welcome and introduction keith hinkley director of adult social care east sussex county council
TRANSCRIPT
Welcome and IntroductionWelcome and Introduction
Keith HinkleyDirector of Adult Social CareEast Sussex County Council
Aims of the conference
• Share understanding of the issues• Learn about the support and help that is
available – information stalls and workshops • Hear the latest national perspectives on social
care sector development• Network with other providers and commissioners
to share best practice, develop partnerships and contribute to service development
Local Social Care Market
• Key partner in the delivery of social care
• Plural and diverse local care economy
• Significant employer
• 21% of the Council’s spend
• Nearly 19,500 service users and carers
• Responding to the needs of a large self-funding population
Transforming Adult Social Care
• Facing the challenges– Financial climate– Ageing population– Rising demand for services
• Personalisation
• Collaboration and cooperation
• Dialogue and support
Transforming to Personalisation
Practice
Systems
Relationships
Services
Organisational change
• Restructuring the Social Care Pathway
• Reablement
• Neighbourhood Support Teams
• Domiciliary Integrated Intermediate Care
• Investing in doing things differently– East Sussex 1Space– PrePaid Cards– Assistive Technology (Telecare)
Supporting Providers
• Communication, Communication, Communication
• Market Position Statement – published today
• Social Care Training Prospectus
Today
• National Policy Perspective – Department of Health
• Care Quality Commission• Social Care Institute for Excellence• Skills for Care• Workshops
– New developments and workforce redesign– Safeguarding Vulnerable Adults– Dignity and diversity– Dementia and End of Life Care
Making a difference for peopleIan BiggsDeputy Director of Operations (South)1 May 2012
People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights, wherever care is provided and wherever they live, despite changes in the system
Role of a regulator
The regulation system
Regulation
Adult social care
5
Innovative use of information
Reduced overall cost
Single system of registration
Single set of standards – the essential standards of quality and safety
Strong enforcement powers
1
2
3
4Dental services
NHS
Independent health care
Primary care
CQC – what CQC does and does not do
What CQC does not do
We do not make assessments of commissioning – although we can comment on
shortcomings via themed reviews and investigations
We do not assess quality above essential standards
We only promote improvement by focusing on non-
compliance
Inspectors are encouraged to describe what they see,
comment on good practice and reference it
CQC’s role
Register – inspect – enforce – publish
CQC registers care providers then checks whether they are meeting essential standards
If not, we take action – they must put problems right or face enforcement action
We publish what we find as quickly as possible
We share what we know with our partners
We put a premium on users/ whistleblowers
We monitor the care of those detained under the MHA
Inspection Analysis Voices
Palette of Regulation
Themed inspections
Scheduled inspections
Responsive inspections
Investigations
Themed reviews
Quality Risk Profiles
Other data sources
Whistleblowing
Safeguarding
Website feedback
Telephone or written feedback
Third party feedback
Scale of CQC regulated care
Primary medical services
9,000 locations
NHS Trusts
2,500 locations
Independent healthcare
2,500 locations
Adult social care
24,500 locations
Independent ambulances
300 locations
Primary dental care
10,000 locations
Combined outpatients and inpatients
77.4 million
People using adult social care services
1.75 million
Dental appointments
36.4 million
From April 2009
Ongoing
April 2014 onwards…
CSA until Sept 2010
Apr 2010-13
CQC’s lifecycle – a five-year programme
Phase 1 - legacyHCC, CSCI, MHAC
Phase 2Design and build
Phase 3Registration
Phase 4Implement and review
Phase 5Optimising the model
Principles ofinspection
New approach to inspections
Timely
At least once a year or once every two years depending on the provider
Focused
Inspections will focus on outcomes that are important
to people using services
Flexible
We can use different types of inspection to respond to concerns
Unannounced
We do not notify providers before we carry out inspections
Enforcement
It is the duty of health and social care providers to ensure compliance at all times
Should a provider not be compliant with the standards required, CQC can:
give a warning notice
impose conditions
suspend registration of some services
issue a fine
prosecute
close services by cancelling registration
CQC is cost blind
18
New CQC website
• Consumer focused
• Clear about what we do/can offer the public
• Focused on ability to look up location level reports/see major action we’re taking
• Information for providers and corporate information clearly signposted
Health and Social Care Bill 2011, ALB review 2010
CQC well placed in Bill – joint licensing with Monitor; working with Clinical Commissioning Groups, NHS Commissioning Board, NICE, ADASS and other major players
Creation of HealthWatch England – ‘Consumer champion’ within CQC for health and adult social care services in England. Independent body within the regulator. Start date 1 October 2012
Arm’s Length Bodies review – taking on new responsibilities:
Human Fertilisation and Embryology Authority
Human Tissue Authority
HealthWatch
Local Government Information Board
20
Making a difference in the South
What we found
What we did
What was the result
Beautiful house and garden with sea view
Staff too busy to interact or respond to requestsNo choices
Not clean
Bored and lonely
4 warning notices
Listening and responding
Choices Things to do
Meals a social occasion, view of the sea
21
Making a difference in the South
What we found
What we did
What was the result
Poor maintenance
Lack of dignityPressure sores
and tissue damage
Poor care planning
6 warning notices
New manager
Investment in property
Health improvements
Personalised careplanning
Notice of proposalto cancel
22
Making a difference in the South
What we found
What we did
What was the result
Woken earlyWhistlebower
Compliance actions
Calmer atmosphere
Better information and plans of care
People choice about routines
Early to bed
5.30am inspection
Lack of overnight monitoring
23
Prompts for debate
People with personal budgets may choose to purchase unregulated care
Shift from care home to home care. Are people offered real choice?
CQC commencing programme of inspections of domiciliary care
24
Closing comments
The public puts its faith in those who run and work in care services
There must be a culture that won’t tolerate poor quality care, neglect or abuse – and encourages people to report it
The regulator cannot be everywhere, so we need to regulate with others
We remain cost blind in checking standards
25
Questions
CQC – Helping make care better for people
www.cqc.org.uk
Questions?
Reform of Adult Social Care, and the social care market: next steps
William Vineall, Department of Health
Personalisation Conference, Uckfield, 1st May 2012
The reform timeframe
Social Care Vision
__________Nov 2010
Law Commission
Report__________
May 2011
Dilnot Commission
Report___________
July 2011
Caring for our future -
engagement_________Sept - Dec
2011
Care and Support
White Paper and progress
report on funding
__________spring 2012
Legislation
Personalisation
• An improved outcomes measure; brokerage; clarifying the personal budget offer
• Pilot direct payments in residential care; default in legislation to be a personal budget
Market shaping
• Clarify market shaping role of Local Authority; establish central body to look at market shaping; supply side statements for HWB Boards.
Market shaping & personalisation – response from engagement
Personalisation policy
• 2013 objective for all eligible people to be provided with a personal budget, preferably as a direct payment
• Latest figures from IC show 446,000 (29.2%) users/ carers receiving self-directed support in 2010-11, up from 216,000 (13%) in 2009-10
• ADASS survey 2011 -57 of 58 respondents expected to meet objective
• But wide regional variation remains
• ADASS report ‘The case for Tomorrow’ – challenges in delivering personalisation for older people
• Snapshot survey commissioned via ADASS, currently underway, also ask questions re older people and outcomes
Social care market is well established
• A diverse range of services supports personalisation, giving people, families and carers, greater choice and control.
• We have care services which are typically responsive to local needs, and reflect local circumstances.
• We have a diversity of different models in social care:– 87% of providers of residential care have one or two homes; and the ten
biggest providers account for 10% of the market (post Southern Cross)– Strong not-for profit sector– Variety of new models such as microenterprises and mutuals.
But there are challenges ahead…
• Changing role of local authorities – Personalisation and rise in self-funders, means a shift in the role of LAs from
directly commissioning services to facilitating local markets.– How are/will LAs responding to this challenge? For example, more
information, building relationships? Are new skills, new information required?
• Continuous improvement– In a system where LAs have fewer direct levers, how can we encourage
continuous improvement in the market?– How can we empower those purchasing care? How can we drive up quality
and encourage innovation?
Market Oversight: key issues
• Managing large-scale failure – Risks that no single local authority can manage? – Complex structures to disentangle, need for co-ordinated
approach?
• A changing market– Will we see further consolidation in the market? – Are complex business and financial likely to become more
common? – How is social care linked to other markets – e.g. property, health?
• Building stable and sustainable markets– What are the respective roles of central government, local
government, providers and the CQC?
Recent commentary
• Open Public Services White Paper– commitment to develop continuity regimes based on six key
principles
• Response to ‘Oversight of the Social Care Market’ Options Paper– A range of views
• NAO Report – DH should determine where market oversight is not sufficient,
following on from Vision in 2010– DH should have further arrangements nationally/locally to protect
users from provider failure
• PAC recommendations– DH should specify acceptable local market share– DH should clarify action in cases of large scale provider failure – DH must decide how it will monitor large scale providers
Options for market oversight & continuity
• Ensure essential services continue to be provided to users in the case of provider failure
• Ensure essential standards of quality are met
Not:
• To support any single player in the market
• To ensure facilities stay open, regardless of performance
→ Supporting vibrant care market
→ Effectiveness and proportionality
→ Minimising burdens on business & local government
→ Avoiding moral hazard; aligning incentives
Pre-failure interventions
Post-failure interventions
Market Intelligence and monitoring
Type of intervention
Government Objectives
Key Considerations
Options
Strength of intervention
Light touch Regulation
we help to improve social care standards
Transforming Your Services Through People
Karen Stevens – Skills for Care
Covering …….
• Why this and why now
• Principles of Workforce Redesign
• Some examples from Workforce Innovations Programme
Principles of workforce redesign to support service redesign
Principle 3 - Nurture champion, innovators and leaders, encourage and support organisational learning
Principle 4 - Engage people in the process, acknowledge and value their experience
Principles of workforce redesign to support service redesign
Principle one –Take a whole systems view of organisational change
Principles of workforce redesign to support service redesign
Principle two – recognise how organisations, people and partnerships respond differently to change
Principles of workforce redesign to support service redesign
Principle 3 - Nurture champion, innovators and leaders, encourage and support organisational learning
Principle 4 - Engage people in the process, acknowledge and value their experience
Principles of workforce redesign to support service redesign
Principle five – Be aware of the way adults learn
Principles of Workforce redesign to support service redesign
Principles of workforce redesign to support service redesign
Principle Six – change minds, change systems
Principles of workforce redesign to support service redesign
Principle seven – develop workforce planning strategies that support transformation and recognise the shape of resources available in the local community
East SussexPersonalisation Conference
Robert TempletonSocial Care Institute for Excellence
About SCIE
Organisational knowledge
Practitioner knowledge
A KNOWLEDGE BASE FOR
SOCIAL CARE
User knowledge
Research
Policy
We think we will get this...
...and we get this!
The outcomes people say they want -social care related quality of life
Accommodation cleanliness and comfort
Dignity
Food and nutrition
Safety
Personal cleanliness and comfort
Control over daily life
Occupation
Social participation and involvement
Social Work Practice Pilots
The Think Local Act Personal Partnership
• National and umbrella organisations committed to personalised community based social care
• Owned by the sector including people who use social care and family carers
• Starting from the outcomes and experiences important to people
Markers of progress
• Set of statements from people saying what they would expect to see if personalisation is real and working well
• Matched against key elements to be in place to make this possible
• These are “markers” that will help show how well a locality or organisation is doing in achieving personalisation and community-based support
The Challenge
Shift from a “professional gift” to the “citizenship” approach
There is no history of “turning needs into cash”
Getting caught up in the politics of the NHS
What may help
Ensure that champions at all levels and in all parts of the system
Introduce personalisation in to training and identify champions
Proceed at a pace that will allow good learning to be used building on the pilot work over a number of years. (not a big bang)
Knowing what works
The best method for researching any given topic is that which will answer the research question most effectively
The lived experience of service users/carers and the practice wisdom of practitioners can be just as valid a way of understanding the world as more traditional research
Robust, Reliable and Relevant
Further information
Contact: Robert Templeton
Tel: 020 70247722
Email: [email protected]
Web: www.scie.org.uk