Patricia Heslop

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Mr. Derek Winter
HM Senior Coroner
Civic Centre
Burdon Road
Sunderland

SR2 7DN

8 June 2018
Dear Mr. Winter,

Inquest into the death of Patricia Heslop
Regulation 28 Report to Prevent Future Deaths Response

We write in response to your Regulation 28 Report following your investigation into
the death of Mrs. Heslop. This response has been prepared by HC-One and
addresses the concerns listed 1 to 9 in section 5 of your Regulation 28 Report.

As you are aware from the evidence provided during the inquest, HC-One has taken
this incident extremely seriously. Two investigations were undertaken by the
organisation immediately following the incident and work has been ongoing to
establish how services can be improved and lessons learnt from this incident.

We address the concerns identified as numbered in the Regulation 28 report and
provide details of action taken together with actions that will be implemented in the
future.

1. Falls Reporting.

1.1 You have identified that the fall was unwitnessed and was unreported.
Evidence was heard from a number of HC-One employee witnesses, none of
whom were able to identify the circumstances of any fall or confirm that staff
were aware of Mrs. Heslop requiring assistance. It is therefore acknowledged
that any fall was unwitnessed and / or unrecorded.

1.2 Evidence was provided in the statement of [I Head of

Standards and Compliance with HC-One, as to the existing procedures in place
at HC-One for incident reporting. HC-One recognises the importance of

HC-One
T 01325 351100 F 01325 351144
Correspondence & Registered Office: Southgate House, Archer Street, Darlington, County Durham, DL3 6AH

Registered in England and Wales; HC-One Limited, registration no. 07712656; Meridian Healthcare Limited, registration no, 01952719; |
HC-One Beamish Limited, registration no. 05217764; HC-One Oval Limited, registration no. 10257888; RV Care Homes Limited, registration no, 07417290.

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incidents and falls risk assessment management and positively encourages
openness and transparency from all staff regarding any issues involving the
care and welfare of residents, specifically including any incidents of falls. This
culture of openness and transparency is a golden thread throughout all
company policies and procedures all of which are underpinned by our vision
and values of accountability, involvement and partnership to achieve the best
health and care experience for our Residents.

The company has an Incidents; Reporting, Investigating and Learning guidance
document for Home Managers, which indicates there to be three components,
which must always be followed to ensure effective incident management,

1. Accurate and detailed incident reporting

2. Incident investigation

3. Learning lessons as a result of the incident

This guidance requires that any accident, incident or untoward event, involving
aresident, whether it causes harm or not be recorded on an incident form by
the Home team and uploaded on to the Datix (Risk Management) System, as
outlined i tti(‘i‘i;é;*;*;~*~SC* her statement and at the inquest. The
Datix system predominantly records falls, ill health, medicine errors,
safeguarding and complaints and has been designed with integral prompt
questions to elicit maximum information from the individual providing the
information, Allincidents are then required to be determined in terms of risk,
grade levels of harm and severity of issues. Once the incident is entered onto
Datix, an automatic alert notifies the appropriate area and specialist teams
and senior management within the company, depending on the severity of the
incident. This will determine who will undertake any necessary investigations.
Falls are automatically reported at group level (Managing Director) area level,
{Area Director/ Area Quality Director), home level (Home Manager) through
these internal reporting systems.

All incidents must be investigated and the HC-One policy stipulates that those
undertaking an investigation should aim to complete this within 14 days of the
date of the incident. The investigating officer is asked to consider many aspects
around compliance with policies and procedures, known risks and controls,
levels of training, colleague practice and conduct, care plans and risk
assessments etc. and opportunities missed.

The investigating officer is guided though the process through use of an
investigation template, which leads them through the fact findings to
conclusion and actions to prevent future incidents.

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1.6 Following this incident, action has been taken at Hebburn Court to ensure that
all staff have the knowledge, skills and tools to identify, record and manage
falls to reduce risk and prevent harm. All staff have been reminded of the
importance of alerting nursing colleagues and managers to any fall and
documenting within the individuals' records. Learning on this has been
facilitated by reassignment of the falls prevention module from our award
winning online learning platform, Touchstone. In addition staff have received
further coaching and assessment of competencies in this area through staff
meetings and individual supervision sessions. Training statistics in this area are
currently 93.5% of the staff team and plans remain to press for this to increase to
100% by the end of June 2018.

1.7. Additional Duty of candour training has been undertaken with all staff. Our
Standards and Compliance team leader has delivered training on Duty of
Candour to the Hebburn Court staff team and the CQC guidance on Duty of
Candour has been printed and placed in the nurse’s offices. As mentioned
above supervisions for all nurses and nursing assistants, which have included
discussion on the contents of the Duty of Candour guidance, have been
completed and will continue to be refreshed annually. Our Standards and
Compliance team support colleagues in Home teams to determine whether an
issue meets the criteria for duty of candour through revision of incidents that are
input on the Datix system and offer same day advice, if the person inputting the
information has not recognised the incident appropriately.

1.8 Since the inquest the internal inspection team have visited and assessed the
home and found staff to be competent and confident in falls management
and Duty of Candour, which will continue to be assessed at every inspection
(which occur a minimum of twice each year) to ensure sustainability of this
learning and practical application.

2. Care Records documentation.

2.1 You identified that there appeared to have been a change in Mrs. Heslop’s
presentation and a number of factors preceding her hospital admission were
not collated and recorded in her care records. This includes the use of
wheelchair, a rocking manoeuvre which involved two members of staff and the
fact that two members of staff are required to support Mrs. Heslop when
walking. It was acknowledged by HC-One during the inquest that these matters
were not recorded as they ought to have been nor were the family informed as
they should have been, both in accordance with policies and therefore
company expectations.

2.2 Oral evidence was provided during the inquest hearing by Po
mz: respect of a pilot electronic care planning system to be implemented

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across HC-One. HC-One is now able to provide further information in respect of

this system which, we suggest will address a number of the additional concerns
identified during the inquest hearing.

2.3 Significant work has been undertaken by HC-One to introduce an electronic
care planning system, e.care. The pilot has continued to be implemented,
evaluated and refined in a number of homes and the measurable successes
achieved to date have resulted in a date for roll out across the organisation in
October 2018. The electronic system will remove the requirement for paper
care plans to be kept in multiple files and enable all information and care plans
to be stored in one place.

2.4 Evidence was heard during the inquest that there were numerous forms to be
completed by staff and there was a lack of clarity as to who was required to
complete forms and at what time intervals. The electronic records system will
provide a single record system and clear instructions.

2.5 As part of the implementation of the e.care system, all staff will receive training
to ensure they can navigate and optimise its use to the benefit of residents and
their care and support needs. Care, nursing staff and management will all have
access to the system, which places the resident at the heart of the system and
captures all the support needs and actions required to guide and support staff
in meeting their needs. There are categories of care to help prompt
appropriate assessment of need but also infinite options for adding bespoke
information to inform the care planning.

2.6 Areas that were found wanting within your report at Hebburn Court are
included in the e.care system, for example body mapping, the importance,
what it tells us and what we do if and when we find a bruise. This process was
reported on by TT ¢:: we have revisited at Hebburn Court
for all staff and can confirm that all residents have had refreshed body maps
completed. These are regularly reviewed as part of the Resident of the Day
process as a minimum each month or sooner and this means management
have clear oversight of bruising, unexplained or not and can support staff with
learning or other actions to minimise repetition.

2.7 The recording of use of wheelchair and techniques for manoeuvring will also be
recorded in the e.care system, ensuring staff complete appropriate
assessments of needs and making overtly transparent, which is a bonus
compared to the paper system currently in use.

2.8 It is acknowledged that family members were not informed of specific aspects
including use of wheelchair and manoeuvring techniques. This can be
attributed to staff not identifying and recording individual variations to the care
plan and therefore not appreciating the significance of any individual

29

2.10

2.1

assistance provided. The e.care system will ensure that any changes to care
provided are recorded and therefore create a single record of information,
which can then be communicated to relevant professionals and, importantly,
family members. This is possible because of the integral flag and prompt aspect
within the system, which reminds staff of the need to review care plans through
scheduling these and then not allowing progression through the system, without
addressing the action.

HC-One has also undertaken additional work to ensure that shift and Household
leaders have been instructed to obtain as many details of family contacts as
possible and ensure that family contacts are reviewed regularly. This is being
managed through individual coaching sessions by the Area Team on leading
and managing and effective completion of the Resident of the Day process,
which prompts the person completing to review and seek confirmation from
family members or carers that details held are correct and that any specific
parameters are accurate.

Similarly, the Area Team have coached and role modelled good practice staff
handovers at the home to ensure that handovers will include all information.

It is anticipated that a single electronic record system will enable earlier
recognition of signs of deterioration in a patient and more comprehensive,
accurate and consistent recording of individual details.

3. Terminology and identification of a deteriorating resident.

3.)

3.2

You identified that a number of terms were used regarding Mrs. Heslop's
developing condition. provided evidence during the
inquest that whilst it is not possible to remove alll differences in clinical
description (including the use of colloquialisms and staff language) to describe
a resident's individual presentation nor is it necessarily appropriate to do so, it is
however important to provide consistent language and indicators which can
provide an early warning system based on observations.

Evidence was heard during the inquest of the increased use of NEWS early
warning system to enable observations to be obtained. NEWS is a well
validated ‘track and trigger’ early warning score system used in the majority of
UK hospitals. It is based on a simple scoring system in which a score is allocated
to physiological measurements already undertaken when patients present or
are being monitored in healthcare settings. Use of NEWS score assist in the
identification of a sick patient. Evidence was provided that staff at Hebbum
Court have now been trained in the NEWS system. All nurses and senior care
staff have received training in the system and this will also then be delivered to
care staff over the coming few months.

3.3

4.]

5.]

5.2

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The observations obtained from the NEWS system will be entered into the
e.care system as detailed at Paragraph 2 above. This will ensure that an
overview and "joined up thinking" can be obtained in respect of an individual's
presentation. Whilst these observations may not provide a clear explanation of
a change in presentation, they will enable carers to identify patterns of
presentation and any deterioration and therefore ask questions to begin
understanding the need to involve increased support or external professionals
etc.

4. Care records.

A concern was identified in respect of incomplete or inaccurate care records
and lack of review of care records. As detailed in Paragraph 2 above, the
implementation of an electronic care record system will provide a clear and
comprehensive record of each individual. Access to care records will be
enabled for all nursing and care staff, and training in the use of electronic
records system will be provided to ensure that documentation remains up to
date.

§. Incident investigation and witness information.

It is stated in the Regulation 28 Report that no attempts were made to take
statements from individual witnesses immediately after the fall in November
2016. Immediately following the incident in November 2016, an investigation
was undertaken by the then Home Manager, BJ and completed on 26
November 2016. As part of this investigation, witness information was obtained
from 8 witnesses. A further investigation was undertaken by HC-One by LL, Area
Director dated 7 February 2017. For the purposes of this second internal
investigation 12 witnesses were re-interviewed and additional information
obtained. Further witness statements were obtained for the purposes of the
inquest investigation to re-examine the information and provide more
comprehensive statements. It is acknowledged that none of these witness
statements identified any evidence of when or how Mrs. Heslop suffered a fall
or may have been assisted after a fall.

HC-One has a clear incident investigation process in place as detailed in

statement and above. Since this incident action has
been undertaken to ensure the quality of incident investigation reporting is
monitored, which has lead in turn to refreshed Investigation management
training. This has been provided at both Home Manager level and also as part
of an 8 day intensive and practice focussed induction for Area Team
Managers. This was conducted by the Head of Standards and Compliance
and Leadership Development Manager for the company during March and
April 2018.

6.1

7.1

8.1

8.2

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6. Delay in obtaining treatment.

Evidence was heard during the inquest that the delay in obtaining treatment,
whilst did not directly contribute to the death, did result in Mrs. Heslop being in
pain for a longer period than necessary. This can be attributed to by carers
and nursing staff not appropriately recognising and acting upon indicators of
deterioration. The Resident of the Day reviews identify any changes or
deterioration now that the quality assurance system has been reset and
embedded at the home. This will be further enhanced by the e.care system, as
mentioned previously in terms of robust monitoring and reviews of care and
support needs.

7. Use of multiple forms.

There were concerns raised as to numerous forms required for staff to complete
and read rather than an integrated IT system. The evidence provided at
paragraph 2 above provides details of the action taken by HC-One to
implement an improved IT system, which consolidates and simplifies
management and oversight of care delivery and monitoring for individual
residents.

8. Induction and Dementia Training.

HM Coroner notes that comprehensive induction and ongoing dementia
training may be beneficial. We can confirm that induction training includes alll
aspects of the Care Certificate requirements, which is the recognised and
statutory requirement for care staff. In order to achieve the Care Certificate,
staff must complete a workbook, which is validated on a regular basis
throughout their induction. The induction sets out all expectations of learning
and practical assessment to establish competency of each individual, along
with the timescales to achieve. This induction and the training at HC-One has
been awarded ‘centre of excellence’ status by Skills for Care.

The Manager, with Human Resources support review training statistics for
Hebburn Court and action would be taken to ensure that any individual
employee who does not complete their training will receive follow up
correspondence from HC-One to advise that training is required. This process is
now linked to HC One Human Resource procedures. Therefore action has
been taken by HC-One to ensure staff are aware that non-completion of
comprehensive induction training may result in disciplinary action of staff.
Training statistics for Hebburn Court indicate that this has not been experienced
since the incident, with staff embracing all learning opportunities and resultantly
the statistics for the home have stabilised at a level above the minimum
company expectations of 85%.

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8.3. Dementia Training is provided for all HC-One staff. Evidence was provided
during the inquest that Dementia training formed part of the fundamental
training for all carers. This includes four separate modules called, "Open Heart
and Minds". Content starts with understanding dementia and the brain, the
biology of dementia and the experience for the person, through to
engagement and involvement of the person and their loved ones, importance
of the physical environment, use of resources to delivery of person centred,
informed and educated dignified care, and effective support for residents to
promote their personal sense of well-being. This training is completed in 5
stages. Since this incident, HC-One has ensured that staff at Hebburn Court
have all undertaken dementia training. At the time of writing, staff at Hebburm
Court had
e¢ Open hearts and minds 1 - 76.7% with a further 11.6% assigned to new staff.
e Open hearts and minds 2 - 78.6% with a further 9.5% assigned to new staff.
e Open hearts and minds 3- 75.9% with a further 13.8% assigned to new staff.
e Open hearts and minds 4 ~ 79.3% with a further 10.3% assigned to new staff.
e Open hearts and minds 5 - Classroom training has also been scheduled.

A programme of review and full compliance is to be completed by 30 June
2018.

8.4. HC-One is also currently carrying out a further pilot of additional training entitled
"Memory Care". There are three homes undertaking phase | of the pilot
scheme, which involves refurbishment to a research based dementia friendly
environment, with physical resources such as life stations and bespoke training
for the whole staff team. At the same time, there is a phase 2 approach, where
20 homes have training for the team and a starter resource trunk to build their
own life stations based on learning from the resident group about their interests.
Life stations include office environments, football, potting sheds, kitchen and
laundry areas. The aim of this training is to ensure the appropriate ethos is
maintained and there is a focus on the individual resident and how we support
optimising their personal well-being. It is anticipated that training will be rolled
out across homes by September 2018.

8.5 Evidence was heard during the inquest that all staff at Hebburn Court had
undertaken additional refresher training in basic first aid, which is currenily sitting
at 75% with 10% assigned and Safer people Handling, which now stands at
93.8% and Safeguarding at 90.7%.

9. Recognition of appropriate treatment.

9.1 The Regulation 28 report identifies a concern that there ought to have been a
realisation that an x-ray was required to obtain appropriate treatment.

ee 9.2 Evidence was provided during the inquest from nursing staff of their reflection

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and review of this matter both personally and during ongoing staff supervision.
HC-One has taken action to ensure that all those staff involved in this matter
have been informed of the clinical concerns identified during a staff meeting
on 29 November 2016 and during individual supervision sessions with staff.

Further Action taken by HC-One.

Since the inquest hearing in March 2018, HC-One has also undertaken additional
internal scrutiny of Hebburn Court. This requires in depth assessment against
company and regulatory requirements and which results in an overall rating. The
ratings range from Red 1, where issues have been identified that might impact
resident safety and welfare and require immediate attention through to a Blue 5,
where the outcomes for residents sustainably outstanding. The most recent internal
inspection completed in May 2018 awarded a rating of Amber 3/Green 4, indicating
good outcomes for residents.

The most recent CQC inspection report, completed just after the inquest shows an
improved picture with three key questions judged as Good and two as requires
improvement, which can be seen to have improved further in the internal inspection
findings two months later in May 2018.

HC-One has used the recent CQC report, our internal inspection report and
Regulation 28 report to form the basis of ongoing work at Hebburn Court and
hroughout HC-One.

trust that the information provides you with the necessary assurances that HC-One
has invested significant time, effort and resource into investigating this matter including
the specific issues that you have identified with the intention of improving the care
and safety of care home residents, in addition to reducing the risk of any adverse
incidents or outcome in the future.

Yours sincerely

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Mr Derek Winter DL

HM Senior Coroner, City of Sunderland
Civic Centre

Burdon Road

Sunderland

SR2 7DN

06 June 2018

Thank you for your letter of 12 April to the Secretary of State for Health and Social
Care about the death of Ms Patricia Ann Heslop. I am responding as Minister with
portfolio responsibility for adult social care.

Firstly, I would like to say how saddened I was to read of the circumstances
surrounding Ms Heslop’s death. I appreciate how distressing this must be for Ms
Heslop’s family and loved ones and I would be grateful if you could pass on my
sincere condolences.

I can assure you that we are totally committed to preventing and reducing the risk of
harm to adults in vulnerable situations.

We have made it clear, in statutory guidance to support implementation of the Care
Act', that we expect local authorities to ensure that the services they commission are
safe, effective and of high quality. We also expect those providing the service, local
authorities and the Care Quality Commission (CQC) to take swift action where
anyone alleges poor care, neglect or abuse.

1 am advised that following notification of the death of Ms Heslop, the CQC carried
out lines of enquiry to establish if there had been a failing of Regulation 127, which
concems safe care and treatment. This included consideration of whether a registered
person had failed to deliver safe care and treatment where avoidable harm had

resulted to a service user or where a service user had been exposed to a significant
tisk of harm.

The CQC carried out an investigation into the care received by Ms Heslop and the
specific injury that led to her significant injury but was unable to identify a registered
person failure.

An unannounced and comprehensive inspection of Hebburn Court Care Home was
carried out in November 2017, with the report published in March 2018 and available
on the CQC website®. Following the inspection, the rating of the service deteriorated
from ‘Good’, to ‘Requires Improvement’. In addition, a breach of Regulation 17:
Good governance’ was identified relating to the quality and governance systems in
place not being robust. In particular, the CQC identified that although processes were
in place that identified shortfalls across the service, they failed to ensure that
appropriate action was taken to address those shortfalls. A requirement notice was
issued,

I understand that in response to your Report, the CQC has sought an action plan from
HC-One as to the actions and improvements it has made following the death of Ms
Heslop.

We expect all providers to take action to ensure they meet the standards of quality
and safety of care and I hope this information provides assurance that the Regulator
has acted to ensure HC-One complies with these standards.

I understand Hebburn Court Care Home provides nursing dementia care, in which
case the following may be of relevance.

All nurses are required to meet the standards of proficiency that the Nursing and
Midwifery Council (NMC) considers necessary for safe and effective practice as a
nurse at the point of entry to the register.

In March 2018 the NMC published its new standards of proficiency’. These standards
include requirements that, at the point of registration, the registered nurse will be able
to:

3 htep://www.cqc.org.uk/location/1-320350652

4 http://www.cac.org.uk/guidance-providers/regulations-enforcement/regulation-17-good-governance

7 https://www.nmc.org.uk/globalassets/sitedocuments/na-consultation/the-future-nurse-standards-of-proficiency-for-
registered-nurses.pdf

Department
of Health

e Demonstrate the ability to keep complete, clear, accurate and timely records;
and

e Demonstrate the knowledge and ability to respond proactively and promptly to
signs of deterioration or distress in mental, physical, cognitive and behavioural
health and use this knowledge to make sound clinical decisions.

Once nurses are registered with the NMC they are required throughout their careers
to uphold and act in accordance with the professional standards contained within the
NMC’s Code: Professional standards of practice and behaviour for nurses and
midwives (2015) (‘the Code’)®. The following aspects of the Code are relevant to the
concerns raised in your Report:

e Section 10 of the Code relates to the responsibility of nurses to keep clear and
accurate records relevant to their practice and provides that nurses must
complete all records at the time or as soon as possible after an event; identify
any risks or problems that have arisen and the steps taken to dealt with them,
so that colleagues who use the records have all the information they need;
complete all records accurately and without falsification, taking immediate and
appropriate action if they become aware that someone has not kept to those
requirements.

e Section 13 of the Codes relates to the responsibility of nurses to preserve
safety. This includes nurses accurately assessing signs of normal or worsening
physical and mental health in the person receiving care, then making a timely
and appropriate referral to another practitioner when it is in the best interests of
the individual needing any action, care or treatment.

In appropriate circumstances, the NMC enforce the standards set out in the Code
through fitness to practise proceedings.

As you may be aware, in order to maintain their registration with the NMC, every
nurse must ‘revalidate’ every three years to ensure that they practise safely and
effectively. The revalidation process requires the nurse to demonstrate that they have
practised for at least 450 hours, obtained at least 35 hours of continuous professional
development (CPD) (including 20 hours of participatory learning), reflected on their

6

https://www.nme.org.uk/standards/code/

practice and obtained five pieces of practice related feedback. It is for individual
nurses to decide what CPD activity is most useful to their development as a
professional.

I should also point out that it is the responsibility of individual employers to ensure
that their staff are appropriately trained and competent to fulfil the responsibilities of
the role.

On the matter of dementia training specifically, to support a consistent approach to
dementia education and training, we commissioned Skills for Health and Health
Education England to develop a Core Skills Education and Training Framework.
Published in October 2015’, the Framework, which sets out the essential skills and
knowledge needed for all staff working with people with dementia in health and
social care settings, is structured in three tiers, or levels of training, to reflect the
different levels of knowledge specific roles would require.

Tier one, which is relevant to the entire health and care workforce including ancillary
staff, concerns general awareness skills and attitudes and can form part of induction
training as well as foundation training for more advanced practice.

Tier two, is aimed at developing the knowledge and skills of staff that are likely to
have regular contact with people affected by dementia such as care assistants working
in residential or home care and personal assistants.

Tier three is aimed at enhancing the knowledge, skills and attitudes of key staff and is
relevant to registered managers, social workers and other social care leaders who are
managing care and support services for people with dementia.

Since April 2015, newly appointed healthcare assistants social care support workers,
including those providing care and support to people with dementia and their carers’,
have been undergoing dementia training as part of the national implementation of the
Care Certificate. The Care Certificate equips new staff with the knowledge and skills
that they need to provide safe, compassionate care across a range of areas. In terms
of dementia, the Care Certificate maps to Tier one of the Core Skills Framework.

There is no statutory requirement for providers to implement the Care Certificate.
However, CQC inspectors have powers to enforce regulations covering staff

7 hitp://www.skillsforhealth.org.uk/news/latest-news/item/335-new-dementia-core-skills-education-and-training-
framework

Department
of Health

induction and training. As such, they would expect to see induction programmes that
are broadly equivalent to the Care Certificate standards.

The Dementia 2020 Challenge, which is a programme of action to deliver sustained
improvements in dementia care, set the expectation that social care providers deliver
appropriate training on dementia to all relevant staff by 2020 to improve the care of
people with the condition. As part of the implementation of the Dementia 2020
Challenge, we are considering how best to extend Tier two training to all staff across
health and care settings.

It may be helpful to point out the substantial national resources and guidance that are
available to support the commissioning, delivery and inspection of safe and effective
falls prevention and post-falls care for people being cared for in hospitals and other
care settings.

For example, in 2017, the ‘Falls and Fracture Consensus Statement and Resource
Pack’® was produced by the National Falls Prevention Coordination Group which is
made up of organisations involved in the prevention of falls, care for falls-related
injuries and the promotion of healthy ageing. The consensus statement outlines
actions and priorities to encourage and support the commissioning of services which
reduce the risk of falls and fragility fracture.

The National Institute for Health and Clinical Excellence (NICE) Clinical Guideline
161, ‘Falls in older people: assessing risk and prevention”, details the multifactorial
risk assessment requirement of older people who present for medical attention
because of a fall, or report recurrent falls in the past year and includes multifactorial
interventions to prevent falls in older people who live in the community. In addition,
the NICE Quality Standard 86, ‘Falls in older people’'®, sets out best practice for the
assessment and management of someone who falls including guidance on safe
moving and handling and medical assessment.

* https:// www.nice.org.uk/guidance/cg161

10

https:// www.nice.org.uk/guidance/qs86

Furthermore, the Department of Health and Social Care is working with the adult
social care sector to implement Quality Matters'' — a shared commitment to take
action to achieve high quality adult social care for service users, families, carers and
everyone working in the sector.

Finally, this summer we will publish plans to reform our social care system to make it
sustainable for the future. The consultation will set out options to put the social care
system on a more secure footing and address issues to improve the quality of care and
reduce variation in practice.

I hope the information I have provided is helpful. Thank you for bringing your
concerns to our attention.