Key consideration for nurses in care settings Rami Okasha Director of Strategic Development, Care Inspectorate

Care Inspectorate Statutory responsibility to provide public protection and assurance, and support improvement That means we: – register care services – inspect them – investigate complaints about them – support improvement nationally and in services Carry out joint strategic inspections of services for children and adults, with others

14,000 Child minders Nurseries Care homes Care at home Housing support Day care Fostering & adoption Residential school care Specialist care services

876 Care homes for older people 75%

876 Care homes for adults 90%

Changing our approach

From 2016/2017 – Subject matter of inspections more aligned to known risk – Move away from quality statements to themes – Shorter, clearer reports – Focus on dementia in 150 services New inspection approaches More proportionate and targeted More focused on outcomes More able to support innovation More responsive to national policy agenda

New National Care Standards Current standards now 12 years old Based around settings, not people & pathways Review now on-going, in partnership High-level principles – April 2016 Generic standards – from 2017 Specific standards – from 2017

Supporting improvement

Strategic inspections Currently reviewing our methodology with Healthcare Improvement Scotland We want an approach which supports partnerships in an era of integration and adds value From April 2017, we will look at strategic commissioning – by commenting on the impact of commissioning on outcomes

Nurses in care settings Nurses play a critical leadership role in care settings Recruitment issues – overreliance on agency staff Currently have 59 nurse agencies registered 2013/14 3 registrations 2014/ /16 5 registrations 18 registrations 15 in progress

Recruitment difficulties Have seen examples of permanent staff leaving and returning as agency staff At December 2014, 36% of care services reported difficulties filling vacancies Geographic patterns: – 60% of services in Aberdeen – 45% of services in Argyll & Bute Sectoral patterns – 49% of care homes for older people – 57% of nurse agencies

Variation requests Some care homes do not currently have nurses So far this year, 40 variation requests to vary skill mix in care homes – eg, replacing a registered nurse with a senior carer Have agreed to variations in 9 HC-1 care homes as part of a larger UK-wide test Now developing a standardised approach to assess criteria and information needed