David James – CQC Policy Team

Technology and regulation Dave James Head of Adult Social Care Policy, Care Quality Commission 2 Generic ASC deck (June Final) 2

Purpose of this session To describe CQC’s approach to assessing outcomes and how this applies to technology in care To prompt a discussion on our approach, future challenges and how we can all work together to ensure technology can be used to underpin high quality care

A quick show of hands Do you think CQC is a barrier to technological innovation in adult social care?

Our purpose and 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 Register Monitor and inspect Use legal powers Speak independently Encourage improvement People have a right to expect safe, good care from their health and social care services Strategy Slides - 24 May 2016 - MASTER

Is it responsive to people’s needs? Is it good enough for my Mum? Ambition for social care: The Mum Test (or Anyone You Love test) Is it responsive to people’s needs? Is it good enough for my Mum? Is it effective? Is it safe? Is it well-led? Is it caring? Generic ASC deck (June Final)

Ratings based on outcomes Outstanding The service is performing exceptionally well. Good The service is performing well and above minimum legal requirements. Requires improvement The service isn't performing and may be in breach of legal requirements. Inadequate The service is performing badly, is in breach and we've taken action.

the service is consistently well-managed and led The Characteristics of Good and Outstanding care SAFE People protected from avoidable harm and abuse Supported to keep themselves and belongings safe and secure EFFECTIVE People’s outcomes and feedback are consistently good Outcomes are consistently better than other similar services CARING people supported, treated with dignity and respect and involved as partners in their care RESPONSIVE Needs met through way services organised & delivered Meet needs of individual and ensure flexibility, choice and continuity of care WELL-LED the service is consistently well-managed and led the leadership, governance and culture drive high-quality, person-centre care More detail sits at KLOE level – this is an illustration at KQ level Use of tech doesn’t change these

Technology in care Technology is changing how care is provided & the benefits can be significant – technology can; give people more control over their health, safety and wellbeing Increase independence, decrease isolation link to services which are important to people enhance the effectiveness of care or treatment help people communicate with families, professionals and staff help staff to prioritise and focus their attention on people who need it most capture and compare data, and share good practice with peers. But technology and other innovations should never come at the expense of high-quality, person-centred care - the interests of the person using the service must be at the heart of any decision to use technology

Technology in care Some questions that will help you prepare if you’re thinking about using technology to deliver care – CQC will want to know the answers too! Involving people Who will the technology affect and how? How will you involve them in your plans? What do they need to know to make an informed choice? Do they fully understand the implications of the new technology? How have you involved your staff? What information and training do they need so they can be confident and competent? Clarity of ambition What outcome do you want to achieve? How will you measure it? Safety and legal considerations What are the practical and legal issues you need to think about before you introduce new technology? What are the risks and how will you manage them, particularly during transition & early implementation? How will you keep people safe?

respects the needs and preferences of the person using the service The (draft!) areas of focus… Person Centred respects the needs and preferences of the person using the service promotes good outcomes for people including independence whilst supporting them to stay safe Drives Improvement positive impact on outcomes clear how tech improves service & evaluation Privacy and Dignity impact on privacy and dignity fully considered e.g. minimising intrusion Open and Transparent people who use, visit or work at the service are aware of purpose and impacts Appropriate and Proportionate best way to meet need or intended purpose Confident Staff staff understand and confident with tech including how to raise concerns or changes in need System Security and Data Protection operated and maintained legally, in a way that keeps people’s information safe contingency plans in place Managing Risk promotes safety – in line with safeguarding processes risks assessed and plans to manage them in place Capacity and Consent people can express views, actively involved in decisions supported to give informed consent & free to withdraw at any time. consent sought in line with MCA The questions on the previous slide translate to some key themes or “areas of focus” The areas of focus are based on our key lines of enquiry, picking out the specific areas that are most relevant for technology or innovation used to support care. They are also mapped to the regulations if you are considering there is a breach. They are intended to assist as a tool to help assess, make a judgement and consider ratings, when technology or innovation plays a significant part in delivering care.

the service is consistently well-managed and led Mapping to the Characteristics of Ratings SAFE People protected from avoidable harm and abuse Supported to keep themselves and belongings safe and secure Confident Staff System Security and Data Protection Managing risk EFFECTIVE People’s outcomes and feedback are consistently good Outcomes are consistently better than other similar services Capacity and Consent Open and Transparent CARING people supported, treated with dignity and respect and involved as partners in their care Privacy and dignity RESPONSIVE Needs met through way services organised & delivered Meet needs of individual and ensure flexibility, choice and continuity of care Person centred Appropriate and Proportionate WELL-LED the service is consistently well-managed and led the leadership, governance and culture drive high-quality, person-centre care Driving improvement …which in turn map to the existing Characteristics

An example of what this looks like in practice Confident Staff Staff understand how to use the technology or apply the innovation and are confident to do so. They have completed any relevant training and understand their responsibilities, including how to raise concerns or changes in need. S3: How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs? S3.1: What arrangements are there, including within the rotas, for making sure that staff have the right mix of skills, competencies, qualifications, experience and knowledge, to meet people’s individual needs? Regulation 12: safe care and treatment Regulation 18: Staffing Regulation 19: Fit and proper persons employed   S3.2: How is safety promoted in recruitment practices, arrangements to support staff, training arrangements, disciplinary procedures, and ongoing checks? S3.3: Do staff receive effective training in safety systems, processes and practices?

Closing thoughts Risk that sole focus on outcomes might not always be enough – e.g. AI making clinical decisions How we do assess the safety of the algorithms? What is our role and what is the role of other agencies? How do we stay on top of current developments? Need to continue to engage and learn, asking; “Is it new?” “How does it affect quality?” “Does it affect CQC’s methodology or scope of regulation?” Answers will determine whether CQC will apply ‘Regulatory Sandboxing’ where implementation of technology can be tested against the regulations in a controlled way, to ensure that regulation achieves the best outcome for people using services. See https://www.cqc.org.uk/guidance-providers/all-services/technology-care for more info CQC was recently awarded funding to test new ways of engaging with innovative providers. The grant from the Department for Business Energy and Industrial Strategy (BEIS) could help CQC examine ‘regulatory sandboxing’, where implementation of technology can be tested against the regulations in a controlled way, to ensure that regulation achieves the best outcome for people using services.

A quick show of hands Do you think CQC is a barrier to technological innovation in adult social care?

Any questions or comments?