Oxfordshire Care Home Provider Meeting 17 November 2015

Agenda

Oxfordshire Adult Social Care Workforce Strategy Care Home Provider Workshops November 2015

Workforce issues & challenges

If we don’t take action … Capacity gap

It’s high – 29.5% PVI sector average – 23.3% Care workers, home care – 38.0% Care workers, care homes – 53.1% Nurses, care homes 3,700 recruitments per year – 54% move jobs within the sector – 46% recruited from outside the sector Turnover

Reducing Turnover

Oxfordshire’s … Social care workers are poorly educated – Less educated than regional and national peers – 54% of care workers have no qualifications More reasons to leave than stay? – Few opportunities for career development – 8.5 care worker jobs for every 1 senior care worker job – Workers do not stay in their roles as long as regional and national peers Managers are older, less qualified and less experienced – 40% of registered managers are over 55 – 23% don’t have a level 4 qualification – Registered managers are older, less qualified and have been in post for less time than regional and national averages Capability

What’s the plan?

15 point framework for action Five actions to build capability 15 Support carers, volunteers and local communities 14 Support competence, qualifications and career pathways 13 Support core skills development 12 Support leadership and management development 11 Support workplace learning cultures Three enabling actions 3 Ensure commissioning addresses workforce issues 2 Improve workforce data & intelligence 1 Develop Workforce Partnership Board, Council & communication strategy 10 Support pre-employment programmes and Apprenticeships 9 Support effective use of technology 8 Develop partnerships in care 7 Support effective employment practices 6 Support recruitment & retention of care home nurses 5 Support recruitment across the county 4 Make the Social Care Commitment

Social care recruitment campaign, including: – Vacancy matching service, resources, information and advice, job centre liaison Values-based recruitment pilot Programme of training & awareness on dementia and assistive technology Workforce planning tool, with Skills for Care Help to Live at Home workforce specification & contract induction Workplace learning culture workshop Workforce data & intelligence analysis Done so far …

Confirm delivery plan and priorities Seek and secure funding Actions for all – No single organisation can fix the problem – Everyone can do something to help Next steps

15 point framework for action Five actions to build capability 15 Support carers, volunteers and local communities 14 Support competence, qualifications and career pathways 13 Support core skills development 12 Support leadership and management development 11 Support workplace learning cultures Three enabling actions 3 Ensure commissioning addresses workforce issues 2 Improve workforce data & intelligence 1 Develop Workforce Partnership Board, Council & communication strategy 10 Support pre-employment programmes and Apprenticeships 9 Support effective use of technology 8 Develop partnerships in care 7 Support effective employment practices 6 Support recruitment & retention of care home nurses 5 Support recruitment across the county 4 Make the Social Care Commitment

Any questions? Contact details: – – or

Oxfordshire Clinical Commissioning Group Proactive Medical Support to Care Homes 2015 New scheme introduced early 2015 to align care home with specific GP practice and provide scheduled weekly GP visit with the aim of providing more anticipatory care to improve quality of care and reduce inappropriate hospital admissions

Oxfordshire Clinical Commissioning Group Features of anticipatory care  Documented advance care planning-what are wishes in the event of deterioration/end of life (preferred place of care, “ceiling” of care, resuscitation status ). Documentation needs to be readily accessible to care home staff and available for patient/next of kin  Reviewing medication regularly – drugs no longer required (eg antidepressants, BP medication), drugs where potential harmful side effects outweigh benefits, drugs which may improve patient quality of life  Identifying medical problems early to prevent escalations  Ensuring supportive measures for end-of-life care in place (good communication with staff/family, anticipatory drugs etc)

Oxfordshire Clinical Commissioning Group Challenges implementing scheme Considerable and growing pressure on GP practices – eg ageing population and increasing complexity of patient problems Some are experiencing recruitment difficulties Historical or current difficulties in managing care home patients Perceived workload problems with providing the care required under this scheme Some consider payments under the scheme insufficient Some concern residents will no longer be able to stay with existing GP where patient preference is for this to happen

Oxfordshire Clinical Commissioning Group How is it going? Slow but steady take-up of the scheme among GP practices Initial data on emergency hospital admissions show encouraging reductions First 6 month data collection from practices in the scheme appears to show good compliance with scheme Survey underway to collect feedback from care homes, GPs and Care Home Support Service to inform any adjustments at formal review early 2016

Oxfordshire Clinical Commissioning Group Growth in number of care homes covered by scheme

Oxfordshire Clinical Commissioning Group Coverage of scheme Nov 2015

Oxfordshire Clinical Commissioning Group Cost and activity comparison of care homes’ emergency hospital admissions

Oxfordshire Clinical Commissioning Group Advanced care plans and medication reviews recorded by practices after 1 st 6 months of scheme Computerised advance care plans (Digital Proactive Care Plan) being introduced to improve capture of preferred place of care and resusc status

Oxfordshire Clinical Commissioning Group Deaths and hospital admissions recorded by practices in 1 st 6 months of scheme

Oxfordshire Clinical Commissioning Group What can care homes do to be “taken on” by practices (if this is wanted) ? Use support provided by Care Home Support Service to ensure organisational aspects of scheme are in place Obtaining good background medical information on each new resident at time of admission including accurate and up-to-date medication CHSS may also be able to help with aspects of optimising patient care to reduce GP time doing so Assisting with advance care planning Discuss with practices their concerns and anything that might help

Oxfordshire Clinical Commissioning Group The future ? Emerging strategy across health care providers and commissioners for out-of-hospital care  Promoting ambulatory care (ie specialist input but without a hospital admission)  Preventing patients medically fit for discharge staying in hospital by providing more rehabilitation support and care in their home setting  Possibly expanding “intermediate care” beds in nursing homes ie patients transitioning from hospital to home

Break

1 Ensuring good care in residential and nursing homes Carol Schubert, Inspection Manager, Adult Social Care 17 November 2015

The Mum (or anyone you love) Test Is it good enough for my Mum? Is it safe? Is it caring? Is it effective? Is it responsive to people’s needs? Is it well-led? 28

Focusing on quality Providing better information Encouraging innovation Becoming a more efficient regulator Working with partners to encourage improvement Our new strategy for will help us to achieve these goals 3 What is CQC’s role?

30 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

31 Our new approach

32 Previous Regulations Care and welfare of service users Assessing and monitoring the quality of service provision Safeguarding service users from abuse Cleanliness and infection control Management of medicines Meeting nutritional needs Safety and suitability of premises Safety and suitability of equipment Respecting and involving service users Consent to care and treatment Complaints Records Requirements relating to workers Staffing Supporting workers Cooperating with other providers New Regulations Person-centred care Dignity and respect Need for consent Safe care and treatment Safeguarding service users from abuse Meeting nutritional needs Cleanliness, safety and suitability of premises and equipment Receiving and acting on complaints Good governance Staffing Fit and proper persons employed and Fit and proper persons requirement for directors Duty of candour Fundamental standards

33 Fit and proper person requirement Purpose Ensure directors or equivalents are held accountable for the delivery of care and They are fit and proper to carry out this role Actions for providers Ensure recruitment of ‘directors’ tests whether candidates meet the requirement CQC Registration Respond to concerns raised

34 Special measures Purpose Ensure failing services improve or close Actions for providers Use time available to improve service CQC Services rated as inadequate will go into special measures Time limited period to improve Improvements made – out of special measures No improvement – move to cancel registration

35 Scores on the doors Purpose Public able to see rating of service quickly and easily Actions for providers Display ratings in service and website Suggest accompany with additional information CQC Will provide template Inspection – check that rating is displayed

36 Example of poster showing Good rating Scores on the doors

37 What will market oversight do? 6 Purpose Protect people in vulnerable circumstances by spotting if a provider may fail – and make sure right action is taken CQC will: Monitor finances of ‘difficult to replace’ providers – Provide early warning to local authorities Assist with system response if failure occurs It will not: Either ‘bail out’ struggling providers, or pre-empt failure through inappropriate disclosure of information

38 Our enforcement powers Requirements (formerly known as compliance actions) Warning notices S.28 warning notices Protect people who use services by requiring improvement Civil enforcement powers Impose, vary or remove conditions of registration Suspension of registration Cancellation of registration Urgent procedures Failing services Immediate action to protect from harm Time-limited ‘final chance’ Coordination with other oversight bodies Criminal powers Penalty notices Simple cautions Prosecutions Holding individuals to account Fit and proper person requirement Prosecution of individuals Hold providers to account for failure Severity Protect people who use services by requiring improvement

A challenging environment 13 Most organisations are good or outstanding, but some people get poor care: 7% of services rated were inadequate

Current ratings overall and by key question 40 Source: Ratings data extracted 11/09/ services rated at October 2015

Ratings by service type 41 Source: Ratings data extracted 11/09/2015

Themes from Well-led: Outstanding 42 CQC Published reports – sampled for data on well-led in mid June. Sample size 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted).

Themes common to Outstanding services 43 People who use services, relatives and staff speak highly of the service Effective monitoring, quality assurance and audit systems Open culture - people who use services/staff/relatives given the opportunity to share views and any issues are addressed 75 per cent of services had a registered manager in post consistently, and that manager is supportive of their staff Good leadership extends beyond the manager and includes the provider CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Themes from Well-led: Outstanding sample only 44 Effective systems in place for managing and developing staff Safe care actively promoted – effective oversight of care and staff communication A can do, will do, attitude Effective partnership working Culture of continuous development of the service/manager/staff with best practice being followed Service and/or staff being recognised through national or local awards Strong links with the local community in just under half of the services “This place is brilliant, management care so much as do the staff, everybody knows their role and the atmosphere is amazing.”, “I’m made to feel important, I’m encouraged to better myself” CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Safety is a fundamental expectation …but it is our biggest concern  Not learning from mistakes  Not planning for the future 19 Safety

Safety is our biggest concern Staffing requirements, safeguarding and medicines management are key factors 20 Adult social care

Themes from Well-led: Inadequate sample only 47 CQC Published reports – sampled for data on well-led. In mid June. Sample size 127 services with inadequate ratings for well-led.

Themes common to Inadequate services 48 People who use services and their relatives speak of continuous management churn and change Poor care planning resulting in lack of personalised care Closed culture - people who use services/staff/relatives feeling unable to raise issues or their views not listened to or acted upon No registered manager or, if in post, unable to lead and support staff effectively and consistently Poor oversight of care with care plans not up to date, reviewed or followed CQC Published.

Themes common to Inadequate services 49 Ineffective systems to identify and manage risks and learn from mistakes Lack of supervision and training opportunities to develop staff skills Poor working relationship between the manager and the provider Under developed partnership working and community links Unawareness of best practice Notifications to CQC not being made CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

Good leadership is important to delivering safe, good quality care 24 Leadership

Continue to provide information about individual services Set expectations for services to work with others Undertake thematic reviews – Cracks in the Pathway Look at experience of people in localities What can regulation do to help? Person-centred co-ordinated care not organisational focus Work with vanguard sites ‘Walk the talk’ – work in partnership with others – through co- production and addressing duplication 25

Where we see poor care, we challenge providers to improve Where we see excellence, we celebrate it 26 Encouraging improvement

An outstanding care home ‘Relatives and friends visiting the home told us they only had positive experiences and praise for this service’ ‘Staff told us that they would not like to work anywhere else’ Vida Hall, Harrogate 53

An outstanding care home "We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of their life with as much happiness, love and security as we can give them." Suzanne, Prince of Wales House, Ipswich 54

29 The future Putting quality of care at the centre of change and Innovation

Some thoughts to consider………  Do I have a trusted critical friend, someone independent who will tell me the truth abut my service?  Do I really know what care users think about the care and attention they receive?  Are my staff really clear about our visions and values?  Do I have ways in which to encourage and support my staff to try out innovative ideas?  How do I value and support my staff?

Carol Schubert Inspection Manager, Adult Social Care Thank you

Adult Safeguarding The Way Ahead

What we are doing today ? 1. Changes in adult safeguarding  Ethos and language  National and local changes 2. What does this mean for you?  Implementing making safeguarding personal  Representation & advocacy 3. How we are hoping to help  New web site  Updated procedures  On-line referral  Threshold of Needs Matrix 3. Any questions?

1.Work is person centered and makes safeguarding personal 2.Needs and interests of adults at risk always respected and upheld 3.The human rights of adults at risk are respected and upheld 4.Response is proportionate, timely, professional and ethical 5.Decisions and actions in line with The Mental Capacity Act Key words: Changes in Safeguarding Ethos of Safeguarding Empowerment … Protection … Prevention Proportionality … Partnership … Accountability Empowerment … Protection … Prevention Proportionality … Partnership … Accountability

Changes in Safeguarding New language of Safeguarding Enquiries not investigations or assessments Establish facts Ascertain adult’s views and wishes Assess need for protection, support and redress. How might they be met? Protect from the abuse and neglect, in accordance with wishes of adult where possible Decide follow-up action for those responsible for the abuse/neglect Enable the adult to achieve resolution and recovery

1. New categories 2. Specific mandatory requirement to investigate (section 42 of the Care Act) 3. Making safeguarding personal 4. Representation and advocacy Changes in Safeguarding National Changes in the Care Act

Changes in Safeguarding Changes to categories 10 categories (2 added and one amended by the Care Act) Acts of omission & neglect Physical abuse Domestic violence Sexual abuse Psychological abuse Financial or material Discriminatory abuse Organisational abuse Previously called Institutional Abuse Self-neglect Modern slavery Amended category 3 New categories Exsisting categories

Changes in Safeguarding Section 42 Duty to make enquiries  Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult who meets the criteria is, or is at risk of, being abused or neglected.  This duty continues until it decides what action is necessary to protect the adult and by whom and ensures itself that this action has been taken.

Changes in Safeguarding Making safeguarding personal? (1) At the start of the process a person should be able to say: The help I received made my situation better People asked what I wanted to happen and worked together with me to get it. When things started to go wrong, people around me noticed and acted early. I got the help I needed by those in the best placed to give it. I understood the reasons when decisions were made that I didn’t agree with. People will learn from my experience and use it to help others

Changes in Safeguarding Making safeguarding personal? (2) I felt safe and in control I felt safe and in control People understood me – recognised and respected what I could do and what I needed help with Professionals helped me to plan and manage the risks that were important to me I had good quality care. I had the information I needed, in the way that I needed it The people I wanted were involved People worked together reducing risk to my safety and wellbeing At the end of the process a person should be able to say:

Changes in Safeguarding Representation and Advocacy Must work within existing Mental Capacity Act (2005) Always presume capacity - take reasonable steps to establish a person’s capacity If a person lacks capacity decisions must be in their best interest and ‘least restrictive option’ Always involve the person - consult their family, friends and obtain advocacy where necessary

Changes in Safeguarding The safeguarding duties apply to an adult who: has needs for care and support (whether or not the local authority is meeting any of those needs) and; is experiencing, or at risk of, abuse or neglect; and as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

New OSAB website to replace Safe from Harm (

New online Safeguarding Form (7 th December)

New OSAB Threshold of Needs Matrix

What does it mean for you? 1.What outcomes do you want to achieve? Prevention: take action before harm occurs Protection: support and represent those in greatest need 2.How are you going to achieve these outcomes? Empowerment: person led decision-making and informed consent Partnership: working with others and the local community Proportionality: least intrusive appropriate response to the risk 3.How will you know? Accountability: safeguarding practice and arrangements should be accountable and transparent

Questions

Information Sharing

The Flu Vaccination Winter 2015/16 The following groups are recommended by the NHS to receive the flu vaccine: Everyone aged 65 and over Everyone living in a residential or nursing home Everyone who cares for an older or disabled person All frontline health and social care workers For advice and information about the flu vaccination, speak to your GP or practice nurse. Further information is available on the NHS Choices website: aspx