CQC Thematic Activity

Emma Steel

Bernadette Hanney

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What we will cover

1.Our regulatory model and the context for thematic activity

2.Thematic reviews

3.Themed inspection programmes

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Legislation and standards

Single system of registration

Single set of standards

Strengthened and extended enforcement powers

Parliament Dept of Health

Care Quality Commission (Registration)

Regulations 2009

Health and Social Care Act 2008

(Regulated Activities)

Regulations 2010

CQC

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CQC – what CQC does and does not do

What CQC does not do

We do not make assessments of commissioning – although we can comment on

shortcomings via themed reviews and investigations

We don’t assess quality above essential standards

We only promote improvement by focusing on non-

compliance

Inspectors are encouraged to describe what they see,

comment on good practice and reference it

CQC’s role

Register – inspect – enforce – publish

CQC registers care providers then checks whether they are meeting essential standards

If not, we take action – they must put problems right or face enforcement action

We publish what we find as quickly as possible

We share what we know with our partners

We put a premium on users/ whistleblowers

We monitor the care of those detained under the MHA

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Forms of regulation

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Scale of CQC regulated care

Primary medical services

9,000 locations

NHS Trusts

2800 locations

Independent healthcare

2,500 locations

Adult social care

24,000 locations

Independent ambulances

350 locations

Primary dental care

10,000 locations

Combined outpatients and inpatients

77.4 million

People using adult social care services

1.75 million

Dental appointments

36.4 million

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Priorities in action

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Inspection Analysis Voices

Our Regulatory Compilation

Themed inspections

Scheduled inspections

Responsive inspections

Investigations

Thematic reviews

Quality Risk Profiles

Surveillance

Other data sources

Website feedback

Telephone or written feedback

Third party feedback

Whistleblowing

Safeguarding

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THEMATIC REVIEWS

THEMED INSPECTIONS

• Applicable to all inspectors

• Where information can provide assurance and increase efficacy

• Promotes consistency in follow up of concerns

• increase confidence in Operations'

interpretation of data • Can be precursor to a themed inspection, directing areas to examine

• A sub set of inspectors

• Where data is not available or cannot provide sufficient assurance

• Where supported and coordinated inspection is preferred methodology

•Random set of providers inspected

•Can test the risk model and provide feedback

• Service level

• Risk driven

• Proportionate

Thematic Reviews & Themed Inspections

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Proposed topics so far

• Maternity: staffing and outcomes

• Physical health needs of people with a learning disability

• Pressure sores

• End of life care for people in care homes

• Deprivation of liberty safeguards

• Hospital discharge arrangements

• Medicines management

• Care of people with mental health needs in A&E

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Suitability: a prescriptive commission to identify trusts at high risk of non-compliance within a specific topic area

Purpose: to maximise the use of existing data for risk based activity

Output: a hybrid of data analysis (RAG status at provider level) and expert prompts

Example: maternity: staffing and outcomes thematic review

Type 1 Thematic Review

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Maternity review provider report

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Maternity review provider report

Individual scores are presented here

Click on these questions to find out more about the results including

links to outcomes and national standards.

If data is presented graphically or there is important additional information,you can click here to reveal the graph

Click here to check the data

period and weight of the

data item

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Regulatory response

Initiated responsive review 6

Bring forward planned review 3

Add further concerns to a responsive review already underway

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Highlighted new concerns 13

Aware of risks and enforcement action already being taken 3

Positive local intelligence outweighed risks in the report 6

Total number of maternity providers = 144

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Suitability: collating all available data to create a comprehensive picture; alternative presentation of existing data

Purpose: to present a picture which adds value through correlation or triangulation with other sources

Output: a complete, current data set as a baseline report with limited policy interpretation

Example: Deprivation of Liberty Safeguards thematic review

Type 2 Thematic Review

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Deprivation of Liberty provider report

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Deprivation of Liberty provider report

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Principles ofinspection

New approach to inspections

Timely

At least once a year or once every two years depending on the provider

Focused

Inspections will focus on outcomes that are important

to people using services

Flexible

We can use different types of inspection to respond to concerns

Unannounced

We do not notify providers before we carry out inspections

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CQC Thematic Inspection Programme 2011/12

NHS Dignity & Nutrition Spring/Summer 2011

Learning Disability Services Autumn/Winter 2011

Phase 2 Dignity & Nutrition Winter/Spring 2012

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Why do a learning disability inspection programme?

Serious abuse identified in a service for people with learning disabilities:

• Winterbourne View 2011

History of abuse in learning disability services:

• Ely 1967• Cornwall 2005/06• Sutton and Merton 2006/07

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What does the inspection programme comprise of?

Care Quality Commission is undertaking inspections of 150 locations where assessment and treament and rehabilitation is provided.

A second phase will take the learning from phase one and look at alternative models of care.

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Inspection teams

Lead compliance inspector for this LD review

Compliance inspector portfolio holder

Experts by Experience:p

erson

who has used services

family carer

Professional advisor

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Phase one

Aims

• To reassure people who use services, relatives, the public and CQC that the risk of such abuse occurring in any other unit is minimised.

• To take appropriate action if concerns arise

• To provide information for wider review of LD services.

Actions

Use existing methodology to inspect:

• Outcome 4 (regulation 9) Care and welfare of service users

• Outcome 7 (regulation 11) Safeguarding service users from abuse

• We will report on our findings on every location and produce a national report

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Background to the inspection programme

This review will directly support CQCs two strategic priorities:

• We focus on quality and act swiftly to eliminate poor quality care;

• We make sure care is centred on people’s needs and protects their rights

If we judge during this review that services are not meeting essential standards we will use our regulatory powers to ensure necessary improvements are made

If we judge during this review that people using a service are at risk, we take swift, proportionate action to protect people

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Questions

CQC – Helping make care better for people

Questions?