1. Outstanding services in a time of challenge
Lisa Smith & Rosie McNamara
Research in Practice for Adults

2. Workshop Aims
To give an overview of CQC outstanding service characteristics
To provide the opportunity for delegates to consider what their workforce needs to achieve outstanding

3. Adult social care: Quality Matters
Andrea Sutcliffe, Chief Inspector of Adult Social Care
National Children and Adult Services Conference
4 November 2016 3 3

4. State of Care 2016
Published October 2016 4 4

5. 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

6. Great care
The provider and staff supported people in a number of creative ways to lead a fulfilling life with a commitment and determination to promote people's quality of life.
Innovative ways of involving people were used so people were at the heart of everything. People were listened to and their comments acted on.
A person who liked heavy metal had a CD player and headphones. Another person liked birds – they had their own budgies and love birds to look after.
We observed Zumba. One person decided to get up and dance – staff assisted the person to kick their legs and move their arms. We saw them laughing - this person was almost 100 years old. 6 6

7. 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

8. Poor care
The home was not clean. Bins outside the home were over-flowing and household rubbish was kept in the garden which could encourage pest infestation.
There has been inconsistent leadership at the home, with management changes and periods of management absence.
People were not receiving medicines safely and the temperature for storing medicines was too high to ensure medicines were effective.
There were inadequate arrangements to prevent and control the spread of infection.
Staff employed at the home did not have the skills and knowledge required to support people safely.  8 8

9. State of Care 2016: a challenging environment
Source: Health Foundation: A Perfect Storm, NHS Improvement
Ageing population with complex needs, 85+ up 33%
Greater demand for adult social care, but less access
Two thirds of NHS providers recorded a deficit last year
Shortage of GPs and increasing vacancy levels
Improvement increasingly difficult
Source: ONS mid-year population estimates

10. 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
Some providers resigning contracts, councils warn of more
Recruitment and retention of staff a challenge
Source: CQC – State of Care 2015/16

11. 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

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. Key characteristics of an outstanding service
Safe
Effective
Caring
Responsive
Well Led
What does a good service look like?
What does an outstanding service look like?

14. Safe: Key characteristics
Exceptional and distinctive
Staff highly skilled in recognising and responded when people feel unsafe
Positive culture enabling people to raise concerns and challenge when appropriate, with fear of recriminations. Day to day practice
Moving forward, recognises the need to change, implements change and sustains it
Open and transparent culture
Imaginative and innovative ways to manage risk and keep people safe, empowering individuals to have a full and meaningful life
Seeks out new technology and solutions to ensure people have as few restrictions as possible

15. Effective: Key characteristics
Innovative and creative training and staff development
Supports learning into practice to deliver outstanding care to meet individual’s needs
Works in partnership with other organisations to develop best practice and staff training. Works towards and achieves recognised accreditation schemes
Confidently makes use of MCA 2005, use innovative ways to make sure people are involved in their decision making, that their human and legal rights are sustained
Champions within the service, making sure people experience outstanding quality of life
Excellent links with wider Health and Social Care services
Promotes individual’s wellbeing
Emphasis’ importance of eating and drinking well thus improving people’s wellbeing
Supports individual’s preferences and eating and drinking patterns
Meal times / quality / choice of food are described as exceptional

16. Caring: Key characteristics
Strong, visible person centred culture
Exceptional at helping people to express their views, therefore understand things from the person’s point of view.
Creative, tailored and inclusive methods of communication.
Value relationships and staff go the “extra mile”
People feel really cared for and that they matter
Staff exceptional in enabling people to remain independent.
In depth appreciation of an individual’s need for dignity and privacy.
Compassionate, over come obstacles
People experience a comfortable, dignified and pain – free death. As well as supporting people that matter to the person who is dying with empathy and understanding

17. Responsive: Key characteristics
Staff have outstanding skills and excellent understanding of people’s social and cultural diversity, values and beliefs
Staff care and support plan in partnership with the individual and those that matter to the individual.
Other professionals recognise its focus on person centred care
Flexible and responsive to individual need and preferences
Key links and involvement in the local community

18. Well led: Key characteristics
Track record as an excellent role model
Sustained a positive culture in the organisation
Continually striving to improve
Finds innovative and creative ways to empower people and voice their opinions
Vision and values, person centred and imaginative making sure people are at the heart of the service
Communication is meaningful
Outstanding practice and improvements are sustained over time

19. Skills, Knowledge, Attitudes & Behaviours
What core skills, knowledge, attitudes and behaviours do the workforce need for are service to be outstandingly:
Safe
Effective
Caring
Responsive
Well-led

20. Contact @ripfa https://www.ripfa.org.uk help@ripfa.org.uk 20