1. CQC at The Suffolk Care Conference

2. What we can cover today… Specific Incidents from April 2015 Duty of Candour State of Care Report 2015 The Suffolk Picture so far

3. Specific Incidents Why the change from 1 April 2015? What are the main changes? The main regulations to consider and further guidance

4. What was the position before? Essential standards Powers of prosecution were limited Examination of Specific incidents limited Almost impossible for CQC to prosecute for a failure resulting in a specific incident HSE and local authorities used Section 3(1) of the Health and Safety at Work etc Act 1974 BUT A “regulatory gap” existed (policy, competence and resource) Public Enquiry into mid-staffs – Sir Robert Francis Report

5. Why have we recently changed our approach to enforcement? “Either the CQC should be given powers to prosecute 1974 Act offences or a new offence containing comparable provisions should be created under which the CQC has power to launch a prosecution” Robert Francis “Fundamental standards: the inviolable principles of safe, effective and compassionate care that must underpin all care in the future… will enable prosecution of providers to occur in serious cases” Jeremy Hunt

6. Examples of Reportable Incidents Scalding during bathing Contact with hot radiators resulting in burns Falls from windows (window restrictors) Falls from hoists Falls or trips generally Bedrails and wheelchairs – faulty, inappropriate or inadequately maintained equipment Choking incidents Absconding (unsupervised, lacking capacity)

7. 7 Common features and Outcomes  Evidence of impact on a specific user of the service  Failures at provider/management not individual care worker level (training and guidance, approach to - risk assessments, equipment maintenance or premises safety).  Reasonably practicable to do more?  Availability of and reliance on topic specific guidance (HSE internet page). Obvious risks and well-known control measures.

8. HSCA 2008 (Regulated Activities Regulations 2014 - Regulation 12: Safe care and treatment The intention of this regulation is to prevent people from receiving unsafe care and treatment and prevent avoidable harm or risk of harm. Providers must assess the risks to people's health and safety during any care or treatment and make sure that staff have the qualifications, competence, skills and experience to keep people safe. CQC understands that there may be inherent risks in carrying out care and treatment, and we will not consider it to be unsafe if providers can demonstrate that they have taken all reasonable steps to ensure the health and safety of people using their services and to manage risks that may arise during care and treatment.

9. HSCA 2008 (Regulated Activities Regulations 2014 Regulation 17: Good governance To meet this regulation; providers must have effective governance, including assurance and auditing systems or processes. These must assess, monitor and drive improvement in the quality and safety of the services provided, including the quality of the experience for people using the service. The systems and processes must also assess, monitor and mitigate any risks relating the health, safety and welfare of people using services and others. Providers must continually evaluate and seek to improve their governance and auditing practice.

10. Care Quality Commission (Registration) Regulations 2009 Regulation 16 Notifications about deaths must be sent to CQC without delay. Regulation 17 The intention of this regulation is that CQC is notified of the death or unauthorised absence of a person in any location who is liable to be detained under the Mental Health Act 1983. Regulation 18 Providers must notify CQC of all incidents that affect the health, safety and welfare of people who use services. The full list of incidents is in the text of the regulation.

11. Regulation 18 Con’t Injuries include those that lead to, or that if untreated are likely to lead to, permanent damage to: a person's sight, hearing, touch, smell or taste any major organ of the body (including the brain and skin) bones muscles, tendons, joints or vessels the development after admission of a pressure sore of grade 3 or above that develops after the person has started to use the service any injury or other event that causes a person pain lasting, or likely to last, for more than 28 days For full list refer to regulation (but not exhaustive)

12. Informing people about the incident Providing reasonable support Providing truthful information An Apology when things go wrong Duty of Candour Being open Transparent When things go wrong with care and treatment

13. When things go wrong Death Severe / moderate harm Psychological harm

14. Applying our approach

15. Inspections S2: Are lessons learned and improvement made when things go wrong? W3: How does the leadership and culture reflect the vision and values, encourage openness and transparency and promote good quality care?

16. Enforcing the Duty of Candour We will report on the duty of candour in our inspection reports at provider level. We will assess whether the service requires improvement or is inadequate. Considering whether the regulation has been breached. In all situations we will need to determine the most appropriate, relevant and proportionate approach in meeting this regulation on a case by case basis. A management review meeting to review concerns in relation the Duty of Candour.

17. State of Care 2015: A challenging environment Despite challenging circumstances, the majority of services have been rated as good, with some rated outstanding

18. There is significant variation in quality - and safety continues to be the biggest concern Safety

19. Strong leadership is emerging as more crucial than ever to delivering good care Leadership Effective planning Focus on delivering for people Culture of openness and staff engagement Willingness to collaborate with partners

20. Adult social care A registered manager consistently in post has a crucial influence on quality Staff recruitment and retention remain a serious challenge

21. Everyone should have the right information Everyone should be treated with dignity and respect Providers should ensure equality for their staff Equality Significant variation in access, experience and outcomes

22. The future Strong leadership Good communication with staff and people using services The skills, experience and visibility of management A strong, positive and open organisational culture Learning when things go wrong Strong governance Cross-sector collaboration New models of care Better data transparency Looking to the future together Putting quality of care at the centre of change and innovation

23. Focusing on quality Providing better information Encouraging innovation Becoming a more efficient regulator Working with partners to encourage improvement Our new strategy for 2016-2021 will help us to achieve these goals What is CQC’s role?

24. 24 Suffolk - The picture so far… RatingSafeEffectiveCaringResponsiveWell-ledOverall Outstanding 12511 Good951031269510497 Requires improvement 433614403242 Inadequate94 587 Currently 353 Registered Locations – Care and Nursing Homes, Domiciliary, Supported Living, Extra Care Housing, Community Health Care Services, Community Rehabilitation Services.

25. Thank you enquiries@cqc.org.uk @CareQualityComm