Quality and Risk Profiles (QRP)

1. Quality and Risk Profiles (QRP) December 2009

2. Quality and Risk Profiles (QRP) • Introduction • What are QRPs • What they are not • Information flow ideals and getting the best out of information • The vision? • What’s Happening Now • Versioning and timelines • V0s for NHS, ASC, IHC • V1 for NHS • Future

3. Introduction

4. What are they? • A way of gathering all we know about organisation • So as to assess risk and thus prompt front line regulatory activity • Allow the judgements of this activity to be made robustly and add to the knowledge base • Critically, it builds over time and is never “perfect” • This is essential to support registration (or more specifically the ongoing monitoring of compliance following registration) but, because information can be used flexibly later versions could be focused on different issues

5. What they are not • QRP produces an automated initial risk estimate – it does not produce judgements • The QRP is designed to prompt action, NOT direct it – it requires a decision by front-line inspection staff about what to do in response, tempered by local knowledge and guided by the judgement framework • One size does not fit all – the types and scale of data for NHS, independent health care and adult social care are entirely different.

6. Three distinct QRP activities • Harvesting of different types of information; organising this according to a classification system relevant to purpose; and managing the flows. • A method for calculating risk and presenting findings in a way that front-line staff can use • A way for frontline staff to interpret the profile, use this to make decisions about what to do in response; make judgements and ensure that these are included in our knowledge base and are reflected in the profile.

7. Flow diagram of the QRP Direct data collection VFM Access Periodic Review Local Flavour IR QoL Experience Registration Safety Outcomes Inherent risk Decision Decision Data harvesting – passive /active, surveys, datasets, comments, infocab sweep Data from providers Q&RP system Significant compliance event Info from people with experience of service Info from stakeholders National information Surveys Comments Comments Findings Public ISAs Application Prompted Unprompted Monitoring declarations Variation Map to regs / outcomes / provider taxonomy The register Knowledge base Distillation Compliance risk by UoA Analysis Drill down Activity log & context Contains Intelligence system Public information website Concerns / regulatory plan Publication Additional local evidence/ intelligence CQC findings and judgements on quality Registration “core” of Q&RP Activities in response to view of risk Decision audit trail Workflow support system

8. Turning information into evidence NHS LA, PEAT and ALE already used in this way for Core Standards Assessment of the NHS

9. Care Quality Commission – Quality Profile Anywhere NHS Foundation Trust Inherent Risks Registered in 2010 with 0 conditions imposed Provides general and acute services including emergency surgery and specialist services including Cardiac surgery. For further details click here Summary: Amber Current Intelligence April 15 2012 Surveillance data There is currently 1 live alert There are 4 closed alerts – all were data anomalies Summary: Green Historic Performance Star Rating. AHC and Periodic review performance Special Reviews Patient Surveys Summary: Amber Situational Risk A relatively small Cardiac Surgery department compared with national averages but no consultants operating below College Guidelines For further details click here Summary: Green Registration outcomes 5/21 judgement categories show highest level of risk of poor outcomes for patients See all screening + reports Summary: Red Written Intelligence Inspector interviewsreveal common themes of Dignity and respect (poor) Patient safety (mixed) Hygiene and cleanliness (good) Patient pathways with social care (poor) LINKs report no concerns with this Trust We have 294 comments received on our website 73 (25%) relate to Maternity services, the majority are positive Summary: Amber Population Risk A more deprived, older population with generally poorer CAA ratings for local area For further details click here Summary: Red Regulatory Information Risk Summits show widespread concerns about joint working with social services and PCTs; handling of patient complaints and clinical leadership See all regulatory information Summary: Red Uncertainty Risk 5 interactions in last 12 months. Data flows from trust judged good Uncertainty judged LOWEST

10. What’s happening now ?

11. Time lines and versioning

12. V0.NHS – Delivery January 2010 • Delivered January 2010 • Sector NHS • Purpose Support registration • Format Compendium of existing key information and judgements • Contents up to 20data sources identified from CQC and partner bodies – up to 200 items available will finalise a smaller subset) • Delivery CRM • Plan In place • Training Designed – delivery in December 2009 • Users Assessors, RIEOs • Unit NHS trust (i.e. super location) • Risk model Simple • Inherent risk Minimal, contextual info • Version 0.IHC is designed to allow initial registration to take place.

13. V0.IHC – Delivery April 2010 • Delivered April 2010 • Sector Independent Healthcare • Purpose Support registration • Format Compendium of key information for locations mapped to GaC requirement where possible, not • using GaC sector as for NHS • Contents 9 data sources identified • Delivery CRM • Plan In place • Training To be designed – delivery as part of registration tranche 2 training package • Users Assessors, RIEOs • Unit Location (i.e. current registered entity) • Risk model Minimal – identification of information which shows “concern” • Inherent risk Minimal, contextual info • Version 0.IHC is designed to allow initial registration to take place.

14. Delivered April 2010 Sector ASC Purpose Support registration Format Compendium of judgements against NMS regs mapped to GaC outcomes and other key information not mapped to GaC outcomes Contents NMS judgements, notification and safeguarding data, potentially others including skills for care data, but the overwhelming majority of information available is that gathered by inspectors Delivery tbd Nov 2009 but likely to be dynamic rather than a stand alone report Plan tbd Nov 2009 Training To be designed – delivery as part of registration tranche 2 training package Users Inspectors, RIEOs Unit Location (i.e. current registered entity) with provider “TOP SHEET” Risk model Minimal – identification of information which shows “concern” Inherent risk Minimal V0.ASC – Delivery April 2010

15. Delivered May 2010 Purpose Ongoing monitoring Format Granular data with information mapped to outcome level; risk model tbd but minimum being aggregated at GaC section level {to provide a section risk assessment} designed to prompt regulatory action Sector NHS Contents 30 different data sources with 94 data streams Delivery CRM Plan In place Training to be designed by Dec 2009 – implemented Jan – April 2010 Users Assessors (compliance inspectors), RIEOs Unit tbc {Location} Risk modelIncluded– will develop in later versions Inherent risk Included model Feedback Mechanism to feedback inspector included precise approach tbd V1.NHS – Delivery May 2010

16. Future beyond these versions • NHS: • Updated v1.NHS- As new data become available we will add additional data sources as the year progresses. Initially likely release QRP at set points (but no one big bang). Eventually develop into a ‘live’ document. • Version development – v1.1- 1.n expected throughout 2010 and beyond, as we see it in action, test its efficacy, develop risk model and expand information collation and presentation in the QRP beyond registration outcomes • IHC and ASC: • Development and delivery of version 1s - primary focus of 2010 in these sectors • Designing and developing efficient information flows, feedback loops ect • QRPs for other sectors? GPs, dentists, private ambulances etc