Supporting Improvement – Registration and Inspection March 2010

What is CQC? The independent regulator of health and adult social care – public, private or voluntary sector.

A Merged Commission

Promoting high quality care CQC aims to drive improvement across health and adult social care. Our vision is of high quality care that is: safe has the right outcomes - people get the right treatment they need and are well cared for a good experience promotes healthy independent living available when needed good value for money

Our responsibility for regulation CQC regulates - organisations providing care.. - Services and pathways of care… - People detained under the Mental Health Act - Local Authorities (adults) and PCTs buying care for their communities Includes all children and young people using health services……and services for adults who may be parents/carers

6 Our 5 strategic priorities Our 4 regulatory activities Our 5 delivery priorities Make sure care is centred on people’s needs Championing joined-up care Acting swiftly to help eliminate poor quality care Promoting high quality care Regulating effectively in partnership Registration and compliance monitoring Assessments of quality Mental Health Act visiting Other statutory regimes Register NHS by April, monitor compliance Register ASC and IHC by Oct, focus on poor and adequate Significant organisational change inc field force model A local delivery focus Building our reputation Our Context

Our plans for children’s services work Within the strategic framework…we want to Improve outcomes and experiences Make sure services are joined up and safe Improve health through focus on preventative work and joint inspection / commissioning Improve the information we have Build our own capability to understand issues for children and young people Engage with children, young people and families

How do we make improvement happen? A) Registration and compliance monitoring Applies to provider services (NHS and Independent): Ongoing compliance with new quality standards Monitoring of incidents, concerns and data about providers B) Assessment of quality - commissioning services Limited criteria for , Partnership, joint commissioning, etc C) Assessment of Quality - special reviews and studies of providers, commissioners, partnerships, networks, etc

2. How CQC Regulates - Registration Objective of Registration People experience services that meet essential standards of quality, protect their safety and respect their dignity and rights. Registration Single system of registration Single set of standards Strengthened and extended enforcement powers Adult social care NHS Independent healthcare

Registration and compliance against Standards There are 16 quality and safety standards and a small number of others, arranged into sections: Section 1: Involvement and information Section 2: Personalised care, treatment and support Section 3: Safeguarding and safety Section 4: Suitability of staffing Section 5: Quality and management Section 6: Suitability of management

Example of an OUTCOME Plain English People-focused Outcome-based OUTCOME 7 What should people who use services experience? People using the service: Are protected from abuse, or the risk of abuse, and their human rights are respected That is because providers who are compliant with the law will: Take action to prevent abuse from happening in a service. Respond appropriately when it is suspected that abuse has occurred Ensure that Government and local guidance about safeguarding people from abuse is accessible to all staff and put into practice Make sure that any means of restraint or management of disturbed behaviour that is used is appropriate, reasonable, proportionate and justifiable for that individual Protect others from the effect of the person’s disturbed behaviour. Safeguarding vulnerable people who use services

Relevant Outcomes / Standards for children’s services / safeguarding 1 - Respect and Involvement 2 - Consent13 - Staffing 4 - Care and Welfare14 - Supporting workers 5 - Meeting nutritional needs16 - Assessing quality 6 - Co-operating with others21 - Records management 7 - Safeguarding people 9 - Medicines 10 - Safe suitable premises

Monitoring Compliance CQC will monitor compliance against outcome standards for each service and each location (setting) Quality and Risk Profile for every organisation uses: Data from inspections Information from service users National benchmarked data from others Local intelligence Information is weighted and judged against each outcome Range of enforcement powers are available

Workshop How much have you been involved in registration arrangements? How have you provided assurance against standards? What are the key outcomes standards which have been most challenging?

The Ofsted/ CQC integrated inspection programme

Joint Inspection Programme 3-year programme across all 152 authorities Assessment against two main themes in addition to contribution to partnerships the role of the board: how boards assure themselves in relation to safeguarding and the health of looked- after children whether staff have the right skills and experience to recognise concerns, share information and escalate problems where necessary

Reference documents and rationale for health LAC health statistics remain poor Recent statutory guidance strengthens health role Working Together sets out requirements Joint inspections with CQC and Ofsted focussing on safeguarding and LAC

We will evaluate: Effectiveness and management of safeguarding systems/ frameworks and Child protection concerns Wider safeguarding role of public services Safeguarding of vulnerable groups - asylum seekers, secure settings, Effectiveness of safeguarding supervision and resource allocations Looked after children (LAC) and health services – including quality and effectiveness of LAC placements and care, and support for LAC families and carers Local Children’s Services Inspections

The inspection process PCT has 2 weeks notice of inspection visit - same as Authority List of required documents for advance review within 5 days 7 days CQC on site out of 2 weeks inspection Joint report written within 20 days of visit end CQC letter follows publication of joint report

Basic health process Key Questions Core guidance and standards Working Together CAMHs Review Child Health Strategy Children’s Plan NSF Standard 5 Every Child matters NICE guidance Healthy Weight… Commissioning Guidance LAC Health guidance Teenage Pregnancy Healthy Care StandardLaming report CYP and Care Standard Acts Care MattersStaying Safe Plan CYP Act

Basic health process Key Questions Core guidance and standards Indicators and info required - what does a good service look like? What data do we have? What data do we need? Safeguarding Review (CQC) Core Standards declarations LSCB commentaries Healthy schools / healthy care Local assessor information Serious Case Review reports DCSF data National indicators – Teen pregnancy, obesity, CYP Plan / Local Area Agreement LAC doctor annual report YOT / YOI reports Needs assessment / priorities

Basic health process Key Questions Core guidance and standards Indicators and info required - what does a good service look like? What data do we have? What data do we need? Themes to explore on site visit Defined in advance Depends on local factors “Filling gaps” in data

Basic health process Key Questions Core guidance and standards Indicators and info required - what does a good service look like? What data do we have? What data do we need? Themes to explore on site visit Info about area/ orgs Judgem ents/ risk about area Joint report to DCS / GO Information gathered feeds into Ofsted process and gradings and informs CQC

Basic health process Key Questions Core guidance and standards Indicators and info required - what does a good service look like? What data do we have? What data do we need? Themes to explore on site visit Info about area/ orgs Judgem ents/ risk about area Joint report to DCS / GO Health report to PCT / SHA / assessor Feed to CQC risk profile / CAA / other engagement

Joint Inspection findings so far ….. Improved focus on training Variable use of CAF - particularly maternity, etc Access for CAMHs - particularly out of area LAC Information sharing and partnerships - disabled children A&E procedures Involvement in SCRs

New requirement - Serious Case Reviews New requirement for PCTs to notify CQC under Chapter 8 para 8.18 Effective from 18 th December Details in CQC’s CE Bulletin 19 Jan Working with Ofsted to join evaluation process for SCRs Enables CQC to have a full picture of potential concerns and monitor action / learning

Summary and Conclusions (helpline) CQC takes safeguarding seriously - a key part of the new regulatory system Inspection and assessment tailored to statutory requirements Focus on improvement and outcomes to empower staff to be innovative and effective We value feedback and communication