A key priority of the Isle of Wight’s ‘Care Close to Home’ Strategy is to deliver significant improvements to the quality of adult social care registered services. This forms part of our adult social care markets and commissioning resource.
The council commissioned a meta-analysis of the all Care Quality Commission (CQC) inspections of care services on the island and used the results to work with a small number of good and outstanding providers in co-creating a free training programme for all Registered Managers (RMs) on the island. An “Outstanding” local provider has been commissioned by the council to deliver the programme, focusing first on RMs from services graded ‘Inadequate’ and ’Requires Improvement’.
In addition, a company director from the independent sector has been seconded into the council/Clinical Commissioning Group (CCG) integrated commissioning team and has led on projects including outcomes based commissioning and development of the council’s Market Position Statement.
Not only have relationships between providers and the council and CCG improved significantly, but the rate of permanent admissions into care homes has reduced by over 60% and delayed transfers from care attributable to ASC figures have improved by over 55%.
The challenge
In late 2016, the Isle of Wight council recognised that the overall quality of care across the adult social care independent sector was significantly below national and regional averages for residential, nursing and domiciliary care. In addition, the numbers of people permanently entering residential and nursing care was significantly above national and regional averages.
By dint of its island status, people living on the Isle of Wight are less likely to be able to access care from other local authority areas than can occur on the mainland, thereby rendering the availability of good quality local care even more important. Commissioners recognised there was an issue and there was a great deal that could be done to improve the situation.
There are 83 care homes and 26 home care providers operating on the Isle of Wight.
The solution
A local care board was set up, including senior representation from the local authority, CCG and integrated NHS trust. This has recently been expanded to include voluntary sector and GP federation representation.
Early on, the local care board integrated the quality and commissioning teams across health and the local authority - and a completely new quality assurance framework and associated processes were introduced. This includes, for instance, a simple “professionals feedback form” that is completed by any professional visiting a care home for any reason. The form asks the professional (above and beyond any specific visit to an individual they are undertaking) about: the appearance of residents; the quality of the physical environment; the observed quality of interaction between staff and residents; and the apparent level of staffing available. The professional is asked to share their observations with a senior member of care staff before they leave the home and to submit the form to the integrated commissioning unit. The quality assurance framework also includes announced and unannounced audits and user and carer feedback and the QA team is accompanied by experts by experience. This enables the quality and commissioning teams to give targeted support as soon as it's needed.
A new post within the integrated commissioning team was funded by the Improved Better Care Fund (iBCF). The post holder is seconded from a local care provider. The role:
- delivers valuable expertise into commissioning processes
- helps break down myths between the provider, health and the local authority.
In particular, the post holder has helped council and CCG commissioners to understand the commercial realities providers face and helped providers understand the severe financial pressures being experienced by councils and the NHS.
Quality is now monitored and reported based on a range of sources including:
- health and care staff feedback
- hard data
- the views of people accessing support.
The local authority has funded Healthwatch to recruit a team of experts by experience to visit services and ensure that quality is defined by the people accessing local support. The local care board has also invested in supporting the local care workforce.
The local authority has worked closely with a local ‘Outstanding’ provider to create a leadership and development programme focused on improving quality for registered managers.
The provider and commissioners co-designed a 10 day programme for registered managers which includes 5 classroom days that cover the following topics:
- Developing and maintaining a positive and open culture
- HR: training, induction and supervision
- Leadership
- Communication listening and learning
- Developing a Quality Improvement Program
- System Resilience (planning for the unexpected)
- Developing and Supporting Personal Resilience
- Bereavement and Looking after Yourself, staff and those in your care
- Major Incident Planning and Business Continuity
- Person Centered Care Promoting and Maintaining Independence
- Collating Evidence for good practice/CQC inspection
- Teamwork and Motivation
- Involving Service Users and Using Feedback Effectively
- Preparing an action plan.
Following the classroom days, the training provider arranges visits to the care homes to provide bespoke support to the RM in order to embed the learning.
The leadership training has already been completed by 20 Registered Managers with almost universal positive feedback about its impact on their leadership and practice. Very positively, of those services inspected by CQC subsequent to the RM completing the training programme, nearly 63% have seen an improvement in their inspection rating.
A Registered Manager who undertook the leadership and development programmer stated:
"I feel inspired and motivated…this training has given me the tools and confidence to tackle some of my harder challenges…knowing there are people out there to help me.”
Additional measures to improve the local quality of care have been: independently led safeguarding threshold workshops with providers; specialist dementia training delivered by the local Dementia Awareness Partnership; and a ‘train the trainer’ style offer for all care providers across the Island as well as specialist behaviour support training.
The impact
Achievements since 1 April 2017 include:
- permanent admissions into residential care reduced by over 60 per cent
- delayed transfers of care across the system reduced by over 55 per cent
- the integrated commissioning team worked with local care providers to co-produce a market position statement, communicating a clear, shared, vision for the future.
How is the new approach being sustained?
The new post has been funded through iBCF for another 12 months, with the training programme funded for another 24 on a decreasing basis. The training provider - Mountbatten, the local hospice - is seeking funding from other sources, including the Integrated Care System (previously STP) and Health Education England.
The hope is that new practices will be embedded into care providers systems after training and that this will continue to deliver sustained improvements in quality and outcomes for local people using these services.
Next steps and lessons learned
The Isle of Wight's next steps for collaboration include an increased focus on strategic links to the vibrant community and voluntary sector, learning from the engagement approach they have taken with care providers.
The Isle of Wight is also working with the Institute of Public Care on moving to an outcomes based commissioning framework across domiciliary care (i.e. away from time and task), for its next reprocurement in 2019. All local providers have been offered the opportunity to participate in the test and learn phase and expressions of interest have been from 8 providers. The expressions of interest were reviewed and the participating providers have been selected based on their willingness and ability to engage as well as their commitment and capability to provide quality care, as shown by their CQC rating being good or above. Five providers were engaged in the pilot process.
One of the lessons learnt was that the independent provider post holder recognised the value of investing as much face to face time visiting providers as possible in the early stages of setting up this type of project. This has proved to be a good investment in improving relationships.
Another positive focus was the relentless emphasis on data, from the initial in depth meta-analysis of the issues raised in CQC reports to the monitoring and reporting on engagement with the independent and impact of the training program. Where homes were inadequate or require improvement leadership and safeguarding were often the key areas for improvement.
Contact
Laura Gaudion, Strategic Commissioning Manager, ASC, Isle of Wight Council, Enterprise House, Monks Brook. Newport. Isle of Wight PO30 5WB
Phone: (01983) 821000
Email: [email protected] web: www.iwight.com
Links to relevant documents:
Quality matters: catalyst for collaboration