The contribution that good leadership makes Kate Terroni

The contribution that good leadership makes Kate Terroni, Chief Inspector of Adult Social Care England 13 November 2019 @Kate. Terroni 1

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 2

Six themes and five questions for quality WELLBEING AND INDEPENDENCE Living the life I want, keeping safe and well INFORMATION AND ADVICE Having the information I need, when I need it ACTIVE AND SUPPORTIVE COMMUNITIES Keeping family, friends and connections FLEXIBLE AND INTEGRATED CARE AND SUPPORT My support, my way WHEN THINGS NEED TO CHANGE Staying in control WORKFORCE The people who support me Is it caring? Is it safe? Is it responsive? Is it effective? Is it wellled? 3

New Chief Inspector: my priorities Voice of lived experience Joined up care Innovation 4

State of Care 2019 Download the report by holding your phone camera to this QR code! 5

Unique oversight of care • • Is it safe? Is it effective? Is it caring? Is it responsive? • Is it well-led? 22, 949 adult social care services 146 NHS acute hospital trusts 234 independent mental health locations 10 NHS ambulance trusts 71 NHS or independent community health providers or locations 55 NHS mental health trusts 200 hospices 1, 033 dental practices 244 independent acute hospitals 6, 850 primary medical services #State. Of. Care 6

State of Care 2018/19: A perfect storm Access and workforce issues Specialist nurse shortage 10% of wards for people with learning disabilities and/or autism rated inadequate, up from 1% in 2018 8% fewer learning disability nurses than in 2015 #State. Of. Care 8% of acute wards for adults and psychiatric intensive care units rated inadequate, up from 2% in 2018 7

Adult social care specific findings Overall 80% rated good 4% outstanding 15% requires improvement • Concerns about capacity set against 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 1% inadequate #State. Of. Care 8

Leadership and culture • Involving people who use services and their families • Shaping the culture of the organisation • Staff feeling valued, given a voice and empowered to ‘steer the ship’ • Constant focus on improvement “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 9

Driving improvement across health and social care: themes • Report series features providers that have increased their quality rating considerably • Similar themes for all reports • What themes stand out? • Leadership • Culture • Person centred care • Staffing & support • Outward looking • Happy staff means better care 10

Leadership: workforce challenges A study commissioned by Age UK noted that in some areas of the country, the lack of specialist workers is severely limiting the care that providers can offer Providers’ profits have decreased by one percentage point from September 2016 to September 2018, driven mainly by increases in staff costs of 9. 6%, which in turn are driven by a 28% increase in costs of using agency staff Data from Skills for Care shows that the vacancy rate for registered nurses working in social care more than doubled from 2012/13 to 2018/19 (4. 1% to 9. 9%) Source: State of Care 2019 11

Beyond individual organisations • Beyond Barriers highlights organisations are focused on individual drivers for success, rather than thinking as a system; system incentives are needed • For people to receive highquality care there is a need for; strong vision, governance, culture and leadership of organisations and place 12

Beyond Barriers: Barriers • People experience the best care when people and organisations work together to overcome a fragmented system • Dedicated staff regularly going beyond the call of duty • There were examples of good practice in every local system we looked at • Where local leaders share a clear vision, it provides a shared purpose for people and organisations across the local health and social care system • But in a fragmented health and social care system there are barriers to collaboration at a local and national level 13

Beyond Barriers: Enablers Funding: Health and social care organisations are limited in how far they can pool resources and use their budgets flexibly across prevention, social care and healthcare Managing performance: Organisations are held to account for their own performance, not the performance of the system as a whole Workforce: Services do not always have the right staff, in the right place, at the right time – the health workforce and social care workforce are seen as separate entities Oversight: Regulation usually looks at quality of care in individual providers, rather than across a system as a whole 14

How can you improve and collaborate? • What choices do you make each day that help, or hinder joint working? • How can you and providers in your area collaborate? • Can you form alliances across your local system? 15

Medicines in health and adult social care report • Recommendations for adult social care providers include: • Adoption of NICE best practice for medicines guidance • Consider having an attached / named pharmacist • Ongoing staff training for handling medicine • Clear leadership for the handling medicines • Published June 2019 16

New guidance on relationships and sexuality • Supporting people to form and maintain relationships while helping them to understand risks • Also diversity, protecting people from harm, physical disabilities and the importance of offering an environment welcoming to LGBT+ people • Published February 2019 17

Published and forthcoming Soon: • Supporting people’s sexuality and sexual safety in adult social care 18 18

Thank you – any questions? Meet us on our stand meet an inspector, today! www. cqc. org. uk enquiries@cqc. org. uk @Care. Quality. Comm @Kate. Terroni Kate Terroni Chief Inspector of Adult Social Care 19