1. Secondment & Strategic review of care home sector update Rosamunde Willis-Read CQC/NCC
11 September 2014
Nottinghamshire County Council

2. Secondment from CQC Aims:
to improve ways of working across CQC & the Council through the development and embedding of partnership working with key stakeholder agencies
understand respective roles & remits

3. Secondment outcomes Completion of strategic review of care home sector
Develop a changing approach to quality - refine & focus quality monitoring - OUTCOMES
Develop a risk tool
Escalation process
Develop proactive & responsive approach
Dementia quality mark audit & award

4. Why a strategic review? Local & national media interest
Financial collapse of Southern Cross
Winterbourne View
Own intelligence about poor quality care
CQC intelligence
Dovetail with initiatives via board; Care Act

5. Who were the strategic board members?
Nottinghamshire County Council,
Nottingham City Council,
Newark & Sherwood Clinical CCG, Mansfield & Ashfield CCG,
Nottingham North & East Nottingham West CCG, Rushcliffe CCG,
Nottingham City CCG,
Nottingham City & Nottinghamshire County Healthwatch
Community Programme
Chaired By Allan Breeton, Independent chair of Nottinghamshire Safeguarding Adults board
1] Healthwatch is the independent champion for health and social care in England:
[2] The Community Programme was launched in July 2011 to identify issues between primary and secondary care to improve the patient, carer and clinical experience and has developed 10 projects to deliver this. programme

6. Who weren’t as involved?
Nottinghamshire Care Association
Care Quality Commission

7. What did we look at & why? (ToR) 1
Processes to measure quality
(CQC, the County and City Councils & CCGs)
State of current care home sector
Identified areas of overlap by agencies

8. What did we look at & why? (ToR) 2
Gaps in the sector Challenges for providers
Compliance and regulation Dementia Quality Mark
Quality Monitoring
Current methods used to address poor quality in care homes

9. Conclusion Steady stream of issues with some care home quality
Commissioning messages not being ‘heard’
Not using ‘good quality’ providers enough
Understand impact of, measure, then inform & refine support to care homes

10. Recommendations Share findings with CQC to inform methodology
Enhance audit through outcome focus*
Adopt targeted approach to commissioning
Increase engagement with providers
Launch commissioning strategy publicly
Coordination of inspections, visits, audits
Provide partnership improvement suggestions to CQC
Highlight nursing shortage nationally
Targeted approach to leadership & quality deficits in care homes – task force

11. Recommendations continued..
Evaluate effectiveness of existing clinical and specialist support to care homes
Use quality monitoring information to inform opportunities for sector led support
Consider CCG and Council alignment re QM
Include Healthwatch in information sharing
Agencies to report regularly re quality to NSAB

12. Next steps for strategic review
Submit to governance
Organise working group to plan implementation
Extend CQC Inspection Manager secondment to support
Develop media strategy
Implement recommendations
Monitor progress formally

13. Secondment achievements
Refined & outcome focused quality audit process
Risk management approach -
- information sharing
- internal & external escalation procedure
proactive & responsive work approach
swifter reporting to provider & public
involvement of residents & relatives

14. Dementia Quality Mark (DQM)
Initial round of Dementia Quality Audits completed by independent organisation
Outcome 136 homes dementia care specialists; 34 achieved DQM
Applications to apply reduced from 105 in to 82 in
Second round of audits currently under way
Any questions?

15. Media V Quality
Close working with CQC & CCG resulted in closure by providers of 3 care homes
Information shared with CQC re financial viability lead to CQC urgent location removal
Council terminated contract with 4 care home providers
Number of contract suspensions have reduced significantly

16. Thanks for listening
Any questions?