Partners in Care Conference February 2012Debbie Westhead

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Background

Regulator for health and social care – created in April 2009

Putting people, their families and carers at the centre of everything we do

Doing things differently – by using information to target poor provision

People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights, wherever care is provided and wherever they live, despite changes in the system

Role of a regulator

The regulation system

Regulation

Adult social care

NHS

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Innovative use of information

Reduced overall cost

Single system of registration

Single set of standards – the essential standards of quality and safety

Strong enforcement powers

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4Independent

health care

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 do not 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

About us

We look at outcomes: a person’s experience of care

We involve people who use and provide services and listen to their voices

We use a wide range of sources of evidence and use local networks and intelligence

We focus on how care is delivered

We are responsive – taking swift action to follow up concerns

We carry out unannounced visits

Where we are now

Since launch in April 2009 we have introduced a new and radically different regulatory system for health and adult social care in England

We have registered the NHS (April 2010), independent health and adult social care (October 2010), and in dental and independent ambulance services (April 2011)

We have implemented a complex piece of legislation against a series of inflexible Parliamentary deadlines

We have developed and rolled out new systems, processes, methodology, guidance, new ways of public reporting

We are still processing high volumes of new providers and variations to existing registrations

GP registration on hold until April 2013

CQC in a changing environment

We have had a challenging external environment – but we are acknowledging mistakes and adapting to changing circumstances

CQC was set up as a risk-based regulator – but the public and providers want regular inspection across the board

We have committed to review and evaluate our model and have received additional funds from government to do this

We have listened to challenges to our regulatory model

We seek to strengthen and simplify our regulatory model to improve how we inspect and take action

Our approach will continue to be outcome-focused, responsive and risk-based but in addition we want to:

inspect most providers more often

focus our inspections on the relevant standards

take swift regulatory action to tackle non-compliance

Consultation on our proposals began in September 2011 and will end in December 2011

Refining our regulatory model

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

How we gather evidence to monitor compliance

Looking at outcomes, a person’s experience of the care they receive

Involving people who use services in our reviews of compliance

Using a wide range of sources of evidence

Focusing on how care is delivered

Being targeted and responsive – taking swift action to follow up concerns

How we capture information

We hold a Quality and Risk Profile on each provider summarising all relevant information

The Quality and Risk Profile enables us to assess where risks lie and prompt front line regulatory activity, such as inspection

As new information arrives, it is added to the profile and assessors and inspectors are alerted to take action proportionate to the risk

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Forms of regulation

How can meeting essential standards drive improvement?

Concern

As part of CQC’s Dignity and Nutrition Inspection programme our inspectors judged the respective trust as being non-compliant :

Outcome 1 - respecting and involving people

Outcome 5 - meeting nutritional needs Outcome

CQC’s inspection prompted the trust to address concerns and take a broader look at the care they provided

They said, "it (CQC’s inspection) really helped us think very differently about how we make sure our patients are receiving the care they should.”

The state of health and social care in England: an overview of key themes in care in 2010/11

How can meeting essential standards drive improvement?

Concern

Last November, friends and relatives of several older people with dementia contacted CQC to share their experience of poor quality care at a care home.

CQC found 8 of the16 essentials standards were not being met, including:

Outcome 4 – Care and welfare of people who use services

Outcome 9 – Management of medicines Outcome

A new manager was employed by the home to address the various issues identified.

On our return to the home two months later, our inspectors found that the

situation has significantly improved.

The state of health and social care in England: an overview of key themes in care in 2010/11

Enforcement

It is the duty of health and social care providers to ensure compliance at all times

Should a provider not be compliant with the standards required, CQC can:

give a warning notice

impose conditions

suspend registration of some services

issue a fine

prosecute

close services by cancelling registration

CQC is cost blind

New CQC website

New site developed with the help of our inspection staff, the public and providers – launched October 2011

Improved, accessible information for the public, the site features a dedicated section for organisations we regulate

Every provider and location has a profile page where we publish our reports, latest judgments about the care provided and latest regulatory activity

People visiting the site have access to detailed information on services including full reports by inspectors and information from people who have used a service

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How it looks

• Consumer focused

• Clear about what we do/can offer the public

• Focused on ability to look up location level reports/see major action we’re taking

• Information for providers and corporate information clearly signposted

Health and Social Care Bill 2011, ALB review 2010

CQC well placed in Bill – joint licensing with Monitor; working with Clinical Commissioning Groups, NHS Commissioning Board, NICE, ADASS and other major players

Creation of HealthWatch England – ‘Consumer champion’ within CQC for health and adult social care services in England. Independent body within the regulator. Start date 1 October 2012

Arm’s Length Bodies review – taking on new responsibilities:

Human Fertilisation and Embryology Authority

Human Tissue Authority

HealthWatch

Local Government Information Board

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Closing comments

The public puts its faith in those who run and work in care services

There must be a culture that won’t tolerate poor quality care, neglect or abuse – and encourages people to report it

The regulator cannot be everywhere, so we need to regulate with others

We remain cost blind in checking standards

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Questions

CQC – Helping make care better for people

www.cqc.org.uk

Questions?