1. Working together to deliver quality, person centred care
James Frewin, Head of Inspection, London
London Care and Support Forum, Croydon
28 March 2018 1
Generic ASC deck (June Final) 1

2. Our purpose and role
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve
Register
Monitor and inspect
Use legal powers
Speak independently
Encourage improvement
People have a right to expect safe, good care from their health and social care services
Strategy Slides - 24 May MASTER

3. Regulation to inspire improvement
What we do:
Set clear expectations
Monitor and inspect
Publish and rate
Celebrate success
Tackle failure
Signpost help
Influence debate
Work in partnership
Generic ASC deck (June Final)

4. Four priorities to achieve our strategic ambition
Our ambition for the next five years:
A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care
Encourage improvement, innovation and sustainability in care
Deliver an intelligence-driven approach to regulation
Promote a single shared view of quality
Improve our efficiency and effectiveness

5. The landscape of care GP practices 58.9 m registered with a GP
Care homes
460,000 beds
223,000 Nursing home beds
237,000 Residential home beds
NHS hospitals
93.9 million outpatient appointments / year
12.6 million inpatient episodes / year
23.7 million A&E attendances / year
636,000 baby deliveries / year
England
55.3 m (45.2m adults)
Dentists
22 million adults seen by NHS every 2 years
6.8 million children per year
Ambulances
6.9m calls receiving a face to face response
10 NHS trusts
251 independent ambulance providers
Health & social care staff
1.2m NHS staff
1.58m in adult social care
Private hospitals
Over 1,200 private hospitals and clinics
Home-care 500,000 + people receiving home-care support at any one time

6. Adult social care: stats and facts
Older people and people living with dementia, long term physical conditions, mental health needs, physical and learning disabilities
Diverse needs
£20 billion contribution to economy
1.4 million staff
Public, private and voluntary providers
Significant Sector
16,000 locations caring for c.460,000 people in care homes, nursing homes and specialist colleges
Residential Care
8,500 community services providing personal care for 500,000+ people at home or Shared Lives schemes, supported living and extra care housing
Community Care

7. Are adult social care services
closer to the tipping point?

8. Variation and the tipping point
Source: CQC ratings data, 31 July 2017
Some areas closer to the tipping point, others further away
Factors affecting the tipping point vary geographically – ratings variation is one aspect
ADULT SOCIAL CARE RATINGS BY LOCAL AUTHORITY
Percentage of
good and outstanding
Top 20%
Upper 20-40%
Middle 20%
Lower 20-40%
Bottom 20%

9. Adult social care ratings
CQC ratings data – 2 March 2018

10. Ratings by service type
CQC ratings data – 2 March 2018

11. Ratings by key question
CQC ratings data – 2 March 2018

12. Adult social care findings
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

13. Quality matters

14. Quality Matters: what people told us they wanted
Click for each of the four photos

15. Quality matters - joint commitment to improve adult social care
Agreed priorities to improve quality
No single person or organisation can improve the quality of adult social care on their own
Everyone who uses, provides, commissions, oversees or supports care and support services has a part to play

16. Promote quality through everything we do
Quality matters - principles
Promote quality through everything we do
Support and encourage improvement
Coordinate action

17. What does quality mean to people?
By following these principles and encouraging others to do the same, we enable people using services to say:
“I have considerate support delivered by competent staff”
“I am in control of my support, in my own way”
“I feel in control and safe”
“I can decide the kind of support I need”
“I have the information I need when I need it”
“I have access to a range of support that helps me live my life”

18. Quality matters – action plan
Acting on feedback, concerns and compliments
Measuring, collecting and using data more effectively
Commissioning for better outcomes
Better support for improvement
Shared focus areas for improvement
Improving the profile of adult social care

19. Quality matters: in the future
Person centred, co-ordinated care
True partnerships
Meaningful choice
Great staff 19

20. Local system reviews
How well do people move through the health and social care system, with a particular focus on the interface between the two, and what improvements could be made?

21. Local system reviews
CQC is reviewing health and social care systems in 20 local areas to find out how services are working together to care for people aged 65 and older at different places within the system.

22. Key messages from our interim report
Without good relationships and a shared, agreed vision between system partners, achieving positive outcomes is significantly compromised
More focused action is need on keeping people well, with joined up processes to identify and support people to stay safe and well in their usual place of residence
The focus on individual organisational outcomes is distracting from the needs of the wider system to work effectively for the people it serves. Focusing on DToC in isolation will not resolve the problems that local systems are facing.
Final report due out:
3 July

23. How systems work together
Interim report : Key findings 1
How systems work together
We found a strong commitment and enthusiasm from organisations and staff working across health and social care services to meet the needs of people who use services, their families and carers.
However for systems to work appropriately there has to be effective relationships and leadership accountability.

24. How systems work together
Areas for priority action for system leaders
Develop a shared vision and system-wide strategy agreed by system leaders
Invest time in positive and productive system relationships
Agree and define cross-system leadership accountability

25. Managing capacity, market supply and workforce
Interim Report: Key findings 2
Managing capacity, market supply and workforce
People’s choice about their health and social care is limited in many of the systems we reviewed due to a shortage of capacity and range of options.

26. Managing capacity, market supply and workforce
Areas for priority action for system leaders
Ensure ‘choice’ criteria for people moving between health and social care services
Agree the high impact changes and prioritise implementation in accordance to the level of need
Establish risk sharing agreements
Develop clear and longer term arrangements with VCSE sector providers

27. Moving beyond delayed transfers of care
Key findings 3
Moving beyond delayed transfers of care
We have seen examples of where a focus on delayed transfers of care (DToC) has improved the speed at which people are moving between services, however, this can divert attention from other important issues

28. Areas for priority action for system leaders
Moving beyond DToC
Areas for priority action for system leaders
Ensure timely access to data
Systems should access and apply national guidance and support available

29. Local system reviews - areas for priority focus
We encourage national leaders to:
Enable and encourage health and social care partners to establish aligned objectives, processes and accountabilities.
Address the risks in the social care market as a matter of priority and ensure that there is a national focus on joint health and social care workforce strategies.
Enable local systems to invest in out of hospital services to keep populations well through preventative support.
Although we are reporting at an early stage of the review programme and have only published reviews of systems in six local authority areas, common themes are emerging that we believe should be addressed at a national level. We will continue to keep these under review throughout the remainder of the review programme and make comment in our final report in summer 2018.

30. Shared vision and strong leadership
Local collaboration and joined up care
Golden thread connecting vision to delivery through different organisations
Shared vision and strong leadership
All staff to share that vision and deliver to action
Work together as part of a system

31. high quality care for all
All we want is…..
Person-centred
co-ordinated
high quality care for all 31

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