Trade Associations meeting Adult social care Trade Associations meeting 14 September 2016 1 1

Agenda No. Agenda item Lead Time Welcome and introductions Sue Howard   Welcome and introductions Sue Howard 10.00 2.  Minutes and actions from last meeting Arti Luther 10.05 3.  Ratings and updates 10.10 4.  Issues raised by Trade Associations 10.20 5.  Mental Health Update Emily Weston 10.45 7.  Single shared view of quality Charles Rendell 11.05 8. AOB 11.25 2

Welcome and introductions

Minutes and actions from last meeting

Ratings and updates

Current ratings overall and by key question for active locations Current ratings up to 8 September 2016 Note: Figures in chart are percentages Source: CQC ratings data

Current overall ratings by service type Source: CQC ratings data

Current overall ratings by size of care home Small = 1-10 beds, Medium = 11-49, Large = 50+ Source: CQC ratings data

Current overall ratings by size of domiciliary care agency The above chart presents data we have for DCA locations that have been rated and the number of people using the service. There is a trend suggesting that locations providing care to a smaller number of people are performing better than larger services. This analysis is based upon 2,214 rated DCA locations. Source: CQC ratings data and CQC community PIR data from May 2016

Overall ratings by publication quarter – Residential social care Residential social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 186 666 1,050 7 2015 Q2 191 898 1,306 4 2015 Q3 174 928 1,277 15 2015 Q4 163 877 1,515 13 2016 Q1 181 978 1,813 18 2016 Q2 170 999 1,850 29 2016 Q3 151 714 1,238 26 Source: CQC ratings data

Overall ratings by publication quarter – Community social care Community social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 19 63 186 5 2015 Q2 27 153 313 2015 Q3 389 3 2015 Q4 28 183 469 2 2016 Q1 224 728 13 2016 Q2 37 280 869 2016 Q3 30 200 624 12 Source: CQC ratings data

Overall ratings by region (rated locations) Figures in chart are percentages of rated locations Source: CQC ratings data

Overall ratings by region (all locations) Figures in chart are percentages of all locations with the grey % being location not yet rated Source: CQC ratings data

Hospital discharge needs assessment

Mental Heath Update

Inspection of mental health services – who does what? Hospitals Directorate Adult Social Care Directorate Primary Medical Services Directorate Mental Health Trusts – inpatient and community Independent mental health services – inpatient and community Substance misuse services where treatment is carried out (medical or psychosocial) Housing with care for people with mental health or substance misuse issues Domiciliary Care Agencies Care homes Care homes with nursing GPs – Mental health care looked at alongside other healthcare provision

Substance misuse services Regulated activity determines inspection type Regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Hospital inspection Adult social care inspection Accommodation for persons who require treatment for substance misuse Accommodation for persons who require nursing or personal care Treatment of disease, disorder or injury Personal care Assessment or medical treatment for persons detained under the Mental Health Act 1983 Diagnostic and screening procedures Nursing care

Update on adult social care mental health registration and inspection (1) Adapting to new models of care – registration and inspection Single inspections where possible Revision of approach to inspecting combined providers Risk enablement v. risk avoidance Greater focus on role of leadership at provider/corporate level Simplification of registration system and queries Development of risk-based registration (set out in strategy) Role of relationship management – review across all sectors Improved understanding for inspectors on mental health provision, new emergent models and risk enablement at all levels Development of specialisms for inspectors “What good looks like in…” guidance Improved training on issues such as assessing medicines management   Simplifying system of registration and queries so that it is more relationship based by area or provider Reviewing role of relationship management across all sectors Looking to develop risk-based registration (set out in strategy) Inspection report and feedback standards Format of reports being looked at for next phase Improved factual accuracy process Single inspections where possible Revise approach to inspecting combined providers Greater focus on role of leadership at provider/corporate level Next phase approach needs to be flexible enough to cope with new models of care – registration and inspection

Update on adult social care mental health registration and inspection (2) Enhancing inspector skills and knowledge about mental health Inspection report and feedback standards Revision of report format for next phase of inspection Improved factual accuracy process Improved understanding for inspectors on mental health provision, new emergent models and risk enablement at all levels Development of specialisms for inspectors “What good looks like in…” guidance Improved training on issues such as assessing medicines management   Simplifying system of registration and queries so that it is more relationship based by area or provider Reviewing role of relationship management across all sectors Looking to develop risk-based registration (set out in strategy) Inspection report and feedback standards Format of reports being looked at for next phase Improved factual accuracy process Single inspections where possible Revise approach to inspecting combined providers Greater focus on role of leadership at provider/corporate level Next phase approach needs to be flexible enough to cope with new models of care – registration and inspection

Single shared view of quality

We promote a single shared view of quality The challenges facing our health, public health and social care system require a joined-up approach and increased partnership between national bodies. We are working with our partners, providers and the public to agree a definition of quality and how this should be measured based on the five key questions. Strategy 2016 set out our commitment to a shared view of quality. What that means is: Greater alignment – eg so that we use the same language, definitions, expectation and measures as other organisations that regulate and oversee care quality. Reduced duplication – eg so that there aren’t multiple different agencies asking for the same information in different ways and at different times. We know we can’t do any of this alone – we must work with people who use services, providers, and other partners locally, regionally and nationally.

We’re making a shared commitment to quality with other national bodies We will work together more effectively to safeguard quality and encouraging improvement in quality, by: Supporting commissioners, providers and professionals with the tools, information and capability they need to pursue quality improvement; Reducing the administrative requirements of oversight and regulation, to free up time to focus on quality improvement; and Championing quality, with and for people who use services, as a shared goal that requires all of us to commit and to act. Just one of the ways in which we’re working to promote a shared view of quality is through the National Quality Board. The National Quality Board brings together the national oversight bodies for health, public health and social care. CQC’s Chief Inspector of Hospitals co-chairs the board. Through the board, and with input and challenge from our partners (eg LGA, NHS Confed, NHS CC, SCIE), we’re about to launch a shared commitment to quality. This is just a document – but it makes clear that we will work together more effectively to support commissioners, providers and professionals to maintain and improve quality.

Turning our commitment into concrete action Thinking about how the national bodies work together with providers, professionals and commissioners to maintain and improve quality: What would it look like it we were really effective at maintaining and improving quality together? What would the national bodies be doing and saying? What do we currently do that doesn’t help to maintain and improve quality together? What one change would have the greatest impact on maintaining and improving quality? To turn our commitment into concrete action, we want to know what matters most to you.

AOBs