The Regulation and Quality
Improvement Authority
Glenn Houston
RQIA Chief Executive
December 2015
The Role of RQIA
Legislation
RQIA Strategy Map: 2015-18
RQIA Stakeholder Outcomes
Transforming Your Care
“The policy aim for some time has been to shift care
from institutional settings to home and community
settings.”
“Ultimately, older people want to stay at home, living
independently for as long as possible, and the
current model of care does not always provide the
support needed to do so.”
“Following from the key principle that home
should be the hub of care, the Review
recommends that steps are taken to support
greater provision of services for older people at
home and in the community.”
Domiciliary Care Agencies
Trust Area
‘Conventional’
‘Supported Living’ Total
BHSCT
27
34
61
NHSCT
21
52
73
SEHSCT
30
35
65
SHSCT
23
33
56
WHSCT
18
34
52
188
307
Total: 119
Domiciliary vs Residential Care
Number of residential
care home places
Estimated weekly
domiciliary care hours
2011
2015
2011
2015
224,473
250,798
4773
4210
Source: RQIA
Source: DHSSPS
Number of registered domiciliary care agencies and residential care homes
350
300
250
200
Number of residential care homes
Number of Domiciliary Care Agencies
150
100
50
0
2011
2012
2013
2014
2015
2015-16 Domiciliary Care Inspection
Themes
Conventional Domiciliary Care
Theme 1 –
The views of service users and their carers / representatives shape the
quality of services provided by the agency
Theme 2 –
Management systems and arrangements are in place that support and
promote the quality of care services.
Supported Living Domiciliary Care
Theme 1 – Staffing arrangements
Suitable staff are supplied to meet the assessed needs of service users
Theme 2 – Service User Involvement
Service users are involved in the care they receive
Domiciliary Care – Service User Engagement
• In 2014-15 RQIA conducted over 600 interviews of service users
or their representatives
• Overall, there was a high level of satisfaction from service users
and their representatives
A number of positive comments were received, including:
However a number of issues were identified, including:
Key Issues Going Forward
•
•
•
•
•
National Minimum / Living Wage
Commissioning Arrangements
Market stability
Workforce retention / career structure
Regulation and Quality Improvement
Contact RQIA
The Regulation and Quality
Improvement Authority
9th Floor Riverside Tower
5 Lanyon Place
Belfast
BT1 3BT
Web:
www.rqia.org.uk
@RQIANews
Regional Review of Domiciliary Care
A Managed Change
An Agenda for Creating a Sustainable Basis
for Domiciliary Care in Northern Ireland
Rationale
• Strategic Importance
• Operational Challenges
• Risk Management
• Impact of Procurement
Terms of Reference
• Identify a more coordinated regional model for the
development and procurement of the service
• Compare Trust arrangements for delivery of
domiciliary care to identify best practice
• Examine service interfaces with domiciliary care
• Consult with stakeholders about their experience
of domiciliary care
• Undertake an analysis of the market
• Improve information relating to domiciliary care
Analysis
• Information - Activity/Finance data must improve
• Market - Needs more detailed analysis and
monitoring to manage risk effectively
• Stakeholders - Focus on funding and workforce
• Interfaces Domiciliary, Reablement, Self Directed
Support development needs financial and strategic
co-ordination to achieve service change
• Trust arrangements - Scope for standardisation
• Regional Model - Requires further research
1. Focus and Structure
Structure - A ‘Task Force/Project’ approach to
Domiciliary/Community Care development
Community Care Project Group/Task Force
Residential Care Domiciliary Care Nursing Care
2. Priority Tasks
• Service Model - Review impact of GB based outcomes based
models to inform service development
• Information - Improve domiciliary care information - activity
and finance
• Produce an Electronic Care Monitoring System Business Case
• Finance - Coordinate regional domiciliary funding to meet
demographic and cost pressures and shape strategic change
• Assess impact of the Living Wage and review comparative
hourly costs of care for statutory and independent sectors
• Contingency – Require Trust review of contingency planning
arrangements
3. Joint Working
• Procurement – Work with Business Services
Organisation (BSO) in coordinating and
managing tendering processes to move to a
regional approach
• Policy - Clarify Departmental view on charging
for services and update practice Circular in
line with recent NICE guidance
4. Participate/Influence
• Workforce – Contribute to Departmental
Workforce Planning Project
• Liaison with NISCC to inform progress
regarding workforce development
Domiciliary Care in
Northern Ireland
A Report of the Commissioner's Summit
Unknowns
• Outcome of WHSCT Tendering
• Registration of the Workforce
• ‘Living Wage’
• Impact of HSC structural change
• Impact of other market changes
Making The Case for Domiciliary Care
The importance of sustained lobbying
Expect to be challenged
Objectivity not anecdote
Status quo is not an option
The foundation of community based care
Person-centred domiciliary
care services – present
experience, future challenges
Maeve Hully
3rd December 2015
27
Patient and Client Council
The Patient and Client Council is your voice on
health and social care issues.
We are here to:
 Listen and act on people’s views
 Encourage people to get involved
 Help people make a complaint
 Provide advice and information
Introduction
Providing high quality care enables people to have the best
possible quality of life
Challenges facing Health and Social Care which will impact
on domiciliary care services:
 Increase in number of older people
 Growing numbers of people living with long-term
conditions
 Health and social care budgets under increasing
pressure
Ageing population
 We are all living longer and the number of older people
living in the community is set to increase.
 In 2035 there will be 65% more people aged 65+ compared
to 2014.
 Anticipated greater demand for particular Health and Social
Care services including domiciliary care.
2036
473,000
2014
Over 65’s
286,000
Over 65’s
65%
Domiciliary care cervices in Health and
Social Care
Approximately 80% of recipients of domiciliary care are older
people. In Northern Ireland at present Health and Social
Care services provide:
250,000 hours
per week of
domiciliary
care
Domiciliary
care provided
for 25,000
people
It is estimated that this will need to double in
the next 20 years.
£206m per
annum for
domiciliary
care
What people have told us
32
We’ve had thousands of
conversations!
 People’s views have
helped us write over 60
reports
 Reports have provided us
with insight into people’s
experiences of their Health
and Social Care and what
they would like to see in
the future
Person-centred care; people’s
experiences
“Services to fit
around carer
and client rather
than the other
way round.”
“Staff are the
most important
factor of home
based care”
“Care in the
community
providing the
dignity that
people
deserve.”
“Improved
support for
people who wish
to remain / be
cared for in their
own home.”
“Treat every
service user
as unique.”
Care at Home: Older people’s
experiences of domiciliary care
In 2012, we spoke to older people and their carers about
their domiciliary care services.
People told us domiciliary care is important because:
 It can enable people to remain in their home
 It helps maintain a sense of independence
 People appreciate the support of homecare workers who
are kind, reliable and willing to help
 Carers are reassured that their relative is regularly
monitored
Care at Home: Older people’s
experiences of domiciliary care
Issues and themes which continue to be expressed to us
through our work:
 Importance of consistency of care
 Older people want to know who is coming to their home
 People also want to have a conversation with their
carers and are worried that they have too little time at
each call
 They also want to know that homecare workers are
treated well, properly trained and enjoy the job they do.
Self-directed support
Self directed support, through a
personal budget allows individuals
and families to make informed
choices about the way care is
provided to them.
It is intended to support
independent living by giving people
more choice, control and flexibility
over their own care.
“By fully engaging
with patients and
their families, much
can be learnt.
Patients need to be
involved and feel
their voice can be
heard.”
“Direct
payments
(need to be)
easier to
access.”
The future
 Increased demand for services.
 Higher proportion of older people in our society.
Increased number of people with long term conditions /
co-morbidities = greater and more complex needs.
 Supporting people in their desire to live at home will
continue to be important.
 Work force which needs supported to deliver this care.
 Involving people in decisions about their care.
 Self directed support needed so that people are
enabled to make decisions about their care.
Questions?
Thank you for listening
www.patientclientcouncil.hscni.net
39
The right time, the right place.
Making the case for homecare
Colum Conway, CEO, NISCC
3 December 2015
The Role of the NISCC in the Quality
Framework
Registration
And Regulation
• Strengthen Public
Protection
Improving
the Quality
of Social
Care
Practice
Workforce
Development
• Strengthen the
professionalism
of the workforce
Standards
• Raise Standards of social care practice
42
NISCC’s Register (as of Sept 2015)
Currently 23,276 registered:
43
Registration of Final Groups of Social Care
Workers
• In June 2015, the Minister for Health, Social Services
and Public Safety announced the start of compulsory
registration for:
 Domiciliary Care Workers
 Social Care Workers in Supported Living
 Day Care Workers
• Timeline – compulsory registration to be introduced
by March 2017
44
Our Approach to Registration
•
Working directly with employers and social care
workers to support the application process
•
Using the NISCC on-line portal for registration
•
Developing a Registration information pack
•
Developing a video guide to support the application
process
•
Providing information workshops
•
NISCC has developed a section of the online portal
for employers
45
46
47
• This section will give employers (endorsers) interactive
views of all their staff currently registered or applying, to
include:
– their current registration status, including conditions
– when their annual fee or renewal date is due
– if they have been removed and the reason (ie nonpayment)
– new applications and their status (ie waiting for ID,
Fee, Endorsement)
– letting NISCC know if an employee has left their
organisation
• Employer can export this information to a spread sheet
and sort/ manipulate the data to suit their49
needs

It is an employers’ responsibility to ensure their
staff maintain a valid registration for the duration
of their employment

When compulsory registration is introduced, it will
be an offence for an employer to employ a Social
Care Worker who is not registered
Know
Understand
Be able to
do
Standards of
Practice for
Social
Workers
Behaviour
Attitudes
Values
Know
Understand
Be able to
do
Standards
of Conduct
Standards of
Practice for
Social Care
Workers
Safe and competent practice



We have updated the
Code (Standards of Conduct) and
developed Standards of
Practice
They set out the universal
standards expected of
social workers and social
care workers that they
must uphold in order to be
registered to practise in NI.
Effective from 1 November 2015
Standards of Conduct




Protect the rights of
service users
Earn and keep trust
and confidence
Help service users to
be independent
Help service users to
protect themselves


Encourage public trust
and confidence in the
social care services
Be accountable for your
work and take
responsibility for
professional development


Understand the main
duties and
responsibilities of
your own role within
the context of the
organisation in
which you work
Be able to
communicate
effectively




Deliver personcentred care which
is safe and effective
Support the
safeguarding of
individuals
Maintain health and
safety at work
Develop yourself as
a social care worker




Our role is to set
standards of conduct and
practice
These are the standards
that service users and the
public tell us they expect
Across NI, registrants are
proud to uphold these
standards every day
The standards are of
benefit to everyone who
cares about social work or
social care
Educators can use the Standards
to help students understand what
it means to be a registered
professional
Employers can use them to
support their staff in upholding
standards as part of ensuring
quality and safety
Social workers and social care
workers can use them as a way of
reinforcing their professionalism
Service users and carers can use
them to provide feedback about
the care they receive

PRTL- 90 hours

Workforce Development Partnership
•
Promotion and recruitment into the
workforce
Qualifications and skills to support the
workforce
Supporting managers in the workforce
Communicating the right messages
•
Leadership
•
•
•

Developing resources to support practice
DOMICILIARY CARE TOOLKIT
IOS/Apple:
https://itunes.apple.com/gb/ap
p/domiciliary-caretoolkit/id844143321?mt=8
Android:
https://play.google.com/store/
apps/details?id=com.learningp
ool.domiciliary
Caring for a person living with
dementia at home.
Fiona Brown
Service Manager
Caring
• Difficult task but also rewarding
• Proper support and understanding
• 2/3 of people with a diagnosis of dementia live at home
What is dementia?
•
•
•
•
•
Progressive
Terminal
Physical cause
Affects everyone differently
Affects individuals ability to think, learn, reason and
remember
• There is no cure
• With the right support, people with dementia can live well
• Dementia is caused by diseases of the brain
•
•
•
•
•
•
62% Alzheimer's disease
17% Vascular dementia
10% Mixed dementia
5% Rarer causes of dementia
4% Dementia with Lewy bodies
2% Frontotemporal dementia
• 225,000 people develop dementia every year in UK, that's
roughly one person every three minutes
Common issues associated
with Dementia
•
•
•
•
•
•
•
Changes in personality
Changes in behaviour
Difficulty in communication
Fear of strange places or things
Lack of insight
Changes in life pattern
Isolation
Main concerns associated with caring for a
person living with dementia in their own home.
•
•
•
•
•
•
•
•
Aggression / agitation
Non Compliance
Lack of personal hygiene
Confusion with simple tasks
Lack of insight
Inability to following instruction
Sun downing
Difficulty in time and place
However there is no difference in caring for
someone with dementia in their own home than
any other care environment.
Except?
There is a need for proper training, care
packages, carer support and education.
Benefits of living at home
• The person may be more comfortable in their own
environment
• They may be more secure
• They may be more content
Impact on Carers
• Informal Carers may feel stressed and need support
• Dementia is a gradual long good bye and this is emotional for
the family
Golden rule
• People living with dementia are losing their rationale.
Try and think of the situation the person with dementia
finds themselves in, the fear, the uncertainty, the sheer
unknown.
• Jump from your reality into their reality.
• How would you feel?
• How would you like to be treated?
• How would you deal with the unknown?
Common issues and ideas
how to manage the situation
Bathing/ Showering
Some people with dementia find the whole experience of
bathing/showering terrifying. However it doesn't have to be.
• Take your time
• Explain what is happening short simple pointers.
• If the person doesn't understand try and show them what they are to
do.
• Ask the family what was the person routine around personal care was
there a favourite time of the day for bathing?
• Remember a shower is frightening for people with no rational, it’s a
cascade of water falling on them from above they are drowning.
Aggression
Misconception everyone with dementia becomes aggressive.
Very few people living with dementia become aggressive.
They may become agitated, frustrated or bored.
What we may seen as aggression could be their way or expressing
numerous things including
1. Pain
2. Hunger
3. Frustration
4. Infection
5. Dehydration
6. Boredom
7. Abuse/neglect
Confusion with
simple tasks
What is a simple task?
Making a cup of tea.
Is it?
Think of the steps to making a cup of tea.
Add increased confusion, self doubt, and forgetfulness what
happens?
Think of other ways of demonstrating what you need the
person to do simple fun ways. Singing the task, using different
colours fount sizes in texts
Sundowning
• Common issue
• Lack of stimulation.
• A need to be needed to be busy
• Why do people sundown?
• What can we do now for the person to ease sun
downing?
The bookshelf model
of memory storage
Hippocampus memory
Person with dementia
• memories like books on a bookshelf
• stored over time
• most recent on top.
• bookshelf wobbles
• top shelf books affected first
• progressively lower books fall.
People with dementia ….
• Need to feel that they still have a purpose
• Need to be accepted and valued as they are
• Have a right to a meaningful existence whatever their health
needs
• Look for ways to connect with a person with dementia
• Recognise that although the brain damage and past life
experiences of the person with dementia cannot be changed,
we can change the way we provide care
Things to remember
1.
2.
3.
4.
5.
6.
7.
8.
9.
Be Calm.
Be Clear.
KIS Keep It Simple
Maintain eye contact with the person living with dementia.
People with dementia may be losing their rational and act on feelings
Use different methods of communication.
Explain clearly what you are doing.
Support person with dementia to do what they can still do with support.
Consider other reasons why a person maybe exhibit behaviours rather
than just seeing it as a symptom of dementia.
10. Talk to the informal carer about likes/ dislikes/ past experiences.
11. Never force a person living with dementia to do something they don’t
want to do.
12. Be truthful never try and bluff a carer or person with dementia.
Don’t Panic
Contact us through the
National Helpline 0300 222 11 22
What services do we offer?
•
•
•
•
•
•
•
•
•
•
•
1:1 support visits
Carer support groups
Dementia Information Programmes
Carer Information Support Programmes (CrISP)
Befriending
Friendship groups
Activity Groups
Singing for the Brain
Dementia Friendly Community workshops
Helpline
Advocacy services
How can you help?
Volunteering Opportunities
• Service Support
• Information support
• Fundraising Campaign and media
• Governance
If you are interested in any of the above opportunities contact
Your local volunteer Officer on 028 90387486
Empowering service users:
Self-directed support and
homecare
UKHCA Northern Ireland Provider
Forum 2015
Jonathon Holmes, Policy Officer, UKHCA
3rd December 2015
Self-directed support – beyond the
jargon
Simple concepts and complex language!
“Placing the individual at the centre of any model by promoting a better
outcome for the service user, carer and their family”
(Transforming Your Care)
Achieved by three mechanisms
o
A direct payment
o
An individual service fund
o
A managed budget
Okay, but does it really matter?
In short, yes.
Self-directed Support fundamentally changes the way care will be
purchased.
Goodbye to block contracts and Hello to personal budgets
The individual must be at the centre of the care plan
Does the demand exist?
Adults Receiving Direct Payments
3,500
3,000
2,500
2013
3,043
2012
2,895
1,000
2,704
1,500
2,608
2,000
2014
2015
500
0
Source: DHSSPS Direct Payments Quarterly Returns
What are ‘outcomes’?
“In social care, an ‘outcome’ refers to an aim or objective you would like
to achieve or need to happen – for example, continuing to live in your
own home, or being able to go out and about.” (TLAP)
?
How is this any different from how we’ve always cared for people?
A new commissioning framework
Source: LGA and University of Birmingham, Commissioning for
Better Outcomes
What does good look like?
o
I have the information and support I need in order to remain as independent
as possible.
o
I have opportunities to train, study, work or engage in activities that match
my interests, skills and abilities.
o
I have care and support that is directed by me and responsive to my needs.
o
I have considerate support delivered by competent people.
o
I can plan ahead and keep in control in a crisis.
o
I know the amount of money available to me for care and support needs,
and I can determine how this is used.
Source: TLAP, Making it Real, The I Statements
Concerns and opportunities
Concerns
o
Fewer guaranteed hours
o
Fewer regulated providers – more personal assistants
o
Increased costs – actual cost and unit cost
o
Late payment and debt recovery
Opportunities
o
Business diversification
o
An improved relationship between providers and service users
o
Private purchasing could be expected to grow
o
Incentives to integrate
Group activity
Group 1
Sally
Group 2
Daniel
Group 3
Peter
All three receive a direct payment from their Health and Social Care Trust, split into groups and
design a care plan for either Sally, Daniel or Peter.
Try to think how you can creatively meet their needs and support them to achieve their desired
outcomes.
Discussion
Have you worked with people who receive a direct payment or individual
service fund already, what was it like?
How do you think this will effect the way you deliver care?
What are the implications for your business?
Do you think you’re doing this already?
Further Information
UKHCA, Personalisation Factsheet:
http://www.ukhca.co.uk/downloads.aspx?ID=470
The Centre for Independent Living: http://www.cilbelfast.org/
HSCB, Self-directed Support Index:
http://www.hscboard.hscni.net/sds/index.html
DHSSPS, Direct Payments: http://www.dhsspsni.gov.uk/directpaymentsabout