KCHA 2015 Conference New inspection programme for CQC

KCHA 2015 Conference New inspection programme for CQC 11 February 2015 Chris Day 1

Our purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care We will be a strong, independent, expert inspectorate that is always on the side of people who use services 2

The landscape of care General public Care homes Home-care 53 million (35 million adults) • 565, 000 residents Private hospital • 165, 000 going into care per year 700, 000 people receiving home-care support per year 1. 4 million people receive treatment in a private hospital / year • 39, 000 people with learning disabilities in residential care Dentists • 18, 000 in a care home or care in their own home with no kith or kin • 22 million on a dentist list NHS hospitals • 15 million NHS • 7 million private GP practices Health & social care staff • 52 million registered with a GP • 1. 7 m NHS staff • 1. 5 m in adult social care Stroke 1 m Diabetes 3 m • 11 million inpatients / year • 18 million A&E attendances • 5 million emergency admissions / year • 600 k maternity users • 150 m appointments / year Arthritis 8. 5 m • 90 million outpatient appointments / year • 42, 000 detained and treated against their will Cancer 2 m Dementia 0. 7 m 25% by 2020 67% by 2025 100% by 2030 100% by 2032 100% by 2040 NB There is overlap between our different audiences – none are wholly distinct from the others

What kind of regulator? Independent of politics and the system Covers all sectors Clinically driven with expert teams, no guarantees Evidence-based judgement, not regulatory compliance Highlight excellence and expose poor care with transparent ratings Always on the side of people who use services Critical friend Consistent and fair 4

Recent facts and figures 5

Our new approach 6

Timeline October 2013 January 2014 • First ‘wave’ of NHS acute trusts • We published Intelligent Monitoring for all NHS acute trusts • Plans for ASC, GPs, mental health, and community health • First ‘wave’ of inspections of mental health, community health, and out of hours primary care • First ratings published for NHS acute trusts April 2014 July/August 2014 October 2014 • Regulation of NHS acute trusts now using new approach • First ‘wave’ of inspections of GP practices and adult social care • Regulatory handbooks published for consultation for all major providers • First ‘wave’ of inspections of ambulance services • Guidance on legal regulations underpinning our work published for consultation • Plans for dentists and substance misuse services • Regulation of adult social care providers using new approach – first ratings • Regulation of GPs using new approach • Regulation of community and mental health – new approach January 2015 April 2015 • Regulation of ambulances using new approach • First ‘wave’ of inspections of prison healthcare services, dentists, substance misuse services and independent doctors • Regulation of all health and care providers using new model Our New Approach

What are we doing differently? Larger inspection teams including specialist inspectors, clinical experts, and Experts by Experience Intelligent monitoring to decide when, where and what to inspect Inspections will focus on five key questions about services We have developed services/groups and pathways that we focus on in each sector KLOEs (key lines of enquiry) form the overall framework for a consistent and comprehensive approach Ratings compare services and highlight where care is outstanding, good, requires improvement or inadequate 8

Our new approach We ask these questions of services: all Is it safe? Is it effective? Is it responsive? Is it caring? Is it well-led? 9

Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 10

First ASC inspections and ratings Outstanding 4 Good 370 Requires improvement 144 Inadequate 31 As at 19 January 2015 11

Q 4 ratings 2014: by key question Source: CQC ratings published October to December 2014 12

Rating inadequate – sample findings so far ‘We were not assured that there were always sufficient staff available to meet people’s individual needs’ (Safe) ‘The provider had not taken steps to maintain and provide a safe environment for people to live in’ (Safe) ‘There were restrictions imposed on people that did not consider their ability to make individual decisions for themselves’ (Safe) ‘People were unoccupied for long parts of the day’ (Responsive) ‘People were not always supported to receive adequate nutrition and hydration’ (Effective) ‘Staff did not understand their responsibilities under the Mental Capacity Act 2005’ (Effective) ‘Staff felt they were not listened to and were blamed when things went wrong’ (Well-led) 13

Rating outstanding – sample findings so far ‘People and staff had high expectations of what each person could achieve and showed determination to succeed’ (Caring) ‘Staff skills, hobbies and interests were matched with the interests of the people they supported’ (Caring) ‘The management team provided strong leadership and led by example’ (Well-led) ‘Staff were encouraged to challenge and question practice and supported to change things’ (Well-led) ‘The environment had been arranged to promote people’s wellbeing. Staff worked creatively to best use the space to support people’s independence and personal identity’ (Effective) 14

The importance of leadership: being well-led drives up quality “It’s the leaders in organisations who really make a difference to the cultures of organisations – by what they attend to; what they value; what they monitor and what they model in their behaviours. The challenge for us is how can we ensure we have leadership, which ensures that there is a focus on the vision of providing high-quality, continually improving, and compassionate care at every level of the organisation? Not just in the vision or mission statements but in the behaviours throughout the organisation. ” Michael West, The King’s Fund 15

Have your say www. cqc. org. uk/content/special-measures-adultsocial-care-comment-our-proposals Until 30 Jan www. cqc. org. uk/ascmarketoversight From 23 Jan to 20 Feb New requirement to display CQC ratings www. cqc. org. uk From 26 Jan for 4 weeks @Care. Quality. Comm #tellcqc 16

Join our team Inspectors and Registration Inspectors Permanent and secondment opportunities now available - please email: recruitment@cqc. org. uk Specialist Advisors If you have specialist experience in Adult Social Care you could assist us in inspections – please email: adultsocialcarerecruitment@cqc. org. uk Experts by Experience CQC is committed to hearing the voices of people who use services. Our new approach uses experts by experience. Contact us here: expertsbyexperience@cqc. org. uk

Thank you www. cqc. org. uk Chris Day Director of Engagement 18