1. © Nuffield Trust Review of aggregate assessment of providers of health and social care in England ('Rating Review‘)

2. © Nuffield Trust TOR Process Early merging headlines Questions for discussion Next steps

3. © Nuffield Trust Terms of reference I To map the current system of assessing the quality and safety of care of providers of health and social care and the current system of accountability for quality of care. To identify the advantages and disadvantages of aggregate assessment of providers of health and social care. To identify in broad terms how best to combine relevant current and historic data on quality (safety, effectiveness, and user experience) and information from inspection to provide useful, credible and meaningful aggregate assessment for comparing the performance of organisations providing health care and social care. Key goals will be to use existing metrics, rather than require costly new data collection, and not to create extra burdens on providers.

4. © Nuffield Trust Terms of reference II To suggest priorities for developing data and testing metrics in the short to medium term to allow better aggregate comparative assessment. To identify which organisation/s might be best placed to provide such aggregate comparative assessments.

5. © Nuffield Trust TOR Process Early emerging headlines Questions for discussion Next steps

6. © Nuffield Trust Process I Report to SoS by 31 st March 2013. This is an independent report (no DH ‘sign off’) but ongoing meetings with DH and SoS The Review Secretariat is support by an expert advisory Group. Studying literature (relevant work by a range of bodies) Engagement with relevant individuals, bodies and sectors Engagement events with stakeholders(Jan and early Feb) Formal online consultation process (8 weeks to 15 th Feb)

7. © Nuffield Trust TOR Process Early emerging headlines Questions for discussion Next steps

8. © Nuffield Trust Early emerging headlines Positive view that an aggregate rating can add value but worries about how the rating would be compiled e.g. who should set standards (govt or professionals with public)? Sector led improvement provider differentiation: care homes, domiciliary care, children's services for example but generally accepted much less heterogeneity than in hospitals. There is less data available in social care for surveillance, therefore the role of inspection may be more significant as would emphasis on care and compassion.

9. © Nuffield Trust TOR Process Early emerging headlines Questions for discussion Next steps

10. © Nuffield Trust Under CSCI… Validity Were aggregate CSCI ratings of the quality of social care providers perceived to be accurate or a fair assessment? Use Did local authority commissioners use aggregate ratings, or inspection reports of the quality of social care providers that were published by CSCI? If so which were more helpful? Did the public/clients/carers/relatives use the CSCI ratings, or inspection reports?

11. © Nuffield Trust Under CSCI… Impact Did ratings (inspection reports) from CSCI help to push up quality in social care providers? Is there strong evidence? If so in which providers was the impact greatest? What was the mechanism by which providers improved? To what extent did public reporting of aggregate ratings (inspection reports) have an effect?

12. © Nuffield Trust Now I Is an aggregate rating a good idea for social care? Rating: content How should the indicators that would go into such a rating best be identified? To what extent should there be national or local political input? Or should this be an exercise free of vested interests? Balance of inspection vs indicators? What outcomes (as opposed to inputs or process) measures exist to assess quality in social care? If there were a national aggregate rating across care providers, would there need to be differentiation across different providers?

13. © Nuffield Trust Now II Performance If a provider is not achieving required standards as assessed by the CQC what happens? What are the main incentives for a care provider to improve performance? Could a published national aggregate rating help? Is there clarity in the roles (to assess quality of care) between CQC and local authorities? If not, how could a clear division of responsibilities be identified?

14. © Nuffield Trust TOR Process Early emerging headlines Questions for discussion Next steps

15. © Nuffield Trust March 2011 www.nuffieldtrust.org.uk Sign-up for our newsletter www.nuffieldtrust.org.uk/newsletter Follow us on Twitter (http://twitter.com/NuffieldTrust) © Nuffield Trust