Regulating the dental sector Tracy Norton Compliance Manager (Central Region) 4 October 2012

People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights, wherever care is provided and wherever they live, despite changes in the system Role of a regulator

CQC – what CQC does and does not do What CQC does not do We do not make assessments of commissioning – although we can comment on shortcomings via themed reviews and investigations We do not assess quality above essential standards We only promote improvement by focusing on non- compliance Inspectors are encouraged to describe what they see, comment on good practice and reference it CQC’s role Register – inspect – enforce – publish CQC registers care providers then checks whether they are meeting essential standards If not, we take action – they must put problems right or face enforcement action We publish what we find as quickly as possible We share what we know with our partners We put a premium on users/ whistleblowers We monitor the care of those detained under the MHA

Scale of CQC regulated care Primary medical services 9,000 locations NHS Trusts 2,500 locations Independent healthcare 2,500 locations Adult social care 24,500 locations Independent ambulances 300 locations Primary dental care 10,000 locations Combined outpatients and inpatients 77.4 million People using adult social care services 1.75 million Dental appointments 36.4 million

Principles of inspection Our approach to inspections Timely At least once a year or once every two years depending on the provider Focused Inspections will focus on outcomes that are important to people using services Flexible We can use different types of inspection to respond to concerns Unannounced We do not notify providers before we carry out inspections

What can you expect at a dental inspection? A scheduled inspection will check compliance against five regulations (from across the five domains). Inspectors will use information we already hold to plan which regulations will be inspected – and also extend the range of inspection on the day if it becomes apparent there may be non-compliance in other regulations. We have to inspect the 16 essential standards across a period of five years. We will always inspect Regulation 9 (Outcome 4 – Care and welfare of people who use services) at every inspection. At first inspections we will usually inspect regulation 12 (Outcome 8 – cleanliness and infection control) using the HTM01-05 Essential Quality Requirements to look for expected practices.

What can you expect at a dental inspection? We will want to speak with patients using the service where possible We will want to speak with the registered manager We will look at a surgery We are unlikely to observe treatment but may wish to observe the initial dialogue (relating to medical history etc) When inspecting Regulation 12 we will want to speak with the dental nurses and ask them to show us the procedures for cleaning and decontamination We will ask for documentary evidence where necessary ( if records are computerised we will look at those) We will not be giving you advice about how to comply – we are an arms length regulator and therefore that is not our role

Compliant or non-compliant? If we find that you are compliant with each of the regulations we inspect against then you will usually not receive an inspection for two years (unless we receive information which requires us to bring forward our next scheduled inspection or carry out a responsive inspection). If we find you are non-compliant we will use our judgement framework (published) to judge the impact on people using the service (minor, moderate or major). We will take compliance or enforcement action according to the criteria within the judgement framework (minor impact = compliance action; moderate = compliance action or warning notices; major = warning notices). If we find non-compliance across a number of regulations we will use our regulatory escalator model to help determine our regulatory response.

Following up non-compliance If we have set compliance actions we will ask you to submit a report describing how and when you will return to compliance. We will re-inspect within three months of the date at which you tell us you will be compliant. If we have issued warning notices we will give you a date by which we expect you to be compliant. We will re-inspect shortly after that date. If we find further evidence of non-compliance in the same part of the same regulations we will consider and use our enforcement powers.

Reporting our findings You should receive a draft report within 10 working days of the site visit (or the last day we gather evidence). The report will have been through our quality monitoring procedures. Reports are sent to the Nominated Individual and the Registered Manager. You will have an opportunity to comment on the factual accuracy of the report. The final report will be published on our website. If you have received warning notices you may make representations against the publication, but not the issuing of the warning notices. Guidance and the appropriate form are on the CQC website.

c What have we learned? NHS trusts – April 2010, 400 providers Private healthcare – October 2010, 1,500 providers Adult social care – October 2010, 12,500 providers Dental care – April 2011, 8,200 providers Early engagement is vital No two sectors are the same Tailored approach to registration for each sector Partnership approach to guidance

12 What have we learned? Different risk in different sectors Tailor our approach to compliance Journey of improvement, continue to work with each sector Sectors are dynamic, important we are dynamic and responsive Open dialogue

13 The future Inspection of each dental provider every two years at least Cover a wide range of regulations Inspectors to access dental specialists Improved registration process CQC strategic review – What should successful regulation by CQC look like?

Consultation on fees Share your views on the fees that registered health and social care services should pay. We have launched a consultation on the fees that we propose to charge health and social care services that are registered with us. The changes for the fees in 2013/14 include: redefining fees categories. a change to the banding of fees for primary dental services. Send us your responses Send us your feedback onlineSend us your feedback online. us at The consultation closes on Friday 21 December 2012.

15 Closing comments The public puts its faith in those who run and work in care services There must be a culture that won’t tolerate poor quality care, neglect or abuse – and encourages people to report it The regulator cannot be everywhere, so we need to regulate with others We remain cost blind in checking standards

16 Questions CQC – Helping make care better for people Questions?