1. CQC Thematic Activity
Emma Steel
Bernadette Hanney

2. What we will cover
Our regulatory model and the context for thematic activity
Thematic reviews
Themed inspection programmes

3. Legislation and standards
Parliament
Dept of Health
Care Quality Commission (Registration) Regulations 2009
Health and Social Care Act 2008 (Regulated Activities) Regulations 2010
CQC
Single system of registration
Single set of standards
Strengthened and extended enforcement powers
The legislation requires any provider of regulated activities anywhere in England, to register. The requirement to register is based on what you do, not on the type of organisation. Most providers will register for several activities.
The legislation also sets out the requirements for quality and safety. These are the bottom line – not complying with these regulations is an offence, and we have powers to restrict or even close services which do not comply with them, or we can start court proceedings which can result in fines. It depends on which will be proportionate and the most effective way to protect patients and ensure improvement.
This form the platform for all of our regulatory activity. Our core business is that of ensuring compliance with these regulations, which means thematic activity needs to support the essential standards specifically and help our operations staff target those providers most likely to be non-compliant. 3 3

4. CQC – what CQC does and does not do
CQC’s role
Register – inspect – enforce – publish
CQC registers care providers then checks whether they are meeting essential standards
If not, we take action – they must put problems right or face enforcement action
We publish what we find as quickly as possible
We share what we know with our partners
We put a premium on users/ whistleblowers
We monitor the care of those detained under the MHA
What CQC does not do
We do not make assessments of commissioning – although we can comment on shortcomings via themed reviews and investigations
We don’t assess quality above essential standards
We only promote improvement by focusing on non- compliance
Inspectors are encouraged to describe what they see, comment on good practice and reference it
This is a slide not to dwell on, but for the purpose of today’s discussion it’s worth highlighting the fact that CQC is not an improvement body beyond the minimum standards. We only seek to improve those providers that fail to meet the minimum standards and so our thematic activity will be developed with that principle as it’s foundation. 4 4 4

5. Forms of regulation
It’s a complicated field with many players. 5

6. Scale of CQC regulated care
Primary medical services
9,000 locations
Independent healthcare
2,500 locations
Independent ambulances
350 locations
NHS Trusts
2800 locations
Adult social care
24,000 locations
Primary dental care
10,000 locations
Some indication of CQC’s scope – about 31,600 providers operating around 50,000 services when we welcome primary care providers into regulation in 2012.
But, the bare numbers hide the complexity.
Primary care will be a huge part of what we regulate. There are 409 NHS trusts but some trusts may have 2, 3 or 4 hospitals, each with huge complexity and hundreds of beds. An independent hospital can be large and complex, a care home can be just a handful of beds. But the volume of providers and fragmentation of the social care market makes it time consuming to handle and challenging to develop methodologies that draw out the ‘outliers’ i.e. the most risky providers.
The NHS (both primary and secondary care) is data rich, leading us to have a much greater opportunity to exploit this as a resource to identify risk of non-compliance. The social care and independent health care sectors are significantly less wealthy when it comes to quantitative data but there is still a valuable qualitative data set which holds potential in identifying risk. The difference in both volume and type of available data is a major factor in the type of methods we employ.
Combined outpatients and inpatients
77.4 million
People using adult social care services
1.75 million
Dental appointments
36.4 million 6

7. Priorities in action Our regulatory model:-
Using information to identify risk is one of the integral tasks of our regulatory model and we will demonstrate how we do this through the gathering of and analysis of quantitative an dqualitative data as well as observations and talking to people who use services through our inspection methodology.
Taking swift action– working with providers when a problem is identified to put it right before going on to take stronger action only if needed.
Information for choice – eg. New provider profile on our recently re-launched website

8. Our Regulatory Compilation
Inspection
Analysis
Voices
Themed inspections
Scheduled inspections
Responsive inspections
Investigations
Thematic reviews
Quality Risk Profiles
Surveillance
Other data sources
Website feedback
Telephone or written feedback
Third party feedback
Whistleblowing
Safeguarding
This then presents the range of methods which we employ to monitor compliance.
Bernadette will be talking specifically about themed inspections which is one of the 3 different types of inspection we undertake. This activity is underpinned by the information we collect from the public and people who use services and the methods we employ to analyse quantitative data.

9. Thematic Reviews & Themed Inspections
Applicable to all inspectors
Where information can provide assurance and increase efficacy
Promotes consistency in follow up of concerns
increase confidence in Operations' interpretation of data
Can be precursor to a themed inspection, directing areas to examine
A sub set of inspectors
Where data is not available or cannot provide sufficient assurance
Where supported and coordinated inspection is preferred methodology
Random set of providers inspected
Can test the risk model and provide feedback
THEMATIC REVIEWS
Service level
Risk driven
Proportionate
THEMED INSPECTIONS
First Richard will take you through a couple of examples before Bernadette talks about themed inspections.

10. Proposed topics so far Maternity: staffing and outcomes
Physical health needs of people with a learning disability
Pressure sores
End of life care for people in care homes
Deprivation of liberty safeguards
Hospital discharge arrangements
Medicines management
Care of people with mental health needs in A&E
Selected due to risks identified in operations e.g. pattern in risk register, gaps in assurance

11. Type 1 Thematic Review
Suitability: a prescriptive commission to identify trusts at high risk of non-compliance within a specific topic area
Purpose: to maximise the use of existing data for risk based activity
Output: a hybrid of data analysis (RAG status at provider level) and expert prompts
Example: maternity: staffing and outcomes thematic review

12. Maternity review provider report

13. Maternity review provider report
Individual scores are presented here
Click on these questions to find out more about the results including links to outcomes and national standards.
Click here to check the data period and weight of the data item
If data is presented graphically or there is important additional information,
you can click here to reveal the graph

14. Total number of maternity providers = 144
Regulatory response
Total number of maternity providers = 144
Initiated responsive review 6
Bring forward planned review 3
Add further concerns to a responsive review already underway
Highlighted new concerns 13
Aware of risks and enforcement action already being taken 3
Positive local intelligence outweighed risks in the report 6

15. Type 2 Thematic Review
Suitability: collating all available data to create a comprehensive picture; alternative presentation of existing data
Purpose: to present a picture which adds value through correlation or triangulation with other sources
Output: a complete, current data set as a baseline report with limited policy interpretation
Example: Deprivation of Liberty Safeguards thematic review

16. Deprivation of Liberty provider report

17. Deprivation of Liberty provider report

18. New approach to inspections
Timely
At least once a year or once every two years depending on the provider
Focused
Inspections will focus on outcomes that are important to people using services
Flexible
We can use different types of inspection to respond to concerns
Unannounced
We do not notify providers before we carry out inspections
Principles of
inspection
As part of CQC’s proposed changes inspections can be:
Responsive
Scheduled
Thematic
Timely
Once a year for all adult social care and independent health care locations and NHS acute hospitals; all NHS Ambulance Trusts - at least one service in all other trusts
Once every other year for all primary dental practices and primary medical services
CQC may decide to focus on additional outcomes based on the care a service provides, the level of information we have, the risks to people and the approach relevant to the sector regulated
Focused - NHS, adult social care and independent healthcare services will focus on one fixed outcome from five key areas of essential standards – the focus will be smaller for other types of services e.g. dentists

19. CQC Thematic Inspection Programme 2011/12
NHS Dignity & Nutrition Spring/Summer 2011
Learning Disability Services Autumn/Winter 2011
Phase 2 Dignity & Nutrition Winter/Spring 2012 19 19 19 19 19

20. Why do a learning disability inspection programme?
Serious abuse identified in a service for people with learning disabilities:
Winterbourne View 2011
History of abuse in learning disability services:
Ely 1967
Cornwall 2005/06
Sutton and Merton 2006/07 20 20 20 20 20

21. What does the inspection programme comprise of?
Care Quality Commission is undertaking inspections of 150 locations where assessment and treament and rehabilitation is provided.
A second phase will take the learning from phase one and look at alternative models of care. 21 21 21 21 21

22. person who has used services
Inspection teams
Lead compliance inspector for this LD review
Compliance inspector portfolio holder
Experts by Experience:
person who has used services
family carer
Professional advisor 22 22 22 22 22

23. Phase one
Aims
To reassure people who use services, relatives, the public and CQC that the risk of such abuse occurring in any other unit is minimised.
To take appropriate action if concerns arise
To provide information for wider review of LD services.
Actions
Use existing methodology to inspect:
Outcome 4 (regulation 9) Care and welfare of service users
Outcome 7 (regulation 11) Safeguarding service users from abuse
We will report on our findings on every location and produce a national report
A thematic review approach will be used with existing methodology but tools an guidance adapted for this specific review

24. Background to the inspection programme
This review will directly support CQCs two strategic priorities:
We focus on quality and act swiftly to eliminate poor quality care;
We make sure care is centred on people’s needs and protects their rights
If we judge during this review that services are not meeting essential standards we will use our regulatory powers to ensure necessary improvements are made
If we judge during this review that people using a service are at risk, we take swift, proportionate action to protect people 24 24 24 24 24

25. CQC – Helping make care better for people Questions?25 25 25 25 25