Health and Social Care Act 2008 Registration Outcomes Hertfordshire Fiona Wray Compliance Manager Hertfordshire March 2011

Registration timeline NHS Trusts April 2010 Oct 2010 April 2011 April 2012 Adult social care and independent healthcare providers (CSA) Primary dental care (dental practices) and independent ambulance services Primary medical services (GP practices and out of hours)

Transitional Registration Services previously registered under Care Standards Act Some new to scope services included as part of registration 27,000 transitional registration by 01 April 2010 Providers offered ‘batch windows’ in which to apply Self declaration of compliance against 16 essential standards at each location Cross referenced with other information held by CQC Some site visits were conducted Looking for evidence of non compliance Utilised CQC Judgement Framework and Setting the Bar guidance

Registration under Health and Social Care Act 2008 Widen scope of registration Registration relates to the provision of ‘Regulated Activities’ Registered at provider level rather than location Location is a condition of registration Registration no longer includes ‘categories’ of care or need It is against the law to carry out a regulated activity without registration

Application made Application assessed Judgement made Judgement published Regulatory judgement Regulatory response Judgement on risk Information capture Information analysis Ongoing monitoring of compliance Registration application Registration Cycle

Application made Application assessed Judgement made Judgement published Registered Registered with conditions Registration refused in part Registration refused Registration application Registration Cycle

Levels of Compliance Four levels of compliance  Level 1 Two or more compliance conditions applied  Level 2 One compliance condition applied One or more moderate concerns  Level 3 One or more minor concerns  Level 4No concerns identified

Transitional Registration Outcomes Levels of Compliance Level 1-1:0% Level 2: 23% Level 3: 5% Level 4: 72%

Transitional Registration Outcomes Levels of Concern Compliant – 87% Minor – 9% Moderate – 2% Major – 1% Tbc – 1%

Transitional Registration Conditions Restrictive Conditions  Registered manager  Bed numbers (where appropriate)  Prohibit the provision of nursing care Compliance Conditions  Registered manager  Significant none compliance  Overall major concerns  Provider or location level It is an offence to fail to comply with conditions of registration and may lead to prosecution

Compliance Conditions Registered Manager 77 locations No Registered Manager in post at all services where CQC has a Major Concern

12 Listen to the people who use services – they know what is really happening What Next

Regulatory judgement Regulatory response Judgement on risk Information capture Information analysis Ongoing monitoring of compliance Compliance Monitoring Continuous process Response on information, analysis and risk Quality Risk Profile Minimum frequency of planned review 3 – 24 months Based on ‘level of compliance’

Reviews of compliance Responsive A responsive review of compliance: is triggered when specific information, or a gap in information raises concern about compliance is not a full check of all 16 core quality and safety outcomes is targeted to the area(s) of concern May include a site visit All findings will be published Planned A planned review of compliance: is a scheduled check that looks across all regulated activities (at a location) to assess compliance with all 16 core quality and safety outcomes Will take place at intervals of three months to no less frequent than two years Will be proportionate, with additional activities focused on gaps on information May include a site visit All findings will be published

15 How we capture information We will hold a Quality and Risk Profile on each provider summarising all relevant information. The Quality and Risk Profile will enable us to assess where risks lie and prompt front line regulatory activity, such as inspection. As new information arrives, it will be added to the profile and assessors and inspectors will be alerted and will take action proportionate to the risk.

Information capture People who use services, families and carers New information can come from a variety of sources: Other regulatory bodies and Information Centre Other bodies eg. Ombudsman, commissioners Providers Staff and other professionals CQC Assessors and Inspectors

Evidence to make a judgement To determine whether the evidence is adequate and robust, consider the following points: ● Is it current? (within 12 months or longer if a long-term focus) ● Is it reliable? (is the source credible, is the evidence consistent, can it be validated or triangulated with another source) ● Is it relevant? (is it related to the regulations, the regulated activities and CQC’s remit) ● Is it sufficient? (is there an adequate amount of evidence with enough detail to make an assessment) ● Does it demonstrate the quality of outcomes and/or experiences of people who use services? ● Does it demonstrate what controls (processes) the provider has in place?

Regulatory judgement Regulatory response Judgement on risk Information capture Information analysis Ongoing monitoring of compliance Judgement on risk Information held by CQC Utilise information from others Commissioners LINks Survey’s Request from provider Provider Compliance Assessment

Regulatory Response Actions to maintain compliance with essential standards Report re how they will maintain compliance and the action needed to do so Inform us when they have taken the action detailed Improvement Action Actions to achieve compliance with essential standards People not at immediate risk of serious harm Report re how they will achieve compliance and the action needed to do so Tell us when the action has been taken People at immediate risk of serious harm enforcement will be taken Moderate or Major concerns identified Conduct management review Range of options – civil and criminal Compliance Action Enforcement Action

Reporting Utilised where issue is too serious to wait for report to be produced Send provider ‘compliance action letter Highlighting area of concern and asking them what they are going to do Urgent Compliance Action Public facing document - Published on CQC website Produced after each responsive or planned review of compliance Include standards assessed only Compliance Report

Formal Regulatory Action Civil enforcement action Warning Notice Conditions  Variation / Removal / Imposition  Urgent variation / removal / imposition Suspension  Extend period of suspension  Urgent suspension Cancellation  Cancel registration  Urgent cancellation Criminal law and options Warning Notice Fixed Penalty Notice Simple Caution Prosecution Improvement Action Compliance Action

Offences : Fixed Penalties OffenceFixed Penalties Failure to comply with regulations about quality and safety (see regulation 27 of activities regulations Provider £4,000 Manager £2,000 Carrying out a regulated activity without being registered£4,000 Failure to comply with conditions of registrationProvider £4,000 Manager £2,000 Carrying out a regulated activity while registration is suspended£4,000 Managing a regulated activity while registration is cancelled or suspended £2,000 Obstructing entry and inspection£300 Failure to provide documents or information£300 Failure to provide an explanation of any relevant matter£300

Offences and fines: Prosecution OffenceFine Failure to comply with regulations about quality and safety (see regulation 27 of activities regulations £50,000 Carrying out a regulated activity without being registered£50,000 Failure to comply with conditions of registration£50,000 Offences relating to suspension or cancellation£50,000 False description of concerns£5,000 False statement in applications£2,500 Obstructing entry and inspection£2,500 Failure to provide documents or information Failure to provide an explanation of any related matter £2,500

Notifications Mandatory statutory notifications are a new requirement for the NHS. No longer optional to report to the NPSA or SHA NHS providers submit some notifications to the NPSA. These include; Deaths of people using the service Injuries Abuse and allegations of abuse Events that stop or may stop the service from running safely and properly.

Notifications directly to CQC Not all the notifications exist in the SUI system and some have to be made directly to CQC. These include: Changes to the statement of purpose Absences of registered managers Changes such as a new provider taking over the service, changes of address, changes to services provided Deaths and unauthorised absences of people detained under the Mental Health Act 1983 Applications to deprive a person of their liberty under the Mental Capacity Act 2005

Submission of notifications There is separate notifications guidance on CQC’s website for: NHS providers Adult social care and independent healthcare providers. The guidance explains: How to download or get copies of notification templates The timescales for submitting different notifications How to submit notifications Which NHS notifications are submitted to CQC and which to the NPSA.

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