Fundamental Standards: Improving services through regulation Jo Walsh 1
CQC 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 2
The Mum (or anyone you love) Test Is it responsive to people’s needs? Is it Is it effective? safe? Is it Is it well-led? caring? Is it good enough for my Mum? 3
Regulation to inspire improvement What we do: � Set clear expectations � Monitor and inspect � Publish and rate � Celebrate success � Tackle failure � Signpost help � Influence debate � Work in partnership
Regulation to inspire improvement How we do it: � Five questions � Respond to concerns � Key lines of enquiry � Specialist inspectors � Experts by experience � Ratings characteristics � Reports � Enforcement � Co-production
Implementing the new approach New regulations including Fit and KLOES & Proper Person New approach Ratings and inspections All ASC services published rolled out rated by 2016 Duty of Candour September October 2014 2014 Introduced April 2015 6
New for April 2015 � Fundamental standards � Duty of candour � Fit and proper person requirement � Special measures � Scores on the doors � Market oversight 7
Duty of candour � Purpose Promotes adoption of openness and transparency in � services Supports development of safety culture � � Actions required Inform people when things go wrong � Provide support, truthful information & apology � � CQC Registration � Inspection – existing key lines of enquiry � 8
Fit and proper person requirement • A provider cannot appoint an individual as a director unless the individual: • Is of good character, has necessary qualifications and experience, is in good health, is not linked to serious misconduct or mismanagement in the course of the provision of regulated activities • Is not an undischarged bankrupt, on a barred list, or prohibited from holding the office by statute • Has not been convicted of an offence or removed from a professional regulator’s register • The provider must make available to CQC specified documentary proof of the above and relevant employment history • If a director no longer meets these requirements, the provider must replace the director and inform the director’s professional regulator if the director is a registrant. • CQC must refuse to register a provider unless it is satisfied this requirement is met. 9
Fit and proper person requirement � Purpose Ensure directors or equivalents are held accountable � for the delivery of care and They are fit and proper to carry out this role � � Actions required Ensure recruitment of ‘directors’ tests whether � candidates meet the requirement � CQC Registration � Respond to concerns raised � 10
Special measures � Purpose Ensure failing services improve or close � � Actions required Use time available to improve service � � CQC Services rated as inadequate will go into special � measures Time limited period to improve � If improvements made – out of special measures � If no improvement – move to cancel registration � 11
Scores on the Doors � Purpose Public able to see rating of service quickly and easily � � Actions required Use CQC template to display ratings in service and � website Suggest accompany with additional information � � CQC Will provide template � Inspection – check that rating is displayed � 12
CQC and market oversight Clear relationship between quality of care and finances � 13
What will market oversight do? Purpose: Protect people in vulnerable circumstances by spotting if a � provider may fail – and make sure right action is taken CQC will: � � Monitor finances of ‘difficult to replace’ providers � Provide early warning to local authorities � Assist with system response if failure occurs It will not: Either ‘bail out’ struggling providers, or pre-empt failure � through inappropriate disclosure of information 14
Proposed model for market oversight Step 1 2 3 4 5 6 Provider Regulatory Formal Entry to Regular Further risk Activity engagement action & notification scheme monitoring analysis on risk engagement to LAs If concerns identified and addressed Key: Assessment of risk to financial sustainability (all provisional) likely risk/high risk no cause for concern/very low risk risk clearly identified/very high possible risk/medium risk risk 15
Delivering market oversight � New capacity and capability internally: � New team with expertise and experience in � judging business failure risk � managing restructuring and insolvency processes � Supplemented by: � Access to external advice where needed, e.g. Independent Business Reviews � Advisory Group to scrutinise and challenge delivery of market oversight function 16
So what are we finding now? 17
Latest ASC inspections and ratings Outstanding 19 Good 1863 Requires 1046 improvement 280 2 As at 27 Inadequate April 80 2015 18 18 28028
An outstanding care home ‘Relatives and friends visiting the home told us they only had positive experiences and praise for this service’ ‘Staff told us that they would not like to work anywhere else’ Vida Hall, Harrogate 19
Another outstanding care home "We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of their life with as much happiness, love and security as we can give them." Suzanne, Prince of Wales House, Ipswich 20
Latest ASC inspections and ratings Outstanding 14 Good 791 Requires 353 improvement As at 23 Inadequate 93 February 2015 21 21
Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Andrea Sutcliffe Chief Inspector of Adult Social Care @CrouchEndTiger7 22 22
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