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Market OversightSally Warren Andrea Sutcliffe Ray James

30 October 2014 NCAS

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Andrea SutcliffeChief Inspector

Adult Social Care

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Why market oversight?

Clear relationship between quality of care and finances

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What can it do?

Market oversight aims to:Spot if a ‘Southern Cross’ could happen again

Protect people in vulnerable circumstances

Monitor finances of ‘difficult to replace’ providers

Provide early warning to local authorities

Assist in co-ordinating the system response if failure occurs

Market oversight is not there to:Protect providers from failure

Pre-empt failure through disclosure of information

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Timelines for market oversight

Sept – Dec 2014

• Development of CQC approach and methodology

• CQC engagement on proposed methods

Jan – Feb 2015

Identify and liaise with providers that meet the market oversight entry criteria

April 2015

• Formally notify providers of their inclusion in the scheme and respond to appeals

• Start to undertake financial assessments of providers in the scheme

October2015

Bring specialist providers into the scheme

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A co-production culture

Communication

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This session

Market oversight regime in detail – Sally Warren

Local authority local duty to manage continuity – Ray James

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Sally WarrenDeputy Chief

InspectorAdult Social Care

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Proposed model for market oversight

Entry to scheme

Regular monitoring

Further risk analysis

Provider engagement

on risk

Regulatory action &

engagement

Formal notification

to LAs

1 2 3 4 5 6Step

Activity

If concernsidentified andaddressed

Key: Assessment of risk to financial sustainability

(all provisional)

no cause for concern/very low risk possible risk/medium risk

likely risk/high risk risk clearly identified/very high risk

Step 1 - entry

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• Regulations set out entry criteria and reflect size, localised concentration and spread across the country

• Specialist providers to be nominated via a panel

• Currently expect around 50 corporate providers to be in the scheme

• These operate around 400 registered providers which deliver services from about 4000 locations (30% of all care home beds in England)

• Inclusion in scheme is a reflection of size, not a judgement of risk of failure

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Proposed model for market oversight

Entry to scheme

Regular monitoring

Further risk analysis

Provider engagement

on risk

Regulatory action &

engagement

Formal notification

to LAs

1 2 3 4 5 6Step

Activity

If concernsidentified andaddressed

Key: Assessment of risk to financial sustainability

(all provisional)

no cause for concern/very low risk possible risk/medium risk

likely risk/high risk risk clearly identified/very high risk

Steps 2 and 3 – Intelligent Monitoring

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A. Business context

B. Financial

C. Quality

To allow CQC to understand

provider structure and

operation model

Quarterly financial returns.

Data is a prompt for

further investigation and analysis

Aggregation of quality information, including ratings enforcement, information on concern

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Proposed model for market oversight

Entry to scheme

Regular monitoring

Further risk analysis

Provider engagement

on risk

Regulatory action &

engagement

Formal notification

to LAs

1 2 3 4 5 6Step

Activity

If concernsidentified andaddressed

Key: Assessment of risk to financial sustainability

(all provisional)

no cause for concern/very low risk possible risk/medium risk

likely risk/high risk risk clearly identified/very high risk

Steps 4 - 6: tools available to CQC

1414

Draft for discussion

If elevated risks are identified from financial and quality indicators, CQC will use tools to obtain further information before assessing if failure is likely

Provider engagement on risk

Regulatory action and engagement

Formal notification

to LAs

Activity

Tools Risk

assessment

meeting

Additional financial information requests

More frequent quality inspections

Key stakeholder engagement

Notify relevant LAs

Independent Business Review

Risk Mitigation Plan

a b

c

d

e

f

g

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Transparency in market oversight

• CQC will publish a list of providers within the scheme

• Ongoing judgment of risk will not be published

• LA(s) will be notified if failure is judged to be likely

• Providers will be sharing commercially sensitive information and CQC will have systems to manage this appropriately

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Ray JamesVice President

of ADASS

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Role of Councils

• Detail in Act, Guidance & planned Toolkit• Duty applies for all providers not just those in

Market Oversight Regime• Duty not triggered if business has failed but

service continues to be delivered (e.g. administrator running the business)

• Duty falls to LA where service is delivered not on commissioning LA

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Temporary duty

• LA must involve the person concerned or those acting on their behalf

• LAs have the power to compel information from the provider that would help in this (e.g. care plans, risk assessments)

• Duty to cooperate• Excludes NHS commissioned care

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Insolvency situations

• Where an administrator appointed, LAs should not become involved in the commercial aspects of insolvency but should cooperate with the administrator

• LAs should consider the impact on the provider should they withdraw contracts but this should not be at the expense of people’s wellbeing

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Market shaping and contingency planning

• Important that LAs have thorough understanding of local market (capacity, quality, types of service, trading conditions)

• Should underpin contingency planning; LAs to consider how to respond to failure of a significant provider, linking with neighbouring authorities where necessary

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Promoting responsible behaviours

• Focus on wellbeing of those needing care• Information

• Sharing – Building Trust• Availability of key personal data

• Media Protocols• Local, Regional, National• Clear plan and accountabilities • Communication vital – LAs should have

capacity to react quickly and effectively to minimise uncertainty and anxiety• Service Users, Carers, & Staff

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Thank you

www.cqc.org.ukenquiries@cqc.org.uk@CareQualityComm