CQC Regulation under the Health and Social Care

CQC Regulation under the Health and Social Care Act 2008 SECHA AGM 29 September Louise Bushell and Janet Ortega Compliance Managers

Who are we? We make sure people get better care Who are we improving care for ? People who use services, carers and families People in more vulnerable circumstances Public and taxpayers Our priorities Focus on quality, and acting swiftly to help eliminate poor quality care Making sure care is centred on people’s need and reflects their rights What we will do to achieve our priorities Special reviews and studies Registration Regular reviews of and ongoing Enforcement performance monitoring Mental Health Act visits Publishing information 2

Regulatory functions – how we do our work Ø Outcome-based – Regulation that assesses outcomes experienced by people who use services, rather than targets or processes Ø Risk-based – Responsive to the views of people who use services, using their insights alongside data to trigger regulatory action Ø Enforcement – Earlier identification and swifter action to follow up concerns, including enforcement action where necessary Ø Compliance – Increased compliance by health and adult social care providers; assurance about standards across the board Ø Information – Improved access to timely, relevant and reliable information about our expert judgement of the quality and safety of care Ø Value for money – Reduce unnecessary regulation and associated costs of demonstrating compliance; give providers value for money Ø Process – Improved transparency, speed, consistency and reliability of transactions

Reviews of compliance Responsive A responsive review of compliance: is triggered by specific information that raises concern about compliance is not a full check of compliance for all 16 outcomes (for the core 16 quality and safety standards) is targeted to the area (s) of concern Depending on the concern, may focus on: - the whole provider - one or more locations - one or more regulated activities - a particular service - one or more outcomes May include a site visit All findings will be published Planned A planned review of compliance: Looks across all regulated activities at a location to assess compliance with all 16 outcomes (for the core 16 quality and safety standards) Will take place at intervals of 3 months to no less frequent than 2 years Will be proportionate, with additional activities focused on gaps on information May include a site visit All findings will be published

Site Visits Ø The aim of site visits is to gather evidence of compliance Ø We will have short, focussed unannounced site visits, rather than set piece inspections that require the provider to spend a lot of time in preparation Ø Site visits will primarily centre on the assessment of outcomes - the experiences people have as a result of the care they receive Ø Site visits will be direct checks of compliance rather than assessing compliance through the assurance systems the organisation has in place. Ø Therefore site visits will always include direct observation of care and we will spend time with people who use the service, their families and carers, unless not appropriate to do so. We may also talk to managers and staff. Experts by experience will join us on some site visits to help us engage with people who use services. Ø Site visits will take place as often as required to ensure that providers are meeting essential standards of quality and safety. This is likely to lead to more frequent site visits but shorter duration and more focused.

Monitoring ongoing compliance Judgement on Risk Using the Guidance about Compliance and Judgement Framework: No concern Minor concern Moderate concern Major concern Follow up enquiries will be targeted Regulatory Judgement Maintain registration Improvement actions: Improvement letter Enforcement actions: Statutory warning notice Imposition or variation of conditions Fines Regulatory Response Using framework: Translates minor, moderate or major concerns into regulatory action Takes account of the provider’s capacity to improve Action will be proportionate Prosecution Suspension of registration Cancellation of registration

Evaluating Evidence Ø Essential Standards of quality and safety Ø Judgement Framework Ø Setting the bar: Monitoring of compliance

CQC in a changing environment The public puts its faith in those who run and work in care services - but sometimes care fails or presents too much risk CQC must act swiftly when it sees signs of poor care and take strong action when things go wrong in care services Regulation is not the only answer - quality and safety is everyone’s business Must be greater integration between health and social care – this will improve outcomes and improved efficiencies

CQC in a changing environment – continued We have had a critical 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 are seeking additional funds from government

Moving Forward Pilot methodology for planned review No provider compliance assessments Outcomes 4, 7 and 16 as a minimum Domiciliary care pilot 10

Moving Forward Enforcement policy consultation Judgement framework and our regulatory response 11

Questions • Any Questions? 12