Inspecting to scale Creating a supportive environment

1
Inspecting to scaleCreating a supportive
environment

• Carolyn Denne
• Strategy Manager
• Commission for Social Care Inspection

2
Commission for Social Care Inspection

• Single inspectorate from April 2004
• NCSC, SSI and Joint Reviews
• All social care private, charities and public
  sector
• Regulation, service inspection, performance
  assessment, vfm
• Promote improvement
• Report to Parliament on state of social care in
  England

3
Principles of public sector reform

• National Standards
• Devolution
• Flexibility
• Choice

4
Some key challenges emerging from policy

• Shifting relationship between state and
  individual
• Voice and (informed) choice
• Person-centred support and care (co-producers
  expectations aspirations choice risks)
• Inclusion and diversity (chicken soup)
• From what counts is whats measured to
  measuring what makes a difference (Outcomes)

5
Social care sector a pluralist market

• 29,000 different services registered with CSCI
• 90 residential care and 60 domiciliary care
  provided by the independent sector
• Corporate providers control under 30 of the
  market rest mainly 1 or 2 homes
• 30 people fund their own care
• Many providers small businesses
• 5 million carers 1 million more than 50 hours
  per week

6
Quality of services 5 influences

• Listening to people about experience and what
  they want
• Quality of providers how they run services
• Effectiveness of commissioning
• Operation of the market
• Effectiveness of regulation

7
What people want

• What people say they want

Opportunities
Choice
Independence
Flexibility
Safety
Consistency, competence, courtesy
8
Providers

• Improvements in year to April 2005
• Care homes met 72 of national minimum standards
  (59 in 2002/03)
• 16 of homes met fewer than half of the standards
  (34 in 2002/03)
• 22 of homes met more than 90 of standards (7
  in 2002/03)

9
Commissioning

• Despite pluralism - market not delivering range
  and variety of qualities people want
• Tool to help people achieve their potential
• Need for strategic, long-term view
• Needs of WHOLE population based on thorough
  analysis
• Working in partnership strategic commissioning
  using community well-being and leadership powers
• Better ways of listening to people and taking
  views into account

10
Operation of the Market

• Inadequate information, lack of transparency
  eroding rights as economic consumers and citizens
  - OFT study
• Absence of market development and market
  management King Fund Inquiry
• Engagement with local economic development and
  regeneration strategies
• Procurement practice infrastructure, workforce,
  sustainable commissioning contracting
• Role of the voluntary and community sector
  user-led or managed services social enterprises

11
Regulation

• Principles of good regulation
• Proportionate
• Accountable
• Consistent
• Transparent
• Targeted
• (Better Regulation Task Force, Cabinet Office,
  2000)

12
Regulation - reform

• Inspecting for Better Lives 4,000 people
  responded CSCI reforms over the last year
  within current framework
• DH Review of NMS and Regulations covering all
  adult social care 3 stages of implementation -
  2006/ 2007/2008

13
Recent changes

• New report format
• New ways of seeking views of people who use
  services and more ways for people to contact CSCI
  directly
• Clearer, simpler forms for registration
• Better risk-assessment
• More resources for inspecting poorly-performing
  services
• More unannounced inspections

14
From April 2006

• Variable frequency of inspection based on
  risk-assessment
• Annual quality assurance assessments for
  providers
• Use interactive record of evidence to monitor
  quality
• Make greater use of feedback from people who use
  services
• Annual assessment
• Detailed improvement plans for poor services
• ( Subject to announcement from DH)

15
New inspection cycle

• Record of evidence (Collect)
• Risk-assessment (Assess)
• Hypothesis (Think)
• Action (Act)

16
Benefits of reform

• Better experience and stronger voice for people
  who use services
• Clearer reports - people better informed and able
  to plan their own care and support
• Assessment of service that focuses on outcomes
• Detailed analysis of service quality and market
  trends to inform commissioning and market
  development and drive improvement
• Fewer inspections for good providers
• Culture of improvement not compliance
• Encouragement for innovation

17
Smaller scale services current framework

• Working with people using services and others to
  achieve consistency within current framework
• Volunteer sitting services
• Adult Placement schemes
• Direct payment support schemes
• Proposing to convene small group to consider
  future implications (Inspecting commissioning and
  regulation)

18
Some final thoughts

• If you always do what youve always done youll
  always get what you always got
• The Chinese symbol for crisis includes a symbol
  which means opportunity