Welcome and Introduction

1. Welcome and Introduction Keith Hinkley Director of Adult Social Care East Sussex County Council

2. 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

3. Local Social Care Market • 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 self-funding population

4. Transforming Adult Social Care • Facing the challenges • Financial climate • Ageing population • Rising demand for services • Personalisation • Collaboration and cooperation • Dialogue and support

5. Transforming to Personalisation

6. Organisational change • 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)

7. Supporting Providers • Communication, Communication, Communication • Market Position Statement – published today • Social Care Training Prospectus

8. Today • National Policy Perspective – Department of Health • Care Quality Commission • Social Care Institute for Excellence • Skills for Care • Workshops • New developments and workforce redesign • Safeguarding Vulnerable Adults • Dignity and diversity • Dementia and End of Life Care

9. Making a difference for people Ian Biggs Deputy Director of Operations (South) 1 May 2012

10. 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

11. The regulation system Single system of registration 1 Single set of standards – the essential standards of quality and safety 2 Strong enforcement powers 3 4 Adult social care NHS Regulation Independent health care Dental services Innovative use of information Primary care 5 Reduced overall cost

12. 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 • If not, we take action – they must put problems right or face enforcement action • We publish what we find as quickly as possible • 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 • What CQC does not do • Wedo not make assessments of commissioning – although we can comment on shortcomings via themed reviews and investigations • We do not assess quality above essential standards • We only promote improvement by focusing on non- compliance • Inspectors are encouraged to describe what they see, comment on good practice and reference it

13. Palette of Regulation Inspection Analysis Voices • Themed inspections • Scheduled inspections • Responsive inspections • Investigations • Themed reviews • Quality Risk Profiles • Other data sources • Whistleblowing • Safeguarding • Website feedback • Telephone or written feedback • Third party feedback

14. Scale of CQC regulated care Independent healthcare 2,500 locations Independent ambulances 300 locations Primary medical services 9,000 locations Primary dental care 10,000 locations NHS Trusts 2,500 locations Adult social care 24,500 locations Dental appointments 36.4 million Combined outpatients and inpatients 77.4 million People using adult social care services 1.75 million

15. 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 Implement and review Ongoing Phase 5 Optimising the model April 2014 onwards…

16. Unannounced We do not notify providers before we carry out inspections Timely At least once a year or once every two years depending on the provider Flexible We can use different types of inspection to respondto concerns Focused Inspections will focus on outcomes that are important to people using services New approach to inspections Principles of inspection

17. 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

18. 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 18

19. 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

20. Making a difference in the South Beautiful house and garden with sea view Bored and lonely What we found What we did What was the result Not clean Staff too busy to interact or respond to requests No choices 4 warning notices Meals a social occasion, view of the sea Listening and responding Things to do Choices 20

21. Making a difference in the South What we found What we did What was the result Poor care planning Poor maintenance Pressure sores and tissue damage Lack of dignity 6 warning notices Notice of proposal to cancel Personalised care planning New manager Health improvements Investment in property 21

22. Making a difference in the South Woken early What we found What we did What was the result Whistlebower Lack of overnight monitoring Early to bed 5.30am inspection Compliance actions People choice about routines Calmer atmosphere Better information and plans of care 22

23. 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 23

24. 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 24

25. Questions • CQC – Helping make care better for people • www.cqc.org.uk • Questions? 25

26. Reform of Adult Social Care, and the social care market: next steps William Vineall, Department of Health Personalisation Conference, Uckfield, 1st May 2012

27. The reform timeframe Law Commission Report __________ May 2011 Social Care Vision __________ Nov 2010 Caring for our future - engagement _________ Sept - Dec 2011 Care and Support White Paper and progress report on funding __________ spring 2012 Legislation Dilnot Commission Report ___________ July 2011

28. 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. Market shaping & personalisation – response from engagement

29. 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

30. 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.

31. 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?

32. 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?

33. 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

34. Options for market oversight & continuity Government Objectives Options Key Considerations Strength of intervention Light touch Regulation • Ensure essential services continue to be provided to users in the case of provider failure • Ensure essential standards of quality are met Not: • To support any single player in the market • To ensure facilities stay open, regardless of performance • Supporting vibrant care market • Effectiveness and proportionality • Minimising burdens on business & local government • Avoiding moral hazard; aligning incentives

35. Transforming Your Services Through People Karen Stevens – Skills for Care

36. Covering ……. • Why this and why now • Principles of Workforce Redesign • Some examples from Workforce • Innovations Programme

37. 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

39. Principles of workforce redesign to support service redesign Principle one –Take a whole systems view of organisational change

40. Principles of workforce redesign to support service redesign Principle two – recognise how organisations, people and partnerships respond differently to change

41. 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

42. Principles of workforce redesign to support service redesign Principle five – Be aware of the way adults learn

43. Principles of Workforce redesign to support service redesign

44. Principles of workforce redesign to support service redesign Principle Six – change minds, change systems

45. 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

46. Skills for Care • www.skillsforcare.org.uk • E-news • Karen.stevens@skillsforcare.org.uk

47. East SussexPersonalisation Conference Robert Templeton Social Care Institute for Excellence

48. About SCIE Policy Practitioner knowledge Research A KNOWLEDGE BASE FOR SOCIAL CARE Organisational knowledge User knowledge

49. We think we will get this...

50. ...and we get this!