1. Rami Okasha Executive Director of Strategy and Improvement

2. Compliance Collaboration A changing approach Key points
This is strategic scrutiny led by the Care Inspectorate
Range of provision
Quality assuring adverse events –
deaths of looked after children and young people
initial case reviews and significant case reviews (children and young people)
serious incident reviews (criminal justice social work)
We are discussing with SG requests to review SCRs (adults) and SCRs (MAPPA).
(Adult joint scrutiny comes later, under the relevant section)

3. How good are care services?
Over 85% of care is assessed as good, very good or excellent
Significant variance by setting and sector
Key points
Majority of care is good or better
Some areas are much stronger than others – for care homes for older people, the bar is at 75% but for EY services it is at 95%

4. First standards in 2002 23 separate standards
2,042 mostly input statements
Only regulated health & care
Used primarily for inspection

5. The task in 2015 Single set of standards across health & social care
Designed around a set of overarching principles
Developed by people who experience & provide care
Designed to be future-proof

6. Responsive care & support
Compassion
Responsive care & support
Wellbeing
Be included
Dignity and respect
5 principles

9. Five general standards
I experience high quality care and support that is right for me.
I am fully involved in all decisions about my care and support.
I have confidence in the people who support and care for me.
I have confidence in the organisation providing my care and support.
I experience a high quality environment if the organisation provides the premises.

10. What’s launched now?
One set of standards across all health and social services
Relevant across planning,
assessment, commissioning,
delivery
5 standards statements
No big bang in the roll-out

11. How are the new standards different?
Human rights and wellbeing
Person-led
Outcome focused
Decoupled
from settings
Outcome focused

12. 1 Human rights and wellbeing
Describes what a care service needs to do to meet the minimum.
Describes the quality which I am entitled to experience.

13. 2 Being person-led Staff will treat you politely at all times.
Staff call you by your preferred name or title at all times.
If you need help, your request will be dealt with politely and as soon as possible.
I get the most out of life because the people and organisation who support and care for me have an enabling attitude and believe in my potential.
I experience warmth, kindness and compassion in how I am supported and cared for, including physical comfort when appropriate for me and the person supporting and caring for me.
I experience care and support where all people are respected and valued

14. 3 The outcome focus Your room 12.5 sq.m. Your ensuite
Space
Size
Your room
12.5 sq.m.
Your ensuite
3.5 sq.m. for basin, toilet and shower
Communal space
3.9 sq.m. / person
(not including corridors)

15. The outcome focus 3
I have enough physical space to meet my needs and wishes.
I can independently access the parts of the premises I use and the environment has been designed to promote this.

16. 3 The outcome focus Care Inspectorate registers care homes
We will publish expectations on room sizes
Guidance describes inputs known to work well
Quality is measured through the lens of a person’s experience

17. 4 Decoupled from settings
I am fully involved in assessing my emotional, psychological, social, and physical needs at an early stage, regularly, and when my needs change.
If I have a carer, their needs are assessed and support provided.
I am enabled to live in my own home if I want this and it is possible
If I am supported and cared for by a team or more than one organisation, this is well co-ordinated so that I experience consistency and continuity

18. What’s the Care Inspectorate’s response to the standards?

19. Is this a good regulated care service?
To what extent am I getting the right care and support at the right time to meet my needs and wishes?

22. Care Inspectorate’s response1
No big bang approach
Is this a good regulated care service? 2
We will set out our expectations clearly 3
New model of inspections from April gradually 4
Scrutiny of strategic commissioning
Outcome focused

23. The starting point of our approach is evidence-led self evaluation – the emphasis being on evidence. But this in itself does not lead to improvement. Our experience is when partnerships do make improvements on the basis of self-evaluation rather than when inspectors tell them things, there is greater ownership of problems and more effective solutions (we can reference work done in Dumfries and Galloway here round adult support and protection).
This, coupled with risk and intelligence from a range of sources, leads to intelligence-led scrutiny
That is evidence which leads to evidence-led improvement
Regulatory (enforcement) action is an option by extremely rare
“This ‘Scottish model’ of social care scrutiny and improvement is designed to improve care quality. Quality is assessed by the extent to which care supports positive outcomes, not compliance. Intelligence-led scrutiny, based on robust self-evaluation by care leaders, informs evidence-led improvement activity. Scrutiny becomes a diagnostic tool which evidences to the public, and care leaders, what is working well and what needs to improve. Inspectors can take regulatory action where care is failing, but this is a last resort.
This modern form of scrutiny does not mandate how improvement must take place – that is owned by local care leaders. The model provides independent evidence on whether improvement activity has been successful.
There is therefore an important need to expand our concept of evidence-led improvement to include scrutiny evidence which tests the quality of experience and outcomes, as well as research evidence which tests the efficacy of an intervention itself. Combined, there is potential for a powerful evidence base to help care improve.” 

24. New inspections model - April 2018 onwards
Quality indicator framework using standards for self-evaluation
May well change themes / grades
Proportionate, intelligence-led, risk-based
Recognise that care services are not being asked to meet all standards alone
Commitment to work together during 2017

25. Scrutiny of strategic commissioning
Quality indicator framework with SE at core

26. Big changes? What are the implications for you?