CQC into the future Malcom Bower-Brown Hi – I am MBB, CQC Deputy Chief Inspector for Adult Social Care in the Central Region. And winner of this morning’s long job title prize?! I joined CQC almost two years ago from a social care provider background – a classic case of poacher turned gamekeeper you might say! When I joined CQC people said I must be bonkers but it has proved to be great career move for me and a very exciting time to be part of the organisation. I’d thoroughly recommend a stint in regulation to anyone, as part of your career in social care. Our Central region covers East/West Midlands and East Anglia and I have responsibility for a team of about 200 inspectors who regulate and inspect all registered adult social care services in the region. By adult social care we mean, primarily, care homes; domicialiary care services and hospices. Malcom Bower-Brown Deputy Chief Inspector of Adult Social Care 1 1

Purpose Structure 5 Key Questions Regulatory Model Ratings Timetable Overview Purpose Structure 5 Key Questions Regulatory Model Ratings Timetable Measuring Success I am sure you don’t need me to tell that you that CQC has had its fair share of problems in our short history. In the language of our new ratings scheme, we would probably have been judged as Inadequate or, at the very best, Requires Improvement. However, we have been under new leadership for the last 18 months and have now embarked on a three programme of radical change. We believe, like the balloon, and in one of our favourite regulatory phrases, we are now on an upward trajectory of improvement. Today, I’d like to update you on the progress of our plans for Adult Social Care. With a particular emphasis on ratings. And to consider how we plan to monitor our progress to know if the changes we are making have been successful. 2

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 The starting point in our change programme was to revisit our core purpose and role. Our purpose - We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve We now have an explicit duality of purpose – to ensure services are being provided in accordance with national standards but also to encourage improvement, both in individual services and the sector as a whole. In a major change to our approach, we are moving away from the binary language of compliance versus non compliance. We will now provide a rating for all registered services which we believe will make our findings more accessible to the public, to commissioners and to service providers. And act as a powerful driver of for improvement. 3

Our principles Our principles We are always on the side of people who use services. We promote equality, diversity and human rights. We are independent, rigorous, fair and consistent. We have an open and accessible culture. We work in partnership across the health and social care system. We are committed to being a high performing organisation and apply the same standards of continuous improvement to ourselves that we expect of others. In support of our new purpose and role we have set out six principles to underpin all aspects of our work. To highlight some: We are openly and unambiguously on the side of people who use services and their families. Although we understand the pressures on providers and commissioners, our job is to make sure that people get the quality of care they are entitled to expect in England in 2014. Provider challenge. We are committed to working in partnership with others - commissioners, safeguarding boards, other regulators - to ensure the provision of safe, high quality care However, we must always maintain our independence. Reporting what we find, calling it as it is – without fear or favour. We are also clear that to be credible, we must apply to ourselves the standards we expect of others. We are investing heavily in new systems, structures and approaches to ensure we are the effective and capable regulator that the public and others expect us to be. We are also working hard to change our organisational culture which, for too long has been defensive and inward looking. 4

Moved from generic to specialist approach Three Chief Inspectors: Our new structure Moved from generic to specialist approach Three Chief Inspectors: Deputy Chief Inspectors leading specialist teams in each region One CQC The next stage of our improvement journey was to revisit our organisational structure to make sure it was fit to deliver our new purpose and role. Until March of this year we operated a generic approach to regulation with each of our inspectors having a mixed portfolio of care homes, hospitals, GPs, dentists depending on the spread of services in their local area. The chief criticism of this approach was that we were jacks of all trades and masters of none. People also told us that our inspections lacked rigour, particularly in the hospital sector. The approach to inspecting a care home, a domicilliary care agency, a GP practice and a large teaching hospital are clearly very different. From 1 April we have reorganised into three specialist Inspection Directorates, each led by a Chief Inspector - Andrea Sutcliffe, my boss, is our new Chief Inspector of Adult Social Care Steve Field heads up Primary Medical Services – with responsibility with for dentists and GPs And Mike Richards is the new Chief Inspector of Hospitals. All of our inspectors now sit within one of the new directorates with a specialist portfolio of services to regulate and inspect. We have retained a regional structure with a Deputy Chief Inspector leading the sector inspection team in each of our 4 regions – North, Central, South and London. This gives a total of 12 DCIs in total, three per region. The primary strength of our old structure was our ability to take an integrated, cross sector view and it is vital that we don’t lose this in our new specialist approach. We remain one CQC and are working hard, internally and externally to ensure we retain the ability to regulate in a joined up way and comment authoritatively on a whole system basis. 5

Is it safe? Is it effective? Is it responsive? Is it caring? 5 Key Questions We ask these questions of all services: Is it safe? Is it effective? Is it responsive? Is it caring? Is it well-led? CREWS Although we are now operating a specialist model, all of our inspections, regardless of sector, are based on the same five key questions. Are services safe, effective, caring, responsive to individuals and well-led? CREWS In the past, particularly in hospitals, all we have been able to say following some of our inspections is that some parts of this organisation are compliant with some national standards . A qualification on top of a caveat which is of little use to anyone. In framing these five questions we want to be able to give the public, providers and commissioners straightforward answers to the questions you would expect us to have a view on. 6

Is it good enough for my Mum? The Mum Test The Mum Test Is it good enough for my Mum? Responsive? Safe? Caring? Effective? In the Adult Social Care team, in addition to the five key questions we have also asked our inspectors to apply the Mum test to every service they visit. That is my Mum by the way, the one on the right! Would you be happy for your Mum or other close relative to use the service? And if not, why should we judge it fit for anyone else? Well led?

New Regulatory Model Surveillance The five key questions sit at the heart of our new regulatory approach. We are making big changes in other areas as well. For instance: we are strengthening our approach to Registration – making company directors individually accountable for the delivery of high quality care, and testing this on regular basis as part of our inspections. Following the Southern Cross collapse, from April next year we will also be undertaking a degree of market oversight of the very largest corporate adult social providers. Perhaps the biggest change is the introduction (or reintroduction for those of you who have been around a while) of ratings. NEXT SLIDE

Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve For our new ratings, we have adopted an Ofsted-style 4 point scale – Inadequate, Requires Improvement, Good and Outstanding. We will provide a rating for each our five questions and for the service overall. Read out descriptors A rating will always require an inspection – no self-assessment/desk top review Ratings will determine the frequency of inspections – but 10% sample of good and outstanding Continue to conduct non-rating inspections in response to concerns – up to 15% at present. We hope that ratings will be a powerful driver of improvement. Who would choose/buy an indequate service? Good is new licence to trade. 9

How do we decide a rating? In a major change from our current approach of looking for compliance, our inspectors will start from the position, is this service Good? If yes, left hand channel If no, right hand channel If inadequate, almost certain there will be enforcement action. If requires improvement, then often will be enforcement action. 10

Timetable – Adult Social Care Oct 2013 – March 2014 Co-production and development to shape consultation proposals April 2014 Consultation on regulatory approach, ratings and guidance April – May 2014 Wave 1 pilot inspections June 2014 Evaluation; guidance and standards refined July – Sept 2014 Wave 2 pilot inspections So when will these changes in our regulatory approach take place? In October last year we established a co-production group to help us work up the detail of our new approach and which will continue to meet over the next two years Between April and September we tested aspects of our new approach in two pilot Waves with a cross section of providers. By 1 October this year we will have finalised our new approach. All our scheduled inspections from then on will be ratings based and we aim to have rated all 25,000 registered ASC locations by March 2016. Oct 2014 New approach fully implemented March 2016 Every adult social care service rated

Making a difference? For people using services and the public: You believe CQC is on your side and acts in your best interests – public common sense test We engage compassionately with you and listen carefully to what you tell us We act quickly and decisively in response to poor care and abuse You have increasing confidence in us and trust our independence, expertise and judgement We provide you with clear and authoritative reports The changes I have described represent a very significant programme of change and improvement to our regulatory approach. How will we know if they have made a positive difference? For people how use services and the public READ FROM SLIDE

For local authorities and other commissioners: Making a difference? For local authorities and other commissioners: We respond collaboratively to safeguarding issues You can rely upon the judgements we make to reduce duplication We share information information between ourselves to inform the timing and focus of inspections Our whole system overview supports integration between health and social care We provide annual State of Care reports at national and local level. For local authorities and commissioners READ FROM SLIDE

For organisations providing care and support: Making a difference? For organisations providing care and support: You respect CQC as being open, professional, expert and independent Our service provides value for money We are proportionate, consistent and use fair processes We share your commitment to improving services and our ratings help to drive improvement For organisations providing care and support

Deputy Chief Inspector of Adult Social Care Thank you www.cqc.org.uk Malcolm Bower-Brown Deputy Chief Inspector of Adult Social Care As I said at the beginning, we know we haven’t always got it right in the past. We have however embarked on a journey of change and improvement. To become the regulator the public want and need us to be. And to play our part in ensuring that my Mum, and everyone else’s relatives, get the compassionate, high quality and person-centred care they have every right to expect. Thank you 15