Agenda item

Jess McGregor, Service Director Strategy and Commissioning, and Ray Murphy, Joint Commissioning Manager, Older Adults, were present for discussion of this item.

Duncan Patterson, Care Quality Commission, was also present, and made a presentation to the Committee, copy interleaved.

During consideration of the presentation the following main points were made –

·         The CQC is the independent regulator of health and social care in England. It ensures that health and social care services provide people with safe, effective, compassionate, high quality care, and encourage care services to improve

·         State of Care 2018/19 – People’s experience of care is determined by whether they can access good care when needed. There is a risk of being pushed into inappropriate care settings, and increased demand and challenges around access, and workforce risk, creating a ‘perfect storm’

·         Adult social care specific findings – 80% rated good, 4% outstanding, 15% requires improvement, 1% inadequate. There are concerns about capacity set amongst growing unmet need. Staffing is under pressure with high turnover, high vacancy rates, and a lack of people with the right skills. Continued uncertainty about long-term funding

·         State of care recommendations 2018/19- action needed from Parliament, Government, commissioners, providers and communities for more and better services in the community, innovation in technology, workforce, and models of care, system-wide action on workforce planning, and long-term sustainable funding for adult social care

·         Overview of local systems reviews – in 2017 CQC was commissioned by Government to carry out a programme of 20 local system reviews. CQC has now been asked to continue the programme - 3 new reviews, and 3 follow up reviews published Spring 2019

·         The Beyond Barriers report highlights organisations that are focused on individual drivers for success, rather than thinking as a system - system incentives are needed. For people to receive a high-quality service in a real system, there is a need for strong vision, governance, culture and leadership of organisations. There is also a need to work together to focus on the same metrics for success

·         Key themes for driving improvement – positive reaction to CQC report, leadership, cultural change, person centred care, staffing, working with partners, and building a community

·         Need for consistent, passionate workforce – great consistency of staffing makes a massive difference, there should be limited or structured use of agency staff. Staff need to be empowered to speak out, and suggest changes, and staff should be taken on an ‘improvement journey’. There should be regular supervision and training, robust recruitment and induction, and management should provide bespoke training

·         Outstanding characteristics – People are at the centre, staff who want to offer   improved life, not just a service. Good leadership extends beyond the manager, and there is a need to ensure those values are shared to inspire staff. 75% have a registered manager in post. There should be an open culture, and strong links to the local community, with a can-do attitude, dedicated staff, and be creative and innovative

·         Common success factors – Committed leaders, putting principles into action, culture of staff equality, staff as improvement partners, people who use services being at the centre, utilisation of external help, and continuous learning

·         Supporting providers – Beyond Barriers, quality matters, patch care model, skills for care, Outstanding society, Healthwatch, ADASS

·         Effective staffing – new website resource, case studies where health and social care providers make effective use of their staff, different methods, not just numbers and ratios, how to make best use of skills and disciplines/work across the system, efficiency, teamwork, development. Taking flexible approaches to staffing can have a positive impact for people using services

·         Medicines in health and adult social care – six common areas of risk – prescribing, monitoring and reviewing, staff competence and workforce capacity, supply, storage and disposal, reporting learning from incidents, administration, transfer of care

·         CQC- encouraged improvement by talking about best practice through an independent voice, publish findings, through inspection reports, publications, blogs, learning from incidents, lots of speaking engagements, listening

·         Innovation and technology at CQC – encourage improvement, innovation and sustainability – in next year’s business plan CQC prioritising the development of a robust, and consistent approach, to regulating innovative, and tech-enabled care provision, and complex cross-sector providers

·         Take home messages on tech – as technology and provision evolves, CQC will work alongside people who use, and deliver services, to encourage improvement, stay abreast of technological innovation, refine statutory approach, and welcome discussions with people who use services, providers in the private sector, and entrepreneurs, as to how technology can improve care, while safety and quality of care is ensured

·         In response to an enquiry, as to the merging of the 5 CCG’s in North Central London, and how this would affect service delivery, it was stated that it could be that improvements could be made from working together, however there is the need to consider how much funding will be made available to develop the service to meet its needs

·         Reference was made to the initiatives to recruit and retain care workers, and that this is an important role, and carers needed to be properly rewarded. Carers do have induction and are trained, but there is not a standard qualification for carers. However, there are regulations that need to be adhered to, and there is a need to ensure providers respect protected characteristics, in terms of provision

·         In response to a question, it was stated that the CQC carry out a survey of domiciliary services, and there is a guide for sampling of services. There is usually 10% of the service that is sampled, and specialist staff are often employed to assist in these

·         A Member enquired if residents could complain to the CQC if they had a complaint, as a result of poor provision at a care establishment. It was stated that residents could contact the CQC if there were problems, and if the concerns were relevant they would be followed up

·         It was stated that the CQC were not aware of any domiciliary services being carried out in house, apart from reablement services

The Chair thanked Duncan Patterson, Ray Murphy and Jess McGregor for attending