Current and future developments at CQC Amanda Stride – Head of Inspection Sally Newell – Inspection Manager 6 February 2020 1
Our role and purpose The Care Quality Commission is the independent regulator of health and adult social care in England We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve 2
Overall ratings for adult social care 18,596 (80%) 3,462 (15%) 994 (4%) 288 (1%) Inadequate Requires Good Outstanding improvement Source: CQC ratings data 10/01/2020 Figures are percentages 3
Ratings by key question Safe 81 1 17 <0.5 Effective 88 <0.5 11 1 Caring <0.5 4 91 5 Responsive 85 <0.5 9 5 Well-led 74 2 20 4 Source: CQC ratings data 10/01/2020. 4
State of Care 2018/19 Download the report by holding your phone camera to this QR code! #StateofCare 5
State of Care 2018/19 • People’s experience of care is determined by whether they can access good care when needed • Risk of being pushed into inappropriate care settings • Increased demand and challenges around access and workforce risk creating a perfect storm 6 #StateOfCare
State of Care 2018/19: A perfect storm Access and workforce issues 8% Specialist nurse shortage of acute wards for 10% adults and psychiatric intensive of wards for people with learning care units rated disabilities and/or autism rated inadequate , up from inadequate , up from 1% in 2018 2% in 2018 8% fewer learning disability nurses than in 2015 #StateOfCare 7
State of Care recommendations 2018/19 • Action from parliament, government, commissioners, providers and communities for: • more and better services in the community • innovation in technology, workforce and models of care • system-wide action on workforce planning • Long-term sustainable funding for adult social care #StateOfCare 8
Adult social care specific findings Overall 80% rated good • Concerns about capacity set against growing unmet 4% outstanding need • Staffing is under pressure with high turnover, high 15% requires vacancy rates and a lack of improvement people with the right skills • Continued uncertainty 1 % inadequate about long-term funding #StateOfCare 9
CQC Continues to Change • CQC is transforming to support innovation, cross-sector working and improvement in front line services and the wider system • CQC will have a more targeted, responsive and collaborative approach to regulation so more people get high-quality care: Easier for providers to work with us to do their job and innovate Easier for the public to use what we know to make choices about care Easier for inspectors to do their jobs 10
Improvements: shorter reports and new FAC Reports • More focused, more accessible, better quality • Only one style for all inspection types • Feedback at end of site visit • Providers who tested them find them ‘easier’, ‘great to read and informative’, ‘much clearer’ Factual accuracy • Clarity, efficiency and effectiveness • Separate clear guidance • New form on CQC website 11
Improvements: returning to Good and Outstanding services • New approach • Inspectors spend more time on quality • Shift to 80% of inspectors’ time on observing and speaking with people • Inspectors can flex these guidelines and be curious 7
Leadership and culture • Involving people who use services and their families • Shaping the culture of the organisation • Staff feeling valued, given a voice and empowered to ‘steer the ship’ • Constant focus on improvement “There’s a saying that to be a good leader you’ve got to have good followers. No. To be a leader you’ve got to breed more leaders.” Jamie Stubbs, Senior General Manager Ottley House Nursing Home 13
Driving improvement across health and social care: themes • Report series features providers that have increased their quality rating considerably • Similar themes for all reports • What themes stand out? • Leadership • Culture • Person centred care • Staffing & support • Outward looking • Happy staff means better care 14
Effective staffing • New website resource • Case studies where health and social care providers make effective use of their staff • Different methods, not just numbers and ratios: • How to make best use of skills and disciplines, or work across the system – improving quality, safety, efficiency, teamwork, development • Taking flexible approaches to staffing can have a positive impact for people using services www.cqc.org.uk/effective-staffing-case-studies 15
Oral health in care homes • Less than half (47%) of care homes providing specific staff training to support people’s daily mouth care • 73% of care plans only partly covered or did not cover oral health at all – homes looking after people with dementia being most likely to have no plan • 52% of care homes visited had no policy to promote and protect people’s oral health 16
Medicines in health and adult social care 1. Pharmacy professionals are vital 2. Improve transfer arrangements 3. Policies must be correct and part of practice 4. Report incidents and learn from them 5. Parity between physical and mental health conditions 6. Leadership from local authorities and commissioners 7. Use electronic systems well 17
Equally outstanding: Common success factors 1. Committed leaders 2. Principles into action 3. Culture of staff equality 4. Apply equality & human rights thinking into quality improvement 5. Staff as improvement partners 6. People who use services at centre 7. Use external help 8. Courage 9. Continuous learning and curiosity 18
New guidance on relationships and sexuality • Supporting people to form and maintain relationships while helping them to understand risks • Also diversity, protecting people from harm, physical disabilities and the importance of offering an environment welcoming to LGBT+ people • Published February 2019 19
Long term segregation • People who are in long-term segregation can experience: • more restrictions than necessary • delays in receiving independent reviews. • This is particularly true for people with a learning disability and autistic people. • Our review into Restraint, Seclusion and Segregation found: • missed opportunities • Poor environment • Lack of staff skills • Staff not trying to integrate people onto the main ward Points 1 – 3, The detention of young people with learning disabilities and/or autism, Second Report of Session 2019, Joint Committee on Human Rights 20
Transforming care for people with a learning disability and / or autism? Joint Committee on Human Rights • In July 2019, 2,270 people remained in institutions. • Of this number 57% had a total length of stay of over 2 years • The number of children in these settings has more than doubled from 110 in March 2015 to 255 in July 2019 12% of inpatient services are now rated inadequate (31 October 2019), up from 1% at 31 July 2018 Points 1 – 3, The detention of young people with learning disabilities and/or autism, Second Report of Session 2019, Joint Committee on Human Rights 21
Next steps Following From July We are 2019 we’ve domestic working and been with Ofsted Final report international visiting Registering to consider March 2020 summit we adult social the right the use of with will be care support – restrictive reccomendat submitting services, changing intervention ions to proposals to some in children’s the market Secretary of Secretary of mental for LD / residential State for State in health Autism services Health and January for rehabilitatio and secure Care those at risk n/ low children’s of secure homes segregation hospitals 22
Interim report: a system not fit for purpose for the most vulnerable people “The 39 people we have visited who are cared for in segregation are in a very vulnerable situation. Their world is narrowed to a highly restricted existence in a single room, or small suite of rooms. They have little or no say over decisions about their lives or their future. Many are also a long way from home - which can make it difficult for families to maintain contact” 23
What have we found so far? • There have been missed opportunities early on - many people we visited had been communicating their distress and needs in a way that people may find challenging since childhood • A high proportion of people in segregation had autism • Some of the wards did not have a built environment that was suitable for people with autism • Many staff lacked the necessary training and skills • In the case of 26 of the 39 people, staff had stopped attempting to reintegrate them back onto the main ward • Some people were experiencing delayed discharge from hospital, and so prolonged time in segregation, due to there being no suitable package of care available in a non-hospital setting 24
Overview of our local system reviews • In 2017 CQC was commissioned by government to carry out a programme of 20 local system reviews. • CQC has now been asked to continue the programme • 3 new reviews and 3 follow up reviews published spring 2019 25
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