The Role of CQC Martin Haines Enfield Health Scrutiny Panel 10 - PowerPoint PPT Presentation

The Role of CQC Martin Haines Enfield Health Scrutiny Panel 10 October 2018 1

Our purpose and role • We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve • Register • Monitor and inspect • Use legal powers • Speak independently • Encourage improvement • People have a right to expect safe, good care from their health and social care services 2

Ambition for social care: The Mum Test (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

The landscape of care Care homes GP practices NHS hospitals • 58.9 m registered • • 93.9 million 460,000 beds with a GP • 223,000 Nursing outpatient • 7,700 GP home beds appointments / year practices • • 12.6 million inpatient 237,000 Residential home episodes / year beds • 23.7 million A&E England attendances / year Dentists 55.3 m • 636,000 baby • 22 million adults (45.2m deliveries / year seen by NHS adults) every 2 years Ambulances • 6.8 million • 6.9m calls children per year receiving a face Private Health & social Home-care to face response hospitals care staff 500,000 + people • 10 NHS trusts • 1.2m NHS Over 1,200 receiving home- • 251 independent private staff care support at hospitals and ambulance • 1.58m in adult any one time clinics social care providers

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 5

Our current model of regulation Monitor, Independent Register inspect Enforce voice and rate We register We monitor Where we find We provide an independent those who services, carry poor care, we voice on apply to CQC out expert ask providers the state of to provide inspections , to improve and health and adult health and and judge each can enforce social care adult social this if service, usually in England on care services to give an necessary issues that overall rating , matter to the and conduct public, thematic providers and reviews stakeholders 6

What do the overall ratings mean? Outstanding The service is performing exceptionally well . Good The service is performing well and meeting our expectations. Requires improvement The service isn't performing as well as it should and we have told the service how it must improve. Inadequate The service is performing badly and we've taken action against the person or organisation that runs it. 7

An overview of CQC’s civil and criminal enforcement powers Criminal powers Civil enforcement powers • Requirements • Impose, vary or remove • Penalty notices • Simple cautions (formerly known as conditions of registration • Prosecutions compliance actions) • Suspension of registration • Warning notices • Cancellation of registration • S.29 warning notices • Urgent procedures Holding individuals to account Failing services • Fit and proper • Immediate action to person requirement protect from harm • Prosecution of Protect people who • Time- limited ‘final chance’ use services by individuals • Coordination with other requiring improvement oversight bodies Severity Hold providers to Protect people who use account for failure services by requiring improvement 8

Why do we place a service in special measures? Service is rated Service is rated Inspection inadequate inadequate for one of 5 key questions Service is placed in special Service is given up to measures 6 months to improve Second inspection Service has improved and is Service has not rated requires improvement demonstrated sufficient or above improvement Service is placed in special measures 9

Market oversight Aims Spot if a ‘Southern Cross’ could happen again 1. 2. Protect people in vulnerable circumstances Monitor finances of ‘difficult to replace’ providers 3. 4. Provide early warning to local authorities and assist in coordinating system response if failure occurs MO does not : 1. Protect providers from failure 2. Pre-empt failure through disclosure of information Mechanism – analysis of quarterly financial and quality information to provide the necessary notification to LA(s) so they can invoke contingency planning arrangements 50 providers in the scheme 10

Ambition Our ambition for the next five years: A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care 11 11

Four priorities to achieve our strategic ambition 1. Encourage improvement, innovation and sustainability in care 2. Deliver an intelligence-driven approach to regulation 3. Promote a single shared view of quality 4. Improve our efficiency and effectiveness 12

Our priorities for 2018/19 Quality Inspection Cross- Registration matters and rating cutting work Reducing Supporting Green Paper Transformation duplication for relationships in and other programme providers residential care reports What ‘good’ Registering the looks like in Innovation and Right Support nutrition and technology mealtimes Implications for Address Provider-level inspection and inconsistencies assessment enforcement and improve our approach 13

CQC new approach: Evolution not revolution closer working more targeted more greater and approach that integrated emphasis on alignment focuses on approach that leadership , with NHS areas of enables us to including at Improvement greatest be flexible the level of and other concern , and and overall partners so where there responsive to accountability that providers have been changes in for quality of experience improvements care provision care less in quality duplication

A more targeted, collaborative and responsive approach • Jan 2017, almost 5,900 services were rated RI • 675 services rated RI did not have a Registered Manager • Our strategy set out our ambition to achieve “a more targeted, collaborative and responsive approach to regulation so more people get high- quality care” • In the next phase of our inspections, we will be focussing on services rated RI 15

Key points • The majority of people are receiving good quality care . This is something to celebrate. • Over 80% of inadequate services improve on re-inspection but for services that require improvement nearly 40% don’t improve and 5% get worse • We are focusing on encouraging improvement in services rated RI • We will do this flexibly and proportionately , using inspector judgement and existing risk and enforcement frameworks • We will monitor these services more closely to identify changes in quality (up or down) and respond more quickly, as required 16

Focused inspections based on risk • ASC will use focused inspections based on risk • Inspections will consider Well-Led alongside any other Key Questions where there are risks, concerns or improvement • The 6-month limit for a focused inspection to change an overall rating will, be abolished • Overall ratings will be calculated using • ratings for Key Questions looked at during the focused inspection • ratings for Key Questions not looked at in the focused inspection but brought forward from the last comprehensive inspection • Focused inspections will retain flexibility to expand to become comprehensive inspections where this is necessary 17

Are adult social care services closer to the tipping point? 18

Variation and the tipping point Some areas closer to the tipping point, others further away Source: CQC ratings data, 31 July 2017 Factors affecting the tipping point vary geographically – ratings variation is one aspect ADULT SOCIAL CARE RATINGS BY LOCAL AUTHORITY Percentage of good and outstanding Top 20% Upper 20-40% Middle 20% Lower 20-40% Bottom 20% 19

Adult social care findings 1/2 • 78% rated good, but 19% rated requires improvement and 1% (303 locations) inadequate • Community services rated 86% good. • Nursing homes 28% requires improvement and 3% inadequate, affecting c6,300 people • Caring rated best – 92% good and 3% outstanding. Safe and well-led poorest – 22% requires improvement and 2% inadequate 20

Adult social care findings 2/2 • High-performing services have strong leaders – innovative registered managers known to staff, people using the service, carers and families had a positive impact • High-quality services are person-centred – staff get to know people as people, understanding their interests, likes and dislikes • Most enforcement for poor care relates to governance, safety, staffing and person-centred care • Quality matters joint commitment developed 21

The next State of Care publication is due to be published on Thursday 11 October, 2018