1. Quality & Sustainability in Care Homes: A One City Approach
As a key person in health and social care quality improvement you are invited to this important event aimed at shaping and improving the quality of the older people’s care home market in Leeds.
#qualitycarehomes

2. Councillor Rebecca Charlwood
Executive Member for Health, Wellbeing and Adults

3. Councillor Peter Gruen
Leeds City Council Scrutiny Perspective
Councillor Peter Gruen
Chair of the Scrutiny Board (Adult Social Services, Public Health & NHS)

4. Quality & Sustainability in Care Homes: A One City Approach
Councillor Peter Gruen
Chair of the Scrutiny Board (Adult Social Services, Public Health & NHS)

5. Background Chair of Scrutiny Board – May 2015
Fresh eyes: New perspective
CQC inspection outcomes not routinely considered
Established a system to consider published reports, month-by-month
Pattern of performance soon emerged
Approx. 50% of Care Homes in Leeds require improvement / inadequate

6. Scrutiny Aims Best services for people of Leeds
Health and well-being of all service users & families
Focus on service quality across health and social care
Increasing transparency and robustness of decisions
What gets measured gets managed
What gets managed gets done

7. Scrutiny Perspective
Significant variation in quality across the Health and Social Care Sector
Primary Care – 90%+ good or outstanding
Social Care – 50% (approx.) good with very few outstanding
Safety remains a particular concern
Can you picture similar ‘failing’ standards with schools?
Is the diversity in providing Social Care part of the problem or part of the solution?

8. Changing the focus
Independent OR Council provided services we need to find a way to:
Set a city standard
Raise the bar – collectively and collaboratively
What do providers NEED in order to perform better?
How do commissioners, regulators and providers WORK TOGETHER to:
Raise and maintain quality standards?
Improve the lives of our older and vulnerable people?

9. CQC Position & Future Developments
Debbie Westhead
Deputy Chief Inspector of Adult Social Care, North Region,
Care Quality Commission

10. Quality & Sustainability in Adult Social Care
Copyright: Community Care
Debbie Westhead, Deputy Chief Inspector Adult Social Care
7 April 2017 10 10

11. Our 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.
Strategy Slides - 24 May MASTER

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

13. Overall ratings: England
NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding
Source: Ratings data extracted 24/03/2017

14. Overall ratings: Yorkshire and The Humber
NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding
Source: Ratings data extracted 24/03/2017

15. Overall ratings: Leeds
NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding
Source: Ratings data extracted 24/03/2017

16. Ratings by service type: England

17. Ratings by service type: Leeds
NB. Hospices are not included in this chart – Leeds' only outstanding rated location is St Gemma's Hospice
Source: Ratings data extracted 24/03/2017

18. Ratings by size: England
NB. Figures in the chart s above are in percentages and may not add up to 100% due to rounding.
Small = 1-10 beds, Medium = beds, Large = 50+ beds
Source: Ratings data extracted 24/03/2017.

19. Ratings by size: Leeds
NB. Figures in the charts above are in percentages and may not add up to 100% due to rounding.
Small = 1-10 beds, Medium = beds, Large = 50+ beds
Source: Ratings data extracted 24/03/2017.

20. ASC Re-inspections: Leeds
The chart illustrates the proportion of re-inspected locations in Leeds that have changed ratings between their first and most recent inspection.
The majority of re-inspected locations (59) were of those that were first rated requires improvement, almost half of which (49%) remained unchanged.
Of the four good locations that were re-inspected, one was re-rated as inadequate.
More than 73% of the 15 inadequate locations that were re-inspected improved, 20% to good.
Source: Ratings data extracted 24/03/2017.

21. Outstanding characteristics
People are at the centre and staff want to them to have a life not just a service
Good leadership extends beyond the manager and values are shared to inspire staff
Transparent, open culture with people who use services, staff, families, carers and partners
Strong links with local community
Creative and innovative
A can do, will do attitude – staff dedication
Safe care actively promoted
Always looking to improve
Focus is on people not the regulator!

22. State of Care 2016: Adult social care
The good news
Many services are providing good quality care – over 70%
More than three-quarters of re-inspected inadequate locations improved
84% of community social care locations, including 92% Shared Lives services, Good or Outstanding
Caring achieves highest scores – 90% Good, 2% Outstanding

23. State of Care 2016: Adult social care
The worrying news
26% services Require Improvement and 2% are Inadequate
Poorer performance for safety and leadership
Nearly a quarter of re-inspected inadequate services did not improve
Half of services rated requires improvement did not improve on re-inspection – 8% became inadequate
Services for older people fare worse than those for people with a learning disability

24. State of Care 2016: approaching a tipping point?
Age UK estimated in 2015 over a million older people have unmet social care needs, up 800,000 from 2010
26% fewer older people receive LA funded care – 81% of councils reduced spending on social care
Five-year increase in nursing home beds now stalled
Improvements are becoming harder to make
Some providers resigning contracts, councils warn of more
Source: CQC – State of Care 2015/16

25. State of Care 2016: system failing the Mum Test
Causes of delayed transfers of care
April 2012 to
July 2016
Home care package
Nursing home
Residential home

26. Quality matters: a collective effort
The public – people who use services, families and carers
Staff – capable, confident and supported
Providers – culture, organisation, expectations
Commissioners and funders – expectations of quality
Regulators – monitor, inspect, rate, take action, celebrate

27. What is Quality Matters?
A document that sets out:
a single shared vision of what quality is for adult social care
why the sector and people who use services, their families and carers need to come together to improve quality
a shared set of (initial) priorities to tackle the quality gap.
More than a document: a broad coalition of partners coming together to take concrete action on quality, built around a shared view of what quality is.
CQC, providers, commissioners, SCIE, Skills for Care, Local Government Ombudsman, Healthwatch and more involved.
Minister supports the direction of this work.

28. We’re promoting a shared view of quality that aligns across health and social care
Person-centred high quality care for all
Safe
Effective
Caring & Responsive
(positive experience)
Sustainable use of resources
Well-led

29. Our next phase of regulation
We plan to update our approach and assessment framework to reflect the changing provider landscape
Two consultations on these changes:
December 2016/17 (now closed) and May 2017
more integrated approach that enables us to be flexible and responsive to changes in care provision
more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality
greater emphasis on leadership, including at the level of overall accountability for quality of care
closer working and alignment with NHS Improvement and other partners so that providers experience less duplication 29

30. Consultation 2: adult social care inspection methodology
Our next consultation will cover a range of areas, including the end to end process for inspecting adult social care services
Specific focus on how we will encourage improvement in services that are repeatedly at requires improvement
Improved processes for inspecting services providing care to people in their own homes
Our effectiveness and consistency of how we use our enforcement powers 30

31. Deputy Chief Inspector of Adult Social Care
Thank you
@CareQualityComm
Debbie Westhead
Deputy Chief Inspector of Adult Social Care 31

32. A Provider Perspective
Peter Hodkinson
Chair of Leeds Care Association and Managing Director of Westward Care Ltd

33. A Commissioning Perspective
Mark Phillott
Jo Harding
Head of Commissioning, Adults & Health
Director of Nursing and Quality, Leeds West Clinical Commissioning Group

34. City Bed Overview City-wide Bed Provision
Older people – 92 Homes in the independent Sector with approx beds.
Since 2008, there have been 1,184 new beds in the independent sector and 311 beds removed through Home closures.
The market continues to attract investment with 3 new Homes opened in 2016/17 and a further 3 new homes to open in 17/18.

35. Examples of Current Issues Facing Sector – Older People
Market Shaping Tensions – Nursing EMI Provision
Workforce Issues
Hospital Admission/Discharge
Local Authority Budgets
Provision of Equipment
Medication Errors
Raising the quality of services

36. Started the re-commissioning of independent sector care homes in the City
Review of the Quality Standards
We want to try to incentivise quality services
How best the authority can support the sector to achieve the best quality services for residents

37. Director of Nursing and Quality
Role of the Leeds CCGs in Care Home Quality, Safety, Contracting and Performance
Jo Harding
Director of Nursing and Quality

38. Leeds CCGs contract with approximately 38 care homes with nursing as part of our continuing care responsibilities. We commission continuing care placements and community intermediate care beds
NHS Leeds South and East CCG is the lead commissioning CCG
The collaborative team for community services leads on contract and performance management for CHC and CIC beds – as part of a wider portfolio of community services.
Quality in care homes is primarily monitored by collaborative team with input from a range of professionals including the main CCG Quality team, CCG Medicines Management team, Infection Control team and Continuing Care nurses
Quality information and performance is reviewed at the CHC Contract Management Group and the Community Provider Management Group. Key issues and concerns are reported into the CCG Quality and Safety committee/Assurance Committees

39. Where concerns are identified the continuing health care team works with the home to develop and monitor a remedial action plan
Partnership working with local authority colleagues from Adult Social Care includes joint meetings (Care Homes Provider Group, Care Homes Quality forum), sharing of information, joint quality assurance visits
Further developments being progressed in joint monitoring of homes where CQC has rated ‘inadequate’ and there are significant quality concerns requiring enhanced surveillance and targeted work. Joint meetings with care home, joint quality review visits, joint reports.
NHS England expects CCGs to have oversight of quality in all care homes, including those without nursing. This presents a challenge for the CCG.
Homes without nursing are also discussed at the bi-monthly CQC meeting attended by the CCG and LA, and CCG is also copied into suspension notices from the Local Authority so has some oversight of issues in care homes without nursing

40. NHS Initiatives/Direct Support to Care Homes
Alison Gordon
Julie Budd
Clinical Operations Manager, Dementia & Specialised Citywide Community Teams, Leeds & York Partnership Foundation Trust (LYPFT)
Clinical Team Manager for the LYPFT Care Homes Team

41. LYPFT Citywide Care Homes Team April 2017
Become a Dementia Friend today and make a real difference to someone’s life.
Join Dementia Friends and we’ll help you understand a bit more about dementia, and the little ways you can help.
 Mental health information
  for everyone in Leeds
Mental health information
  for everyone in Leeds

42. Who we are A team of professionals including: Nurses Occupational Therapists Pharmacist Psychologist with access to psychiatrists
With access to medical staff and other relevant professionals

43. What we do We provide secondary mental health services to people residing in 24hr care This includes assessment, treatment and non-pharmacological approaches to care We also provide advice, support and education to care home staff

44. General Information
On average the team receive 900 referrals per year.
Our response to referrals are for the person to be seen within 5 working days
We aim to reduce unnecessary hospital admissions and prevent a step up in care

45. What the teams thinks is good quality care
Person centred “All about me”
Involving carers/relatives
Mental Capacity Act
Back to basics
Meal times (protected time)
Distressed behaviour (management and advice of )
Medication regular review

46. What the teams thinks is good quality care
The environment and Meaningful activity
Monitoring impact of interventions
Supporting staff
Outcome measures
Celebrating successes

47. Challenges ahead
National political climate and impact on all public services
Local (Yorkshire/Leeds)services changes
Partnership working
LYPFT OPS redesign model

48. Thank you Any Questions

49. A Resident’s Perspective
Betty Smithson
Resident’s Representative from Healthwatch Leeds

50. Please move to your allocated table after refreshments.
Workshop
What practical solutions can Leeds put in place to deliver high quality care in older people’s care homes?
What practical solutions can Leeds put in place to ensure a sustainable high quality care home market in Leeds?
How do we work together to achieve them?
Please move to your allocated table after refreshments.

51. Adults & Health Perspective
Cath Roff
Director Adults & Health

52. Plenary Questions and answers to speaker panel

53. Next Steps and Event Close
Thank you