1. Sue Burn Inspection Manager, Somerset ASC November 2017
The state of health care and adult social care 2016/17 and the Next Phase
Sue Burn
Inspection Manager, Somerset ASC
November 2017

2. Unique oversight of health and care
Full picture of the quality of health and social care in England, with ratings for all sectors
Now have a baseline from which to draw conclusions about quality and safety of care and what influences this
21,256 adult social care services
152 NHS acute hospital trusts
197 independent acute hospitals
18 NHS community health trusts
54 NHS mental health trusts
226 independent mental health locations
10 NHS ambulance trusts
7,028 primary medical care services
Increasingly, CQC will report on quality of areas and coordination across services – for care fit for the 21st century
Is it safe?
Is it effective?
Is it caring?
Is it responsive?
Is it well-led?

3. Congratulations to staff
Results are a credit to frontline staff, managers and leaders

4. Health and care services are at full stretch – which impacts upon people
Increased complexity of demand = new challenges
Providers must change to meet complexity and challenges
Future quality of care is precarious
Providers struggling to cope with more complex demand
People waiting over four hours at A&E
More planned operations cancelled and people waiting longer
Increasing demand for mental health services, affecting waiting time
Fewer nursing home beds
Adult social care providers handing back contracts
One in eight older people are not receiving help they need

5. Care providers are under pressure
Need for adult social care continues to rise
4,000 fewer beds in nursing homes - 2% reduction over two years
Source: CQC registration data

6. Are adult social care services closer to the tipping point?
Last year we described adult social care as approaching a tipping point. We said that based on five tests. We have run the five tests again and three of the five are worse:
Unmet need – further increase
Nursing home bed numbers – continue to fall
Agencies handing back contracts – this continues
In addition, 23% of good adult social care services have deteriorated on re-inspection.
The extra £2bn from the Chancellor was a welcome recognition of a system under pressure. But we need a long-term sustainable solution and Parliament need to consider this.

7. Variation and the tipping point
Some areas closer to the tipping point, others further away
Factors affecting the tipping point vary geographically – ratings variation is one aspect
Source: CQC ratings data, 31 July 2017
ADULT SOCIAL CARE RATINGS BY LOCAL AUTHORITY
Percentage of
good and outstanding
Top 20%
Upper 20-40%
Middle 20%
Lower 20-40%
Bottom 20%
There are substantial variations in the quality of care that people are receiving – within and between services in the same sector, between different sectors, and geographically. The impact on people is particularly felt where sectors should come together – we have seen how disconnections in parts of the system are creating real problems for people.

8. Adult social care
78% rated good, but 19% rated requires improvement and 1% (303 locations) inadequate
Caring rated best – 92% good and 3% outstanding. Safe and well-led poorest – 22% requires improvement and 2% inadequate
High-performing services have strong leaders – innovative registered managers known to staff, people using the service, carers and families had a positive impact
High-quality services are person-centred – staff get to know people as people, understanding their interests, likes and dislikes
Most enforcement for poor care relates to governance, safety, staffing and person-centred care
Quality matters joint commitment developed

9. BNSSG and BaNES ratings comparison November 2017 – national July 2017

10. Next phase – evolution not revolution
As a result of consultation and co-production with the sector and CQC staff
Two assessment frameworks – health and social care
Simplified and more open KLOEs and expanded characteristics
Enhanced focus on EDHR + accessible information standard
One provider and inspector handbook
Changes to home care methodology
Greater emphasis on leadership
Focus on Requires Improvement services

11. Next phase – evolution not revolution
Targeting risk
improved intelligence and a provider portal - PIC
Shared view of quality
digital portal will make it easier to share information
Increased working with providers with several locations
spot trends and risks, share information and encourage improvement
Improved stakeholder engagement
No change to CQCs commitment to act on behalf of people who use services ‘the mum’s test’.
inspect-regulate-adult-social-care-services

12. Some key changes for ASC
Safe – support for people when behaviour challenges: Moved from Effective
Effective – processes to ensure no discrimination
Moved from Safe
Effective – organisations working together
Moved from Responsive
Effective – staff working together across organisations Moved from Responsive
Responsive – supporting people at the end of their life Moved from Caring

13. Key Points
The majority of people are receiving good quality care. This is something to celebrate.
Over eighty per cent of inadequate services improve on re- inspection but for services that require improvement nearly forty per cent don’t improve and 5% get worse1
In Next Phase, therefore, we are focusing on encouraging improvement in services rated requires improvement
We will do this flexibly and proportionately, using inspector judgement and existing risk and enforcement frameworks
We will monitor these services more closely to identify changes in quality (up or down) and respond more quickly, as required
STATE OF ASC 2017

14. Five new KLOEs
S1 How do systems, processes and practices safeguard people from abuse?
S6 Are lessons learned and improvements made when things go wrong?
E1 Are people’s needs and choices assessed and care, treatment and support delivered in line with current legislation, standards and evidence-based guidance to achieve effective outcomes?
W2 Does the governance framework ensure that responsibilities are clear and that quality performance, risks and regulatory requirements are understood and managed?
W3 How are the people who use the service, the public and staff engaged and involved?

15. Eleven changed KLOEs
S2 How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?
S4 How does the provider ensure the proper and safe use of medicines?
E2 How does the service make sure that staff have the skills, knowledge and experience to deliver effective care and support?
E5 How are people supported to have healthier lives, have access to healthcare services and receive ongoing healthcare support?
E6 How are people's individual needs met by the adaptation, design and decoration of premises?
C1 How does the service ensure that people are treated with kindness, respect, and compassion, and that they are given emotional support when needed?

16. C2 How does the service support people to express their views and be actively involved in making decisions about their care, support and treatment as far as possible?
C3 How is people's privacy, dignity and independence respected and promoted?
R2 How are people’s concerns and complaints listened and responded to and used to improve the quality of care?
W1 Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person- centred, open, inclusive and empowering, which achieves good outcomes for people?
W4 How does the service continuously learn, improve, innovate, and ensure sustainability?

17. The Assessment Framework
The Framework includes:
Key Lines of Enquiry (KLOEs) – inspectors follow these to help answer the Key Questions they are answering.
Prompts – these are questions which inspectors can select as appropriate to gather the information they need to follow the lines of enquiry and answer the Key Questions they are asking

18. Other changes include……………
Well Led Limiters
The four principles below show events and circumstances that mean that the well-led question can never be rated better than “requires improvement”
(i) The location has a condition of registration that it must have a registered manager but it does not have one, and satisfactory steps have not been taken to recruit one within a reasonable timescale
(ii) The location has any other condition of registration that is not being met without good reason
(iii) Statutory notifications were not submitted in relation to relevant events at a location without good reason
(iv) The provider has not returned the PIR or contact information, where requested by CQC, or supplied the information in another format as agreed in advance. Providers should have this information readily available to them through the internal systems they are required to have to monitor and improve the quality of their service.

19. And…….. Registering the right support
All focused inspections will consider Well-Led alongside any other Key Questions where there are risks, concerns or improvement

20. Thank you #Qualitymatters #Stateofsocialcare www.cqc.org.uk
@CareQualityComm
Sue Burn
Inspection Manager 19