1. QUALITY PROJECTS Adult Joint Commissioning Unit Market Development & Care Standards Team
11 October 2013
Nottinghamshire County Council

2. Why look at quality now?
2012 – number of care homes failing 5 key CQC areas
Changes to CQC Inspection processes
Increase in Council suspensions & repeats
National & local media attention
Increase in referrals of concern
Dementia care quality
Partner’s organisational changes

3. Why look at quality now?
Difficulties quickly analysing information e.g. to respond to Members queries
High vacancy levels – sustainability?
OPPORTUNITY!
Senior leadership support for 1 year secondment swap
CQC CM joins NCC
NCC MDO joins CQC

4. Secondment outcomes strategic review of care home sector
develop a consistent approach to all provider quality monitoring
refine & focus more on OUTCOMES
develop & implement a risk tool
review risk & escalation process
develop proactive & responsive approach
inter agency & public information sharing
dementia quality mark audit & award
Strategic review; look at whether we have sufficient and appropriate mechanisms in place to manage risk in CRHs. Identify themes and trends and refine the work programmed to support the council position.

5. Starting point - Council position on quality
Who is responsible for provider quality?
Understanding what the council position is on quality. What is acceptable and what is not? Care home bandings for OP CRH. 5 bandings for OP, 3 for YAs. Standard met, nearly met, almost completely met, met but could further improve…etc. Why do we place in band 1 & 2 homes? Is this ok? Should we have band 1 & 2 homes if we only want to commission ‘good’ quality care?

6. Who is responsible for provider quality?
CQC?
Commissioners?
Contracts Officers (MDOs/QDOs)?
Managers/owners of the service?
Operational staff/reviewing officers?
Families/carers?
Individuals themselves?
All the above?
The Health & Social Care Act 2008 says the provider and the commissioners are responsible, therefore the MD team must audit quality effectively.

7. Sector position; improving quality – an example
Older person’s care homes
2008/09
10/11
12/13
Band 5 2 34 30
Band 4 22 28 36
Band 3 57 46 45
Band 2
Band 1 39 25
166
170
172
Fair Price for Care and Quality Banding
Other LA’s and their approaches
Presented nationally – acclaimed approach
This shows positive improvement in quality but is it consistent with CQC findings and if not why not?
Nottinghamshire County Council

8. But ? Increasing safeguarding referrals – MASH
Quality referrals in older person’s homes
Consistent levels of non-compliance with CQC
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar 26 24 27 23 35 40 30 51 25
Increasing reactive role
Changing role of reviewing officers?
Differing roles across YA and OP
Currently averaging out approximately 50 quality referrals per month to the market development team.

9. Strategic review of care home sector
Purpose
Review of care home provision across Nottinghamshire County & Nottingham City Local Authorities & CCGs, to identify & agree measures which,
identify & manage risks
promote & support diverse & robust care provision of high quality outcomes for people using services

10. Strategic review- progress & next steps
Revised the risk and escalation procedures in partnership with CQC – final draft
Gathered information about current support & input for care homes
Agreed intelligence multi-agency provided data set & commenced analysis for completion by mid November 2013
Refined NCC internal processes for consistency & produced staff guidance – final draft

11. Consistent approach to monitoring quality - progress
Reviewed NCC system in relation to H& SCA 2008 responsibilities and outcome focus
Redesigned audit tool, descriptors & methodology for use in 2014/15 – future proof! – CQC 5 domains
Developed supporting training package for NCC staff for implementation, including report writing for public sharing

12. Changing approach to quality
Developed, agreed & implemented & a ‘risk tool’
Incorporating
CQC inspection outcomes
Market development team quality audits and referrals
Safeguarding referrals & outcomes
Electronic monitoring outcomes
Provider financial viability
Operational staff feedback
Stakeholder feedback
Health monitoring feedback
Aims & use of risk tool
Indicator of input needed from MDT to improve outcomes or inform restrictive actions
Improve internal NCC knowledge about providers/managers & quality of care
Improve quality of information shared between partners
Increased co-ordination of actions relating to escalating concerns, for example…………

13. Risk tool – progress & next steps
Continued basis for multi-agency information sharing
Embed ownership with QDO as part of portfolio management
Risk panel – critical friend/peer challenge – consistent/ proportionate approach across team

14. Dementia Quality Mark – driving improvement in dementia care
DQM audit tool & methodology developed
Independent auditors secured
Audits completed in July & August 2013
DQM to be awarded to services assessed as delivering high quality dementia care
Beacon status homes
Share results with providers October 2013
Enhanced payments begin November 2013
Audit outcomes to be mainstreamed within annual quality audits for 2014/15

15. Overall project learning points & benefits
True understanding of respective organisations map of the health & social care market
Roles, responsibilities, powers, duties & restrictions/barriers
Differences, similarities: national & local politics
Co-ordinated and complementing
SMART working – team structure, roles, line management, information sharing

16. Overall project learning points & benefits
Improved early warning to issues with quality of care at individual & provider level
Swifter action to encourage improvement in outcomes for people; quicker realisation of positive outcomes
Improved public accountability
Improved resource management for council work enabling balance between responsive and encouraging work

17. Overall project learning points & benefits
Sign up across health & social care quality monitoring; clarity for agencies & providers alike
Reduction of potential duplication in agency input – singing from the same hymn sheet!
Increased confidence in partner agencies & support

18. Overall project learning points & benefits
Reduced impact/burden of monitoring for providers
Safeguarding or quality?
Challenges of communication via different organisational structures & processes
Confidence in judgements about services– safe, responsive, caring, effective, well-led

19. Thanks for listening
Any questions?

20. Contact details
Sue Batty – Group Manager, Joint Commissioning Unit, NCC
Rosamunde Willis-Read – Project Manager, Strategic Quality & Risk, NCC (CQC)