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Andrea Sutcliffe, Chief Inspector of Adult Social Care

National Children and Adult Services Conference

4 November 2016

Adult

social care:

Quality

Matters

Speech notes for the below entitled

presentation

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This is the fourth time I have been asked to speak at the NCAS conference

since I became Chief Inspector of Adult Social Care in 2013. So, thank you

once again for giving me the opportunity. It is, as ever, a real pleasure to be

here.

But I’ve got a problem. After three previous speeches, what on earth can I say

that you have not heard before?

Introduction - notes for slide 1

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You know what the Care Quality Commission is here for – we make sure health

and social care services provide people with safe, effective, compassionate,

high-quality care and we encourage care services to improve.

Purpose - notes for slide 2

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You know how we do it – registering services that meet fundamental standards;

monitoring, inspecting and rating them; taking enforcement action when

necessary; and using our independent voice to influence change and

encourage improvement.

Operating model - notes for slide 3

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You know about the Mum Test – that vital question I want our inspectors to ask.

Is this a service I would be happy for anyone I love and care for to use? And

you know what we ask to make that judgement – is the service safe, effective,

caring, responsive to people’s needs and is it well led?

You’ve met my Mum – well seen her picture at least. I have used it so often I

bet some of you can even tell me when it was taken. For those not in the know

– it was my wedding day and she’s looking happy because it too me nearly 17

years to persuade David to marry me and she was pretty chuffed when I pulled

it off.

What more could there be?

Mum test - notes for slide 4

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Well fortunately CQC and NCAS have been an exemplar of collaboration and

coordinated working and have made sure this conference is happening after

the publication of our State of Care report in October.

The State of Care is our annual report to Parliament and this year’s was a

pretty important one for CQC and I think for the adult social care sector in

particular.

It is our second report since we started our new approach of monitoring,

inspecting and rating services in 2014 and is drawn from the most

comprehensive evidence base about the quality of care we have ever

assembled. I think it is a compelling, fascinating read. I know I am biased but I

hope you will find out for yourselves if you have not already done so. From the

many mentions the report has had this week, it certainly sounds like a lot of

you already have.

What I would like to do today is to share the good news, the worrying trends

and then focus on the most important question – what can we all do about it?

State of Care - notes for slide 5

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Our latest ratings for adult social care show over 70% of services are providing

good or outstanding care – a positive increase on last year – and three

quarters of those services originally rated as inadequate were better when we

re-inspected. That is positive news and I am pleased the vast majority of

people, their families and carers, are experiencing services that do indeed

meet the Mum Test.

There are particular services that consistently perform well – 84% of

community social care locations, including 92% for Shared Lives services,

were rated as Good or Outstanding overall. So now you know the answer to

the badges Shared Lives Plus has been handing out this week – what does

92% look like? It looks like a Good or Outstanding Shared Lives service!

The good news - notes for slide 6

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A striking finding is that 90% of services are rated as Good and 2% as

Outstanding when we ask whether the service is Caring. Take a look at these

quotes from some of our recent reports – when we get it right in social care we

can really make a difference to people’s lives.

The strong performance in this area has been a feature of our new approach

and is due to the amazing dedication and commitment of the many staff

working in adult social care.

They are our unsung heroes but I am sure you agree their contribution

deserves to be recognised, appreciated and valued.

Great care - notes for slide 7

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So today, I would like to pay my own tribute and say thank you.

Thank you - notes for slide 8

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But despite the good and outstanding services we see, State of Care also

highlights the stark reality that great care is not everybody’s experience, with

over a quarter of adult social care services not consistently providing safe, high

quality and compassionate care.

Ratings for safety and leadership remain our greatest concern. 3% of services

have been rated as Inadequate in both these areas with a further 26%

requiring improvement for leadership and 29% for safety.

We are seeing too many services struggle to improve.

Nearly a quarter of inadequate services had not improved when they were re-

inspected – while others closed before we got back to them.

Half of services rated Requires Improvement did not improve on re-inspection

and 8% deteriorated so much we rated them as Inadequate.

The worrying news - notes for slide 9

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Let’s just remember these services provide care and support for people either

in their own homes or they are a 24 hour seven day a week experience for

people living in a residential setting. Poor care like this can have a devastating

impact on the lives of people who depend upon them – it is not acceptable and

in 2016 we cannot and should not tolerate it.

None of us would want services like this for the people we love.

Poor care - notes for slide 10

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An interesting analysis we carried out this year was to look at the comparison

of ratings for services provided for people with a learning disability and those

for older people.

As you can see, services for older people fare worse than those for people with

a learning disability, another worrying trend.

There is so much more that I could draw out from our analysis but I hope I

have given you enough of a flavour to inspire you to take a look at the whole

document.

Older people’s services - notes for slide 11

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I said this year’s State of Care was a pretty important one for our sector and I

think the headlines proved that. Unusually, it was adult social care that

dominated the newspaper print and the airwaves. That strong evidence base I

mentioned meant we could give our clearest warning yet about our concerns

for the sustainability of quality in adult social care. These themes have

dominated our conversation this week.

After a long internal debate about what was the right thing to say we declared

that we felt adult social care was approaching a tipping point. It is eye-catching

language and we needed to be on sure ground to say something like that. So

why did we?

Headline news - notes for slide 12

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First, let’s consider the context of an extremely challenging environment for

health and social care.

People are living longer with individual needs for people of all ages becoming

more complex leading to a greater demand for adult social care. If adult social

care isn't there or isn't good enough, it has a direct impact on people’s lives

and their well-being and the pressure shifts to other parts of the health and

care system.

And we are undoubtedly seeing problems in the health service – for example,

increases in A&E attendances, emergency admissions and delayed

discharges; while two thirds of NHS providers recorded a deficit last year.

Though, I should say this is not just about social care causing all the problems

– we have GP vacancies and reductions in district nursing too.

Challenging environment - notes for slide 13

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But why approaching a tipping point now? Our view is based on the evidence

from our inspections, CQC’s market oversight function, and a variety of

external data.

In 2015, Age UK estimated that more than a million older people in England

were living with unmet social care needs; a rise from 800,000 in 2010. This

evidence echoes analysis from ADASS itself, The King’s Fund, the Nuffield

Trust and so many other commentators.

The number of older people receiving local authority-funded social care fell

26% from more than 1.1 million in 2009 to around 850,000 in 2013/14. And

81% of local authorities have reduced their real-term spending on social care

for older people over the last five years.

Tipping point? - notes for slide 14

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A word of caution here – so much of our policy planning for social care in the

future seems to rely upon a loving family being available, capable and willing to

provide care. But with one in five people over 50, including me, ageing without

children, that may not be the case and strong social care provision at home

and in residential care will be an ongoing necessity.

CQC data shows that a five-year period of steady increase in the number of

nursing home beds – going from 205,000 beds in 2009 to 224,000 beds in

March 2015 – has now stalled, with numbers remaining static since that time.

We have seen examples of providers starting to hand back contracts that they

think they are undeliverable; and I know local authorities are warning of more

to come.

And we all know about the continuing recruitment and retention challenges

across the sector, but especially in nursing.

Tipping point? - notes continued for slide 14

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In many ways the system as a whole is failing the Mum Test - with too many

people facing a situation we would not want anyone we love to experience.

One of the clearest ways we can see that is the analysis of reasons why

people’s transfer of care is delayed from hospitals to the place that is best for

them. This graph shows the dominant trend in the last four years is for delays

to be increasingly caused awaiting a package of care in someone’s own home,

with placements or availability of nursing and residential homes also rising.

The situation in home care is particularly worrying. The late, great Harold

Bodmer whose tragic absence at this conference has been so keenly felt, spoke

for many of us in his Presidential address at the ADASS Spring Seminar when

he said:

“Sustainability of home care is certainly what keeps me awake at night.”

These figures give one indication why. Harold urged us to “up the level of

debate on this and increase the volume” and cautioned against the focus on

“time and task”. He was right then and he would have been right now if he had

been able to say that again.

System failing the Mum test - notes for slide 15

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I hope you will agree with me that Ray James did a fantastic job on Wednesday

speaking on Harold’s behalf. You did him proud Ray.

So before I thoroughly depress you with further facts and figures, we can safely

say yes, it is encouraging that despite all these challenges, there are still so

many services providing good and outstanding care but our analysis of the

pressures and the fragility of the adult social care sector does indeed give

cause for concern for the future.

System failing Mum test - notes continued for slide 15

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As I said earlier, CQC is here to encourage improvement and we will work hard

to try and move the curve on this graph to the right. But I fear that nearly

everything else is pushing the curve to the left. Can we be confident that the

good quality care we see now can be sustained and the improvements

necessary delivered? Certainly, I am not as confident as I would like to be or

indeed need to be.

I can assure you that under these circumstances, CQC will not compromise on

our assessment of quality – we owe it to the people using services, their

families and carers to stay true to our purpose.

That’s why this week we have published information for the public and providers

that reinforces the rights of people living in care homes to have families and

friends to visit; and they and their visitors should not be penalised when they

raise concerns. We will not hesitate to use our powers to enforce these

standards if providers fail to respond appropriately when concerns are raised.

Encouraging improvement - notes for slide 16

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The message from State of Care is clear. Unless the system finds a better way

of working together then we are likely to see more poor care, less improvement

– and a damaging impact on people who use services if providers are tempted

to cut corners when it comes to quality.

This is not just about money – more resources are important but what also

matters is what we do with those resources – another theme of discussion at

this conference. That’s why we need a collective effort for quality.

Currently there is not a coherent and commonly agreed quality strategy for adult

social care. This undermines our collective efforts to make improvements and is

a cause for concern for everyone involved.

A quality strategy that listens to and acts upon the voice of people using

services, their families and carers and galvanises the sector as a whole to make

improvements strategically and practically, would go a long way to making high-

quality care a reality for everyone all the time.

Collective effort for quality - notes for slide 17

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This was something the previous Care Minister Alistair Burt recognised and in

early summer, he challenged the sector to listen to the uncomfortable voices

raising concerns and consider what we could all do to make a difference.

The purpose of a strategy would be to articulate what Adult Social Care can do.

It will be important to complement the quality strategy for the NHS led by the

National Quality Board. People’s experience of care and support is not isolated

within silos but integrated across many different health and social care services.

Our aim to achieve person-centred co-ordinated care needs to recognise and

respond to this reality.

A quality strategy for adult social care needs to speak to the concerns of the

public, people who use services, their carers and families; engage with staff,

providers and commissioners so they can take action; and be supported by the

regulator and national bodies to enable implementation to happen. It should

have influence nationally and be implemented at a local level.

We need to use this strategy for action not reflection.

A shared view of quality - notes for slide 18

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This is work in progress and much more needs to be done to reach agreement

about what we can do and how we can do it.

CQC needs to play its role by working across the national system of health and

social care and using our independent voice to provide leadership & support.

In line with our strategy published earlier this year we will encourage

improvement, innovation and sustainability in care and promote a single shared

view of quality to reduce duplication.

Over the next year we will build on our first round of comprehensive inspections

to learn from what’s worked, align our assessment frameworks across health

and social care and improve our ways of working.

Strategic aims like these are important to guide us but people want to see real

action and real progress so we will also collaborate on practical initiatives to

improve people’s experiences.

CQC contribution - notes for slide 19

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But CQC cannot do this alone. In fact it would be quite wrong of me or anyone

else to think that regulation by itself will improve quality in social care.

The analysis in State of Care that I have shared today sets the challenge – I am

committed to playing my part, improving what CQC does – what will you do?

What will you do? - notes for slide 20

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We all have a responsibility to make social care the priority it deserves to be.

My Mum, your loved one, the people who depend upon good quality social care

now and into the future, need us all to take that responsibility seriously.

Why? - notes for slide 21

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Thank you

www.cqc.org.uk

enquiries@cqc.org.uk

@CareQualityComm

Andrea Sutcliffe

Chief Inspector of Adult Social Care

@CrouchEndTiger7

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