Partners in Care Conference February 2012 Debbie Westhead

1. Partners in Care Conference February 2012 Debbie Westhead

2. 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 2

3. Role of a regulator 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

4. The regulation system Single system of registration 1 Single set of standards – the essential standards of quality and safety 2 Strong enforcement powers 3 4 Adult social care Regulation NHS Innovative use of information Independent health care 5 Reduced overall cost

5. CQC – what CQC does and does not do • 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 • What CQC does not do • Wedo 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

6. 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 areresponsive – taking swift action to follow up concerns • We carry out unannounced visits

7. 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

8. 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

9. Refining our regulatory model • 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

10. Unannounced We do not notify providers before we carry out inspections Timely At least once a year or once every two years depending on the provider Flexible We can use different types of inspection to respondto concerns Focused Inspections will focus on outcomes that are important to people using services New approach to inspections Principles of inspection

11. 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

12. 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

13. Forms of regulation 13

14. How can meeting essential standards drive improvement? • Concern • As part of CQC’sDignity and Nutrition Inspection programmeour inspectors judged the respective trust as beingnon-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

15. 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

16. 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

17. 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 inspectorsand information from people who have used a service

18. 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 18

19. 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

20. 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

21. Questions • CQC – Helping make care better for people • www.cqc.org.uk • Questions?