2/2 The system of safeguards needs to be strengthened, including the role of advocates and commissioners Human rights must be explicitly considered. This is likely to lead to both better care and better outcomes from care CQC should review and revise its approach to regulating and monitoring hospitals that use segregation

Tech: Improving outcomes Good systems and providers can harness technology to enable better care People have told us they have reservations about tech Where it is working well, people describe tech that was “tailored” to their needs

Take home messages on tech As technology and provision evolves, we will: work alongside people who use and deliver services to encourage improvement stay abreast of technological innovation refine our regulatory approach We welcome open discussions with…. people who use services providers private sector and entrepreneurs researchers …..on how technology can improve care, while safety and quality of care is assured 15

Published and forthcoming Soon: Sexual safety and supporting sexuality in adult social care State of Care 2019 16

Deputy Chief Inspector of Adult Social Care www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Debbie Ivanova Deputy Chief Inspector of Adult Social Care 17 17