RNHA What CQC expect 16 October 2014 Nick Kerswell 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 We will be a strong, independent, expert inspectorate that is always on the side of people who use services 2

What kind of regulator? Independent of politics and the system Covers all sectors Clinically driven with expert teams, no guarantees Evidence-based judgement, not regulatory compliance Highlight excellence and expose poor care with transparent ratings Always on the side of people who use services Critical friend Consistent and fair 3

Is it safe? Is it effective? Is it responsive? Is it caring? Our new approach We ask these questions of all services: Is it safe? Is it effective? Is it responsive? Is it caring? Is it well-led? 4

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

Our new approach 6

What are we doing differently? Larger inspection teams including specialist inspectors, clinical experts, and Experts by Experience Intelligent monitoring to decide when, where and what to inspect Inspections will focus on five key questions about services We have developed services/groups and pathways that we focus on in each sector KLOEs (key lines of enquiry) form the overall framework for a consistent and comprehensive approach Ratings compare services and highlight where care is outstanding, good, requires improvement or inadequate

Our new approach 8

Formulating judgements and ratings   Intelligent monitoring and local information Pre- inspection information gathering On-site inspection Speak to staff and people using the service Key lines of enquiry (mandatory plus additional KLOEs identified from information held) Gather and record evidence from all sources Define the questions to answer Write report and publish alongside ratings Outstanding Good Requires improvement Inadequate Apply consistent principles, build ratings from the recorded evidence Make judgements and build ratings 9

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 Following each inspection, we will judge whether services are outstanding, good, requires improvement or are inadequate. We have developed characteristics to describe what each of these ratings looks like (which we’ll take a closer look at in our next table session). 10

The importance of leadership: being well-led drives up quality   “It’s the leaders in organisations who really make a difference to the cultures of organisations – by what they attend to; what they value; what they monitor and what they model in their behaviours. The challenge for us is how can we ensure we have leadership, which ensures that there is a focus on the vision of providing high-quality, continually improving, and compassionate care at every level of the organisation? Not just in the vision or mission statements but in the behaviours throughout the organisation.” Michael West, The King’s Fund

CQCchanges.tellus@cqc.org.uk @CareQualityComm www.cqc.org.uk Get involved CQCchanges.tellus@cqc.org.uk @CareQualityComm www.cqc.org.uk

Thank you www.cqc.org.uk 13