1. Innovation in the care sector
Debbie Ivanova
Deputy Chief Inspector of Adult Social Care
Care Managers Network, 12 September 2019 1

2. 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

3. Current ratings for the South West Region
Source: CQC ratings at 31 July Numbers on bars are percentages. Numbers in brackets are total active locations rated.

4. Human rights based approach to care
Human rights are a legal requirement
Providers should promote non-discrimination and equality
Empowerment of people who use care services

5. 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

6. Consistent, compassionate workforce
“Having the same staff means that they know the little things that make a difference to Jean, like making sure she has a tissue in her sleeve, or seeing if she’d like to spray some of her favourite perfume”
David Eadie, whose wife uses the service
Consistency of staffing makes a big difference
Limited or structured use of agency staff
Empowered staff willing to speak out and suggest changes
No blame culture, learning culture
Taking people on the improvement journey
Regular supervision and training
Robust recruitment and induction process, management providing bespoke training

7. Person centered care
The Butterfly project – people and staff were wearing items to provoke conversation and memory. For example, one resident wore a uniform and this provoked conversation about their time in the armed forces.
Stiperstones,
Chobham, Surrey
Broadwater Lodge,
Godalming, Surrey

8. Are you confident with difference?
People who use services will receive better quality care because services that are confident with difference are more able to meet their needs.
Our aims for 2019–2021
Our regulation assures more people using services that they will experience frontline care delivery that is confident with difference.
We ensure that CQC colleagues are confident with difference so that they can play their part in delivering this objective.
We use the evidence we gather on this topic in our national reports and information to encourage improvement beyond the regulation of individual services.

9. CQC’s study into oral health
Oral health is key to overall health, wellbeing and nutrition
Site visits to 100 care homes
External Advisory Group including commissioners, and representatives from the dental and social care - collaboration
Focus on:
Awareness and implementation of NICE Guideline NG48
Access to dental care (NHS and private) for people living in care homes 

10. What did we find?
73% of care plans only partly covered or did not cover oral health at all – Homes looking after people with dementia being the most likely to have no plan in place
The majority (52%) of care homes visited had no policy to promote and protect people’s oral health
Less than half (47%) of care homes providing specific staff training to support people’s daily mouth care

11. Thematic review of prolonged seclusion, segregation and restraint
Number of people subject to restrictive interventions in these settings
Pathway that the person has followed to end up in segregation and/or prolonged seclusion
Quality of care and of the physical environment
Safeguards in place to protect the person’s rights and to protect the person from abuse
Impact of segregation and/or prolonged seclusion on people who are subject to it and on their families
Impact on other patients/residents and staff
The role of the wider system
Quality of leadership and the culture

12. Interim recommendations 1/2
Independent review of every person in long-term segregation identified on a learning disability or children and young people’s mental health ward
Convene an expert group, that includes clinicians, people with lived experience and academics, to look at what a better system looks like

13. Interim recommendations 2/2
The system of safeguards needs to be strengthened, including the role of advocates and commissioners
Human rights must be explicitly considered. This is likely to lead to both better care and better outcomes from care
CQC should review and revise its approach to regulating and monitoring hospitals that use segregation

14. Tech: Improving outcomes
Good systems and providers can harness technology to enable better care
People have told us they have reservations about tech
Where it is working well, people describe tech that was “tailored” to their needs

15. Take home messages on tech
As technology and provision evolves, we will:
work alongside people who use and deliver services to encourage improvement
stay abreast of technological innovation
refine our regulatory approach
We welcome open discussions with….
people who use services
providers
private sector and entrepreneurs
researchers
…..on how technology can improve care, while safety and quality of care is assured 15

16. Published and forthcoming
Soon:
Sexual safety and supporting sexuality in adult social care
State of Care 2019 16

17. Deputy Chief Inspector of Adult Social Care
@CareQualityComm
Debbie Ivanova
Deputy Chief Inspector of Adult Social Care 17 17