1. Caring for our future Caring for our future: shared ambitions for care and support Emerging thinking: Quality and Workforce November 2011

2. Caring for our future 2 Context Caring for our future: shared ambitions for care and support was launched on 15 th September and runs until early December. It is a discussion with people who use care and support services, carers, local councils, care providers and the voluntary sector about the priorities for improving care and support. The discussion has been jointly led by leaders from the care and support community and senior civil servants from the Department of Health and supported by small reference groups. The discussions have focused on the following six reform areas: – Quality and the workforce – Personalisation – Shaping local care services – Prevention and early intervention – Integration – The role of the financial services These slides represent key findings and emerging thinking from these discussions to date. They are not a statement of Government policy.

3. Caring for our future 3 Workstream: Quality and Workforce What are the priorities for promoting improved quality and developing the future workforce? – Should there be a standard definition of quality in adult social care as quality can often be interpreted differently? What do we mean by it and how should it be defined? How could we use this definition to drive improvements in quality? – How could the approach to quality need to change as individuals increasingly fund or take responsibility for commissioning their own care? How could users themselves play a stronger role in determining the results that they experience and designing quality services that are integrated around their personal preferences? – How could we make quality the guiding principle for adult social care? Who is responsible and accountable for driving continuous quality improvement within a more integrated health and care system? – What is the right balance between a national and local approach to improving quality and developing the workforce? Which areas are best delivered at a national level? – How could we equip the workforce, volunteers and carers to respond to the challenges of improving quality and responding to growth in demand? How could we develop social care leadership capable of steering and delivering this? – How could we improve the mechanisms for users, carers and staff to raise concerns about the quality of care? How could we ensure that these concerns are addressed appropriately?

4. Caring for our future 4 What needs to change? The current situation The social care system often varies in the standard of quality a user of care receives. Whilst there are many examples of excellent care in sector there are still some areas that need to improve. Cost is often the driving principle behind commissioning decisions leading to poorer quality care being provided to the user. The future growth of demand for social care has yet to be fully planned for. The increases in numbers of people needing care must be achieved without compromising on the improvements in personalisation and quality already achieved. The sector is signed up a range of positive outcomes for individuals through the Social Care Outcomes Framework. Where we need to be Social care being filled with great people, doing great jobs that deliver high quality care to people using social care services.

5. Caring for our future 5 Key issues for reform We need to build on the positive and constructive work of those in the sector that excel, identify best practice and work to achieve greater parity in experiences of care and quality outcomes. We need to ensure that we improve the basic quality of care in England to the standard of other peer countries. We need to build on the success of the Social Care Outcomes Framework and make quality the guiding principle for care within a marketplace that has a greater focus on quality as opposed to cost. We must increase capacity and capability within the workforce and continue to improve the relationships between the carer and the recipient.

6. Caring for our future 6 Key findings (1) Commissioning – Leverage through commissioning is not fully utilised. Local authority (LA) commissioning is focused too much on tendering process and cost not quality outcomes. Shortage of information/metrics and outcome data (including user experience) at provider level to support commissioning (by individuals and LAs) for quality. Lack of transparency around commissioning decisions. Need for greater understanding of the complexity of care in some settings (eg care homes), less focus on layers of monitoring and more on supporting development and a partnership approach between commissioners and providers. Empowering Consumers – People power to drive quality not fully utilised Competition and choice won’t drive quality if consumers aren’t informed and supported. Not easy to understand comparative information at provider level (and for the future Personal Assistant level) is available. General consensus that there is a gap left by star ratings and a need for some comparable measure of quality over and above CQC essential standards. Good advocacy and brokerage only available in some areas/for some service users. Personalisation will be delivered through good relationships between users, carers and staff. All three groups need to be helped to achieve a sense of security, belonging, continuity, purpose, achievement and significance. Quality Framework – Lack of common vision and understanding around quality in the sector Lots of evidence for quality exists in the sector but lack of action on it. Most robust evidence needs to be synthesised and prioritised. A comprehensive quality framework and system architecture exists in the NHS (NICE standards, payment by Results, Quality Accounts, Commissioning for Quality Improvement, Information Centre Metrics etc). We have the Social Care Outcomes Framework (which has been well received by the sector) but the overarching quality framework is in an earlier stage of development. It may need additional elements to make it work effectively and needs embedding into the sector also as a behaviour change. Need for greater understanding around incentives, roles and responsibilities around the system for quality.

7. Caring for our future 7 Key findings (2) Funding: Balancing Cost and Quality The combination of the current funding squeeze and inflation means providers are having to do more for less. The drive to reduce costs means that quality is suffering. General consensus that whilst increases in pay/funding above a certain level do not directly relate to higher quality there is a floor below which pay/funding cannot go without having a detrimental effect. Great Jobs: Improving the image of social care as a great career option and place to work There are many excellent examples of high quality working in social care, but this is not always the general perception externally which harms the attractiveness of jobs and the ability to recruit. We have found that there are key areas of the potential workforce that could be targeted (young people, newly retired, men etc) to help meet the challenges of future demand. To do this we should promote social care as an integrated sector with strong values and quality relationships at its heart. We believe that to achieve this will require us to ensure people can recognise jobs in social care that appeal to them, whether that be because they offer a clear career and progression structure or offer flexible working patterns that fit in around a persons day to day life. We believe that the current infrastructure can be developed to achieve this and a recruitment exercise can utilise this to re-brand Social Care as a vibrant area full of great jobs.

8. Caring for our future 8 Key findings (3) Great People: attracting and retaining people with the right characteristics to the profession A career in social care attracts committed people, passionate about making differences for those using services. We must make sure that the training, development and incentives that they encounter within social care support them to realise their potential and create the workforce that fits the future of social care. This means that we will need to develop tailored programmes and recruitment strategies that focus on the transaction between service user and staff member ensuring that people are confident and capable of creating great relationships and using this as the basis of performance monitoring. Also, making sure that staff members are comfortable about working in an integrated way, having worked from the outset of their time in social care to gain experience that goes outside of it into health, housing and areas that support the service user. Great Leaders: developing transformational leadership in social care Social Care is increasingly a sector driven by innovation, in care and technology, at the same time it has the impending challenge of meeting the growing expectations of an increasing population of service users. These challenges will require new programmes of recruitment, training and development that makes sure social care has the infrastructure and diffuse leadership models able to create leaders whose first instinct is to look outwards, integrating across historic boundaries naturally and delivering strategically, with the service users experience always the touchstone for their decisions. From first line managers through to the most senior leaders in social care, we must make sure that all are capable of taking this integrated approach to delivering improved quality and reform.

9. Caring for our future 9 Opportunities The contribution social care makes to the economy in terms of employment (now and in the future), economic growth and wider social policy. High unemployment provides greater scope for attracting people into the workforce. Shift to personalisation, Personal Budgets, Direct Payments puts individuals in control. Recognising and building on increasing numbers of ‘young older people’ as community assets.

10. Caring for our future 10 Commission on funding of care and support recommendations: key findings The group has heard strong support for the Dilnot Commission’s recommendations – people think Government must act now and not delay reform any longer. The strategic approach taken by the Commission supports empowerment of consumers and supports the personalisation/choice agenda. Recommendations of direct relevance to the Quality and Workforce agenda are: – Information and advice strategy – Improved assessment and portability of assessment – Improved integration between health and social care

11. Caring for our future 11 Emerging priorities for action (1) Place social care in the broader context of opportunities for economic activity. The spend on social care is billions, yet the sector struggles at times to recruit and retain staff. Support for carers to remain economically active is also important, also for their own wellbeing. Local authorities (LAs) should have a duty to ensure sufficiency of supply for their population (whether LA-funded or self-funders). Develop a comprehensive quality framework, which builds on the Social Care Outcomes Framework and existing quality architecture in the system eg Local Accounts and sets out the vision and respective roles, responsibilities and incentives of the respective players eg providers, councils, regulator. Consider an interim forum (led by the sector) to help define quality and disseminate best practice in a format that is appropriate to and engaging of the social care sector. On commissioning, should consider emerging work from Think Local Act Personal (TLAP) including work in the sector to identify a range of quality markers. To liaise with markets group and ADASS on potential recommendations. Address the information deficiency to ensure people have sufficient information (including comparable information at provider level) and support to empower them. Link to recommendations from the personalisation working group.

12. Caring for our future 12 Emerging priorities for action (2) Building on the choice/personalisation agenda, but also consider community capability building – eg French voucher systems, volunteering. Urgently increase capacity and capability of the workforce (via a range of means inc apprenticeships, volunteering, flexible working for those wanting to work in the sector for only a few hours per week). Make social care a great place to work for young people, and also create opportunities for people at other stages in their life, including re-entry to the workforce after maternity leave or unemployment and for people entering retirement or partial retirement. Develop career pathways that enable workforce movement. Better support the workforce to cope with the emotional demands of the work (action learning, mentoring, clinical supervision, networks of support). Leaders need professional recognition and support (professional organisation) so that they can function on a more equal playing field with health related partners. Leaders required to engage in continuing professional development. Promote excellent leadership that links with other sectors and creates a clear pipeline from junior to senior management. Quality standards for staff are needed, as well as quality standards for users and carers.