Improving quality through regulation Background Strategy 2013 - 2016 Raising standards, putting people first, published April 2013 June 2013 First of a series of consultations on significant changes – Principles of new model for all care services Detail of NHS intelligence model, inspection and ratings Regulations underpinning the changes Further consultation in October 2013 on further detail and guidance on NHS regulation, fundamentals of care Co-development, engagement and further consultation throughout Andrea Sutcliffe 28 November 2013 1 1

Our purpose and role Our purpose Our role We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care Thousands of people - members of the public, our staff, providers, professionals and others – have given their views during CQC’s consultation on its strategy for the next three years 2

Asking the right questions about quality and safety Effective Caring Responsive to people’s needs Well-led Safe - People are protected from physical, psychological or emotional harm. Effective - in line with nationally-recognised guidelines. Improving health or independence. Caring - People are treated with compassion, respect and dignity and that care is tailored to their needs. Well-led - effective leadership, governance and clinical involvement at all levels. Open, fair and transparent culture. Using people’s views to make improvements. Responsive to people’s needs - treatment and care at the right time, without undue delay, and that they are listened to in a way that responds to their needs and concerns. 3

New Operating Model Surveillance

Characteristics of adult social care services and the people who use them Whole of people’s lives, not episodic Complex and varied needs and aspirations Personalisation hugely important People are often in very vulnerable circumstances; care generally provided in people’s own homes Role of unpaid carers is critical Diverse sector - large numbers of providers, different sizes and types, strong private and voluntary sector Significant numbers of people fund their own care A lack of consistent, high quality data and fewer standards

Top 5 priorities for the Chief Inspector Develop changes to how we monitor, inspect and regulate adult social care services Develop a ratings system for adult social care services Develop an approach to monitoring the finances of some adult social care providers Support our staff to deliver Build confidence in CQC 1 2 3 4 5

Our top ten proposed changes 1 More systematic use of people’s views and experiences, including complaints Inspections by expert inspectors, with more experts by experience and specialist advisors Tougher action in response to breaches of regulation, particularly services without a registered manager for too long Checking providers who apply to be registered have the right values and motives, as well as ability and experience Ratings to support people’s choice of service and drive improvement 2 3 Minimising duplication of activity between CQC and Local Authorities – including work on the information sharing portal Focus on leadership, governance and culture – different approach for corporates and singletons Corporates – how well does the Board deliver its corporate responsibilities, how can we assess well led at a corporate level Accountability for recent failures – how to hold providers to account for failures identified during the inspection that have already been addressed Systematic use of user voice – better analysis of complaints and whistleblowing evidence to inform our approach Asking the right questions at registration – checking people have the right values and motives as well as ability and experience Ratings – vital in adult social care to support consumer choice, and decision making often about a home for life Move away from annual inspections to a frequency informed by ratings – frequency to be decided but Approach to surveillance – better data and indicators – helps us target and direct our activity – e.g. in domiciliary care timeliness of visits and number of zero hours contracts local teams will improve their surveillance, supported by Intelligence 4 5

Our top ten proposed changes (2) 6 Better data and indicators to help us target our efforts New standards and guidance to underpin the five key questions Avoid duplication of activity with local authorities Focus on leadership, culture and governance with a different approach for larger and smaller providers Frequency of inspection to be informed by ratings 7 8 9 Minimising duplication of activity between CQC and Local Authorities – including work on the information sharing portal Focus on leadership, governance and culture – different approach for corporates and singletons Corporates – how well does the Board deliver its corporate responsibilities, how can we assess well led at a corporate level Accountability for recent failures – how to hold providers to account for failures identified during the inspection that have already been addressed Systematic use of user voice – better analysis of complaints and whistleblowing evidence to inform our approach Asking the right questions at registration – checking people have the right values and motives as well as ability and experience Ratings – vital in adult social care to support consumer choice, and decision making often about a home for life Move away from annual inspections to a frequency informed by ratings – frequency to be decided but Approach to surveillance – better data and indicators – helps us target and direct our activity – e.g. in domiciliary care timeliness of visits and number of zero hours contracts local teams will improve their surveillance, supported by Intelligence 10

Adult Social Care Vision The Mum Test Is it good enough for my Mum?

It takes two to tango …. CQC and Local Healthwatch Local Healthwatch and CQC want people to get the services they deserve To do this, we work together We need to share information, co-ordinate local work and listen to each other 10 10

CQC has a statutory duty to work with local Healthwatch CQC and the Healthwatch Network CQC has a statutory duty to work with local Healthwatch We respond to issues raised with us by Healthwatch England We are establishing local relationships and involving local Healthwatch in national CQC developments The basics: the relationship is both national and local, it is with both Healthwatch England and with each local Healthwatch. CQC has a statutory duty to take account of the views of local Healthwatch

Local relationships and information sharing Each Local Healthwatch has regular contact with a named CQC manager Sharing information about people’s experiences of care is vital We want local Healthwatch to share concerns, trends in people’s comments, and reports It is important that Local Healthwatch talk to us about plans to enter and view services – particularly in Adult Social Care Our managers, currently compliance managers, are expected to have contact with each Healthwatch at least every 3 months. Sometimes this is done with groups of Healthwatch – it is up to each area how they arrange meetings and phone calls. We have worked closely with Healthwatch England and the Local Government Association to build up our list of Healthwatch contacts. Local compliance managers meet Healthwatch at least every 3 months.

Sharing information CQC managers will share details of registered services in your area, and discuss recent local inspection findings and forthcoming inspection programmes They will tell you how we have been able to use your information and what difference it has made When we inspect services we are also contacting Local Healthwatch to find more information you have about a service and to involve you where appropriate It is not always easy to share inspection programmes, but we do where we can: this is so that you can direct us to useful information and also that we can coordinate what we do. The new local area profile is particularly useful for local Healthwatch and other bodies. An example of local Healthwatch being involved in inspection processes in the new methodology : local Healthwatch being invited to attend quality summits, and also to advise us on listening events

Sharing information All local Healthwatch receive: Monthly e-bulletins from CQC Local press releases prior to publication You are invited to: Attend quarterly CQC Healthwatch advisory conferences - the next is 11 December, Bristol, on monitoring adult social care Take part in teleconferences to give us advice Advise us on CQC projects – e.g. planning themed inspections in dementia care and emergency mental health care Our communications teams will let you know when we release new national reports – by sending you press releases with links to the reports They will also send any press releases to your local Healthwatch about the findings from inspections of local services in your area. This is usually when we want to alert you to concerns that may be reported in the local press. We send information to you at the same time as the press receive it – with a deadline for when it can be made public. The advisory conferences and telecons are open to all local Healthwatch staff and volunteers and we advertise them through the bulletin.

Moving forward We aim to: hear more from local voluntary and community groups about experiences of care improve work with local volunteers, family carers and advocacy organisations – with local Healthwatch reaching these groups work with other voluntary sector networks e.g. Regional Voices work on sharing information with Healthwatch England – particularly information from local Healthwatch

Next steps Open and inclusive engagement with people from October 2013 to Spring 2014 so they shape and improve the new approach: External advisory groups and other working groups on particular aspects of work Round table events and workshops on specific topics and issues On line forums and discussions, surveys and social media Events and workshops on regulatory approach, standards, ratings Public focus groups and engagement through our network of local groups, including Local Healthwatch

Timelines Oct 2013 – March 2014 Co-production and development to shape consultation proposals March 2014 Consultation on regulatory approach, ratings and guidance March – May 2014 Wave 1 pilot inspections June 2014 Evaluation; guidance and standards refined July – Sept 2014 Wave 2 pilot inspections and initial ratings of some services Oct 2014 New approach fully implemented and indicative ratings confirmed March 2016 Every adult social care service rated

More information Read the new CQC strategy on our website www.cqc.org.uk Telephone 03000 616161 to speak to someone at CQC Email enquiries@cqc.org.uk to send us your information Email the Involvement team to get involved in national CQC developments involvement.edhr@cqc.org.uk

Thank you Andrea Sutcliffe Chief Inspector of Adult Social Care @crouchendtiger7