How the Care Inspectorate is changing
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A short presentation about how the Care Inspectorate is developing new models of scrutiny and improvement in health and social care in Scotland. Delivered to the IVO (Swedish health and social care regulator) in September 2017.
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How the Care Inspectorate is changing
- 1. A scrutiny body which supports improvement: the experience from Scotland Rami Okasha Executive Director of Strategy and Improvement @ramiokasha
- 2. Public body funded by Scottish Government 600 staff Founded in 2011 The Care Inspectorate Legal responsibility: “general duty of furthering improvement in the quality of social services”
- 3. Two separate organisations Formal name: “Social Care and Social Work Improvement Scotland”
- 6. EXCELLENT VERY GOOD GOOD ADEQUATE WEAK UNSATISFACTORY 7,500 inspections of care services 9 – 12 large local area inspections > 80% inspections show good, very good or excellent care
- 7. A new organisational vision in 2014/15 Compliance Collaboration Compliance
- 8. Compliance
- 10. New approach to inspection New national care standards Two big changes between 2014 - 2017
- 11. Every care service inspected in all 4 quality areas • Intelligence led • Better performing services inspected in 2 quality areas • Shorter inspection reports Proportionality
- 12. Where a care service identifies a weakness in self-evaluation but has a plan in place… Self-evaluation Often we would treat this as an example of poor quality Now we see it as a management strength
- 13. Focus on outcomes Inputs Activities Output Outcome
- 14. In 2014/15 80% of care good 6,000 requirements Breach of regulations Power to make a requirement for change only when outcomes for people are poor… or potentially poor
- 15. Duty of user focus Patient and user-centred perspective in supervision
- 16. • Read policies • Check procedures • Inspections start by speaking to people • Short Observational Framework for Inspectors (SOFI) More observation of people’s care
- 17. Involving people who experience care 70 inspection volunteers Join the inspector on an inspections “Experts by experience” 4 inspection volunteers with a diagnosis of dementia
- 18. A continuum of different approaches
- 19. New national care standards 23 separate standards 2,042 technical input statements Only regulated social care & private health care Used primarily for inspection First standards in 2002
- 20. One set of standards across health & social care Developed by people who use & provide care Future-proof The task in 2015
- 22. • Involved 2000 people • 25% from people who experience care Consultation on the overarching principles
- 23. Compassion Responsive care & support Wellbeing Be included Dignity and respect “Safety is what my carer says when they want me to stop doing something” Part of “wellbeing” Safety?
- 24. July 2017 www.NewCareStandards.scot One set of standards across all health and social services 5 standards - 150 statements
- 25. %I experience high quality care and support that is right for me. I am fully involved in all decisions about my care and support. I have confidence in the people who support and care for me. I have confidence in the organisation providing my care and support. I experience a high quality environment if the organisation provides the premises.
- 26. Human rights and wellbeing Outcome focused Person-led Decoupled from settings What is different?
- 27. Human rights and wellbeing What professionals must do to meet the minimum quality. The quality I should experience. 1 2001 2017
- 28. Decoupled from settings2 Delivery in a single care service. • Planning • Assessment of needs • Commissioning by local authorities • Delivery in care 2001 2017
- 29. Person-led • Staff will treat you politely at all times. • Staff call you by your preferred name or title at all times. • If you need help, your request will be dealt with as soon as possible. • I get the most out of life because people have an enabling attitude. • I experience warmth, kindness and compassion, including physical comfort when appropriate. • I experience care and support where all people are respected and valued 3 2001 2017
- 30. The outcome focus Space size 12.5 sq.m. 3.5 sq.m. for toilet 3.9 sq.m. / person communal space 4 I have enough physical space to meet my needs and wishes. 2001 2017
- 31. • Care Inspectorate registers all new care services • We will publish expectations on room sizes Guidance describes inputs we expect to see Quality is measured through the lens of a person’s experience
- 32. How is the Care Inspectorate responding to the new standards?
- 33. Is this a good care service? To what extent are people getting the right care to meet their needs and wishes? Changing the question for inspectors
- 34. What are you doing wrong? Are you doing this right? Are the outcomes good? Is the leadership good? Are key processes in place? Combined self-evaluation / inspection framework from April 2018 Focus on supporting improvement Evidence what you are doing works well.
- 35. Enablers How good is the care? What difference does it make? • Dignity and compassion • Health and wellbeing • People in control of their own lives How do we know? Leadership Staffing Setting Results Key processes care planning Involvement Commissioning Quality illustrations from the new standards
- 36. Expert health team Support inspections Expert improvement support team Support after an inspection shows the need for improvement Supporting improvement
- 38. • Emergency admissions from care homes because of a fall is 4x higher. Self Assessment ToolkitInformation Improvement programmes
- 40. London conference, April 2017 https://www.slideshare.net/RamiOkasha/if-inspection-is-the-enemy- of-improvement-someones-not-doing-it-right
- 41. The ‘Scottish model’ of scrutiny and improvement
- 42. Key learning All change is hard. Don’t rush. Not everything about the ‘old way’ is bad Communication – internal & external Invest in learning & development Trust and listen to our staff
- 44. Rami Okasha Executive Director of Strategy and Improvement @ramiokasha tack så mycket