Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.

On Friday I was speaking at a conference focusing on breaking down the barriers between health and social care to promote integration.

Under the banner of #AllTogetherNow, the joint organisers Care England and the Royal College of Nursing had assembled an impressive array of speakers. The morning started with a compelling case for better joint working from Jane Cummings, Chief Nursing Officer at NHS England and Dr Eileen Burns, President of the British Geriatrics Society.

The morning ended with a great presentation from Dr Peter Carter, Chief Executive of the RCN who shared a bit of history with this clip from 1948 about how nurses were looked after then and brought us right up-to-date with the RCN’s video campaign “This is Nursing.” My favourite video Peter shared though is “My Right to Choose” — a song that emphasises the importance of person-centred care — you won’t regret the few minutes it takes to watch it.

I was sorry I could not stay and listen to Beth Britton speak about her family’s experience of care and the difficulties that the lack of person-centred co-ordination can cause. Beth can always pierce through our professional introspection with a good dose of common sense.

Regulating integration

I was singing off the same hymn sheet as others about the importance of person-centred co-ordinated care but was invited to explain how the regulator can help. I emphasised that we will look at how well organisations work together as part of our inspections of individual institutions but that we will also continue to look more broadly at systems of care in our thematic reviews, like last year’s Cracks in the Pathway. We plan to start looking at people’s experience of health and care in a specific locality by bringing together all the information we know from inspections of NHS trusts, adult social care and primary medical services. It’s also important that we walk the talk and work in partnership too.

Improvement top tips

There was a cracking question from the audience — how do we do this? It’s a question I am often asked, when the regulators say things must change, how are people supposed to make it happen?

So here are my top tips — not just for integration, but any improvement.

Top tip one: it’s hard work

Don’t underestimate the time, commitment and effort it takes to achieve successful, sustainable improvement. Quick fix sticking plasters fall off and sometimes do more harm than good. Get everyone involved, especially people using the service, their families and carers and staff, have a plan, pay close attention to culture and behaviours, make the time needed and be determined!

Top tip two: use what works

Someone somewhere has probably tried to sort out your particular problem before and there are lots of resources available to show how they did which can probably help you. The Social Care Institute for Excellence and Skills for Care are always good starting points and their new joint website Care Improvement Works helpfully brings together their resources linked to each of our five key questions — is the service safe, effective, caring, responsive and well-led?

Last week I was introduced to a resource I didn’t know before but think is brilliant — the virtual dementia-friendly environments website from Stirling University, definitely worth a look.

Top tip three: be inspired by others

There are some great services and a quick look at our Good and Outstanding reports will give you lots of inspiration.

Visiting or finding out about other services will also gives you good ideas. I had the privilege last week to visit Meath Epilepsy Trust in Godalming. I was encouraged to go by members of the Surrey Care Assocation who told me about the transformation Chief Executive Mike Keighley is leading there. I was very glad they’d pointed me in this direction. Meath supports people living with severe epilepsy many of whom also have learning and/or physical disabilities in their residential service, home care and skills and enterprise centre (formerly a more traditional day centre).

The ethos at Meath is to think about what people can do, not what they can’t and to recognise the talent in everyone. I heard tales of white-water canoeing in the Ardeche the week before, a thriving furniture upscaling business and the innovative and successful Art House enterprise. I was inspired and I’m sure you would be too.

Top tip four: listen to people

Every report about poor care we read tells us the same thing — listen to the people using your service and the people working in it. They can spot problems and solutions and can really help you to make the improvements you may need. When I was at Meath I also met four of the residents who are being trained to be internal quality assurance assessors. They already had some great insights on further improvements that could be made.

When we look at how well led a service is, we will be asking about how inclusive and transparent the culture is and a key part of that is listening and responding to the voice of people using services, their families and carers and staff.

Top tip five: believe you can

This goes back to the first top tip — it is hard work but can be successful if you believe you can do it. Another lesson from Meath — so many people using adult social care services are told about what they can’t do, but you should have seen the pride and joy on the faces of the people who were telling me about their white water canoeing trip.

Believe you can and who knows what will happen?

Originally published at

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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