Our next phase of regulation: a more targeted, responsive and collaborative approach 21 September 2017 Amanda Partington-Todd Inspection Manager

The purpose of the consultations How we propose to update our approach and our assessment framework to reflect the changing provider landscape more integrated approach that enables us to be flexible and responsive to changes in care provision more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication Our strategy for 2016 to 2021, published in May 2016, set out an ambitious vision for a more targeted, responsive and collaborative approach to regulation. We have four strategic priorities, which are to: Encourage improvement, innovation and sustainability in care Deliver an intelligence-driven approach to regulation Promote a single shared view of quality Improve our efficiency and effectiveness. The accompanying ‘sector by sector’ publication described how we would regulate and encourage improvement in each sector. The first consultation looked at further detail about how we propose to update our approach and our assessment framework to reflect the changing provider landscape which was aimed at achieving; A more integrated approach that enables us to be flexible and responsive to changes in care provision A more targeted approach that focuses on areas of greatest concern, such as safety, and where there have been improvements in quality. A greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication  This consultation sought views on specific proposals for: how we will regulate new and complex types of providers  changes to our assessment framework, including an updated well-led key question, which has been developed jointly with NHS Improvement how we will regulate NHS trusts from April 2017 how we will aggregate ratings for complex providers, including NHS trusts.   A further consultation in the Spring will focus on how we will regulate adult social care and primary medical services, and will include further detail on the changes we want to make to how we register providers. When we publish our final assessment frameworks we will make them available as online information, as well as documents. This will mean you can find the information you need by searching or navigating our website on whichever devices you use, as well as printing or saving the information to share with colleagues. The information will be in sections of the website for each type of service we regulate. We will clearly show which information is generic to all services.

Consultations on our proposed changes to inspections 20 December 2016 – 14 February 2017 New care models and complex providers Cross sector changes to assessment frameworks Updated guidance for registration of learning disability services Changes to Hospitals inspection methodology 12 June – 8 August 2017 Changes to Adult Social Care regulation Changes to Primary Medical Services regulation Clarifying how we define registered providers and improving the structure of registration Updating guidance on Fit and Proper Person Requirements Closed Winter 2017 Changes to Independent Acute inspection methodology Since December 2016 we have undertaken a series of consultations about ‘Our Next Phase of Regulation’ Consultation 1 (December 2016 - Feb 2017). The outcome of this was published in June 2017. We sought views in relation to --Regulating new models of care --Changes to assessment frameworks across sectors --Registration guidance for learning disability services --Hospitals inspection methodology In addition to publishing the details of the consultation findings, we also published ‘Registering the Right Support: CQC’s policy on registration and variations to registration for providers supporting people with a learning disability and/or autism’ We also published the updated ASC KLOEs, KLOE Prompts and Ratings Characteristics which will be implemented in November 2017. This includes a helpful document which indicates which KLOEs have changed and how http://www.cqc.org.uk/get-involved/consultations/our-next-phase-regulation-consultation-1#response-documents Consultation 2 (June – August 2017) Due for publication in October 2017. We sought views in relation to --Regulation of ASC and PMS services --Improving the structure of registration -- Encouraging improvements in quality of care in local areas --Guidance on Fit and Proper Person requirements Consultation 3 (Expected Winter 2017) will be focussed on changes to the independent acute inspection methodology (Hospitals) as well as a joint consultation on use of resources with NHS Improvement A joint consultation on Use of Resources with NHS Improvement is expected in Winter 2017

Helpful Updates to Share Today New shared inspection handbook Changes to Key Lines of Enquiry and Ratings Characteristics The future of provider information requests Signposting to updated guidance

Shared Handbook for Providers In November 2017 we will be publishing a shared handbook for providers, inspectors and the public. This replaces the current provider and inspector handbooks and ensures that inspection guidance is transparent and clear for all who use it

Assessment Framework Key Lines of Enquiry (KLOEs) Evolution, Not Revolution—Structure of Assessment Framework remains the same Strengthen and Simplify Applying learning from our inspections and changes in sectors Enabling providers to demonstrate how they are developing and adapting Aligning questions we ask of different sectors and service types Promoting single shared view of quality Simpler process to reduce regulatory burden You will be happy to know that the changes coming in November are not revolutionarily different but ‘fine tuning’ our assessment framework based on what we have learned since the ‘Fresh Start’ The goal is to strength and simply our assessment framework rather than proposing major changes to how we inspect Single assessment framework for all ASC services and now better aligned with Health assessment frameworks

Assessment Framework Key Lines of Enquiry (KLOEs) KLOEs Key Changes (Important Themes) CARING strengthened to include resources, time and support for staff to work with people in a compassionate way KLOE questions are more ‘open’ (HOW? Rather than Do/Are?) Information sharing, governance and data security Technology (risk and opportunities) Medicines KLOEs strengthened EDHR strengthened Bigger focus on personalisation Supporting people to live healthier lives

Assessment Framework Key Lines of Enquiry (KLOEs) There are 5 new KLOEs introduced and 11 KLOEs have been amended/moved in light of consultation feedback and aligning wording with Health assessment framework Examples of KLOEs moved to other domains: SAFE—Supporting people with behaviour changes (formerly in EFFECTIVE) EFFECTIVE—Processes to ensure people are protected from discrimination (formerly in SAFE domain) EFFECTIVE—How organisations work together(formerly in RESPONSIVE) RESPONSIVE—Supporting people at the end of their life (formerly in CARING)

Preparing for updated assessment framework These changes come into effect from 1 November 2017 so there’s plenty of time to prepare The updated KLOEs and Characteristics are already on our website for you to review and ask questions now: http://www.cqc.org.uk/guidance- providers/residential-adult-social-care#care- standards The handbook will also be shared on our website in the coming weeks It’s important to remember that, by and large, our inspection processes remain the same but it’s useful for providers to equip themselves with the information about changes to our KLOEs and characteristics so you are prepared when inspectors ask for evidence on inspection.

Preparing for Pre-Inspection Information Requests 21 September 2017 Amanda Partington-Todd Inspection Manager

Preparing for Information Requests From November, the way we ask you to provide information about your services will be changing Following our consultation process, we will be launching a ‘Provider Information Collection’ which is an electronic system developed and tested with providers One PIC replaces the multiple PIR forms formerly sent to providers requesting information Some key changes to share with you that will be coming in relation to the PIR Through consultation and speaking with providers, we will be launching a ‘Provider Information Collection’ service which is a new digital solution which has been developed and tested with providers Providers will be required to update their PIC accounts at least once a year but encouraged to provide certain information more frequently and providers are able to update it at any time

Provider Information At a minimum the information you send should: Tell us about key information related to your service and how it operates How it is meeting the five questions What improvements you plan to make to the service and how you plan to make them Remember that the inspector will use your response in the planning of their inspection so consider what it is that you want to inspection team to know about your service, what your team has achieved and what you are most proud of It is important that you are familiar with the five key questions and the KLOEs so you are able to tell us how you are meeting or exceeding the standards in these areas. The PIR helps us to understand the provider’s perspective and, when necessary, challenge it constructively. This will allow us to assess how providers view themselves in terms of quality against the five key questions and to understand how their improvement plans reflect this, ahead of an inspection. We expect providers to be open and honest with us, sharing all appropriate information. A lack of openness and transparency will be taken into account when we assess the well-led question.

Published Guidance for PIRs There will be further information and guidance published in the coming months about the launch of the PIC In the meantime, we have guidance published on our website for completing the current format of the PIR: http://www.cqc.org.uk/content/provider-information-return-residential- care-services http://www.cqc.org.uk/content/provider-information-return-community- care-services http://www.cqc.org.uk/content/provider-information-return-shared-lives- services

Questions? Amanda.Partington-Todd@cqc.org.uk 03000616161