The social care market today and for the future – ensuring quality and sustainability Debbie Westhead, Interim Chief Inspector Adult Social Care ADASS Spring Seminar 1 May 2019 1

Our role and purpose The Care Quality Commission is the independent regulator of health and adult social care in England We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve

The Mum (or anyone you love) Test Is it responsive to people’s needs? Is it effective? Is it safe? Is it well-led? Is it caring? Is it good enough for my Mum or Dad?

State of Care: what have we found? Access to good care is increasingly dependent on where people live and how well local systems work together It’s an ‘integration lottery’ Ineffective co-ordination of services has led to fragmented care in some areas Current funding mechanisms for health and care services have led to a focus on individual organisations performance rather than joined-up care We can only change the way services work together, by changing the way services are funded 4

Local system reviews: Beyond Barriers: first 20 reviews 20 site visits Final report July 2018 20 local system reports Interim report December 2017 5

Local system reviews: Beyond Barriers: What did we find? Living longer – but with more complex needs Care must be delivered by more than one person or organisation In 2018, we expect care to be personalised A fragmented health and care system designed in 1948 can’t meet today’s needs We must remove the barriers to collaboration at a local and national level and create an environment that drives people and organisations to work together

What we found 1/2 People experience the best care when people and organisations work together to overcome a fragmented system Dedicated staff regularly going beyond the call of duty There were examples of good practice in every local system we looked at Where local leaders share a clear vision, it provides a shared purpose for people and organisations across the local health and social care system But in a fragmented health and social care system there are barriers to collaboration at a local and national level

What we found 2/2 Funding: Health and social care organisations are limited in how far they can pool resources and use their budgets flexibly across prevention, social care and healthcare Managing performance: Organisations are held to account for their own performance, not the performance of the system as a whole Workforce: Services do not always have the right staff, in the right place, at the right time – the health workforce and social care workforce are seen as separate entities Oversight: Regulation usually looks at quality of care in individual providers, rather than across a system as a whole

Additional work beyond the report Three additional visits after the July 2018 report Reading Staffordshire Leeds Findings mirrored first 20 reviews Three follow up reviews where some improvement was found in each e.g. improved relationships, more collaborative culture, delayed transfers addressed Stoke Oxfordshire York Monitoring shows improvements in other parts of the country 9

Influencers of quality – commissioning well is important The public - who use services Professionals - all undertake a personal commitment to deliver safe high quality care when they register Providers – from leaders to the front line Commissioners – what they do and how they do it Regulators - this includes quality regulators, system regulators but also professional regulators

Know your patch: area-level exploration map New map-based tool with multi-sector organisation information and links to: existing intelligence products current rating insight profile relationship owner inspection team

How can you improve and collaborate? OFFICIAL SENSITIVE How can you improve and collaborate? Adult social care is underserved by improvement resources How can you and providers in your area collaborate? Can you form alliances across your local system?

Driving improvement across health and social care Report series features providers that have increased their quality rating considerably Similar themes for all reports What themes stand out? Leadership Culture Person centred care Staffing & support Outward looking Happy staff means better care

Leadership and culture, go hand in hand Involving staff, people who use services and their families, giving them a voice Shaping the culture of the organisation Staff feeling valued and given a voice Develop good teams to be even better, valuing training and development Empowering staff to ‘steer the ship’ “There’s a saying that to be a good leader you’ve got to have good followers. No. To be a leader you’ve got to breed more leaders.” Jamie Stubbs, Senior General Manager Ottley House Nursing Home

Quality matters

A look to the future and in conclusion We await the Green Paper with interest Long Term NHS plan – only one sentence refers to social care… Great quality exists, but... we can’t stand still Flexible positive response to change Challenge the status quo One size does not fit all It’s a collective effort Don’t forget the Mum test! 16

Interim Chief Inspector Adult Social Care www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Debbie Westhead Interim Chief Inspector Adult Social Care 17 17