Transcript Adult Social Care - East Sussex County Council

Welcome and Introduction
Keith Hinkley
Director of Adult Social Care
East 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
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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 selffunding 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
Services
Systems
Relationships
Organisational change
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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
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New developments and workforce redesign
Safeguarding Vulnerable Adults
Dignity and diversity
Dementia and End of Life Care
Making a difference
for people
Ian Biggs
Deputy Director of
Operations (South)
1 May 2012
Role of a regulator
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
The regulation system
Adult social care
NHS
Independent
health care
Dental services
Primary care
1
Single system of
registration
2
Single set of standards
– the essential
standards of quality
and safety
3
Strong enforcement
powers
4
Innovative use of
information
5
Reduced overall cost
Regulation
CQC – what CQC does and does not do
CQC’s role
Register – inspect – enforce –
publish
CQC registers care providers
then checks whether they are
meeting essential standards
What CQC does not do
We do not make assessments
of commissioning – although
we can comment on
shortcomings via themed
reviews and investigations
If not, we take action – they
must put problems right or face
enforcement action
We do not assess quality above
essential standards
We publish what we find as
quickly as possible
We only promote improvement
by focusing on noncompliance
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
Inspectors are encouraged to
describe what they see,
comment on good practice and
reference it
Palette of Regulation
Inspection
Analysis
Voices
Themed
inspections
Themed reviews
Whistleblowing
Quality Risk Profiles
Scheduled
inspections
Safeguarding
Other data sources
Website feedback
Responsive
inspections
Telephone or written
feedback
Investigations
Third party feedback
Scale of CQC regulated care
Primary medical
services
Independent
healthcare
Independent
ambulances
9,000 locations
2,500 locations
300 locations
NHS Trusts
Adult social
care
Primary dental
care
2,500 locations
24,500 locations
10,000 locations
Combined outpatients
and inpatients
People using adult
social care services
Dental appointments
77.4 million
1.75 million
36.4 million
CQC’s lifecycle – a five-year programme
Phase 1 - legacy
HCC, CSCI, MHAC
CSA until Sept 2010
Phase 2
Design and build
From April 2009
Phase 3
Registration
Apr 2010-13
Phase 4
Ongoing
Implement and review
Phase 5
Optimising the model
April 2014 onwards…
New approach to inspections
Unannounced
We do not notify providers before
we carry out inspections
Flexible
We can use different
types of inspection to
respond to concerns
Principles of
inspection
Focused
Inspections will focus on
outcomes that are important
to people using services
Timely
At least once a year or
once every two years
depending on the
provider
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
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
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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
Making a difference in the South
Beautiful house and
garden with sea view
Bored and lonely
What we
found
Not clean
No choices
4 warning notices
What we
did
What
was the
result
Staff too busy to interact
or respond to requests
Meals a social occasion,
view of the sea
Listening and
responding
Choices
Things to do
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Making a difference in the South
What we
found
Poor care planning
Poor maintenance
Pressure sores
and tissue damage
Lack of dignity
What we 6 warning notices
did
What
was the
result
New manager
Investment in
property
Notice of proposal
to cancel
Personalised care
planning
Health
improvements
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Making a difference in the South
Whistlebower
What we
found
Early to bed
What we 5.30am inspection
did
What
was the
result
Calmer
atmosphere
Woken early
Lack of overnight
monitoring
Compliance actions
People choice
about routines
Better information
and plans of care
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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
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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
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Questions
CQC – Helping make care better for people
www.cqc.org.uk
Questions?
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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
Law
Commission
Report
__________
May 2011
Social Care
Vision
__________
Nov 2010
Caring for
our future engagement
_________
Sept - Dec
2011
Dilnot
Commission
Report
___________
July 2011
Care and
Support
White Paper
and progress
report on
funding
__________
spring 2012
Legislation
Market shaping & personalisation –
response from engagement
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.
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
Government Objectives
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Ensure essential services continue to be
provided to users in the case of provider
failure
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Ensure essential standards of quality are met
Not:
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Options
Market Intelligence
and monitoring
Pre-failure
interventions
Type of
intervention
To support any single player in the market
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To ensure facilities stay open, regardless of
performance
Key Considerations
→ Supporting vibrant care market
→ Effectiveness and proportionality
→ Minimising burdens on business & local
government
→ Avoiding moral hazard; aligning incentives
Post-failure
interventions
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
Skills for Care
• www.skillsforcare.org.uk
• E-news
• [email protected]
East Sussex
Personalisation Conference
Robert Templeton
Social Care Institute for Excellence
About SCIE
Policy
Practitioner
knowledge
Organisational
knowledge
Research
A KNOWLEDGE
BASE
FOR
SOCIAL CARE
User
knowledge
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
Control over daily life
Food and nutrition
Dignity
Occupation
Safety
Social participation and involvement
Personal cleanliness and comfort
Social Work Practice Pilots
The Think Local Act Personal Partnership
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National and umbrella organisations
committed to personalised
community based social care
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Owned by the sector including
people who use social care and
family carers
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Starting from the outcomes and
experiences important to people
Markers of progress
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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
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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
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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
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The best method for researching any given
topic is that which will answer the research
question most effectively
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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:
Tel:
Email:
Web:
Robert Templeton
020 70247722
[email protected]
www.scie.org.uk