1. Improving quality through regulation
Background
Strategy Raising standards, putting people first, published April 2013
June 2013 First of a series of consultations on significant changes –
Principles of new model for all care services
Detail of NHS intelligence model, inspection and ratings
Regulations underpinning the changes
Further consultation in October 2013 on further detail and guidance on NHS regulation, fundamentals of care
Co-development, engagement and further consultation throughout
Andrea Sutcliffe
28 November 2013 1 1

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
Thousands of people - members of the public, our staff, providers, professionals and others – have given their views during CQC’s consultation on its strategy for the next three years 2

3. Asking the right questions about quality and safety
Effective
Caring
Responsive to people’s needs
Well-led
Safe - People are protected from physical, psychological or emotional harm.
Effective - in line with nationally-recognised guidelines. Improving health or independence.
Caring - People are treated with compassion, respect and dignity and that care is tailored to their needs.
Well-led - effective leadership, governance and clinical involvement at all levels. Open, fair and transparent culture. Using people’s views to make improvements.
Responsive to people’s needs - treatment and care at the right time, without undue delay, and that they are listened to in a way that responds to their needs and concerns. 3

4. New Operating Model
Surveillance

5. Characteristics of adult social care services and the people who use them
Whole of people’s lives, not episodic
Complex and varied needs and aspirations
Personalisation hugely important
People are often in very vulnerable circumstances; care generally provided in people’s own homes
Role of unpaid carers is critical
Diverse sector - large numbers of providers, different sizes and types, strong private and voluntary sector
Significant numbers of people fund their own care
A lack of consistent, high quality data and fewer standards

6. Top 5 priorities for the Chief Inspector
Develop changes to how we monitor, inspect and regulate adult social care services
Develop a ratings system for adult social care services
Develop an approach to monitoring the finances of some adult social care providers
Support our staff to deliver
Build confidence in CQC 1 2 3 4 5

7. Our top ten proposed changes1
More systematic use of people’s views and experiences, including complaints
Inspections by expert inspectors, with more experts by experience and specialist advisors
Tougher action in response to breaches of regulation, particularly services without a registered manager for too long
Checking providers who apply to be registered have the right values and motives, as well as ability and experience
Ratings to support people’s choice of service and drive improvement 2 3
Minimising duplication of activity between CQC and Local Authorities – including work on the information sharing portal
Focus on leadership, governance and culture – different approach for corporates and singletons
Corporates – how well does the Board deliver its corporate responsibilities, how can we assess well led at a corporate level
Accountability for recent failures – how to hold providers to account for failures identified during the inspection that have already been addressed
Systematic use of user voice – better analysis of complaints and whistleblowing evidence to inform our approach
Asking the right questions at registration – checking people have the right values and motives as well as ability and experience
Ratings – vital in adult social care to support consumer choice, and decision making often about a home for life
Move away from annual inspections to a frequency informed by ratings – frequency to be decided but
Approach to surveillance – better data and indicators – helps us target and direct our activity – e.g. in domiciliary care timeliness of visits and number of zero hours contracts
local teams will improve their surveillance, supported by Intelligence 4 5

8. Our top ten proposed changes (2)6
Better data and indicators to help us target our efforts
New standards and guidance to underpin the five key questions
Avoid duplication of activity with local authorities
Focus on leadership, culture and governance with a different approach for larger and smaller providers
Frequency of inspection to be informed by ratings 7 8 9
Minimising duplication of activity between CQC and Local Authorities – including work on the information sharing portal
Focus on leadership, governance and culture – different approach for corporates and singletons
Corporates – how well does the Board deliver its corporate responsibilities, how can we assess well led at a corporate level
Accountability for recent failures – how to hold providers to account for failures identified during the inspection that have already been addressed
Systematic use of user voice – better analysis of complaints and whistleblowing evidence to inform our approach
Asking the right questions at registration – checking people have the right values and motives as well as ability and experience
Ratings – vital in adult social care to support consumer choice, and decision making often about a home for life
Move away from annual inspections to a frequency informed by ratings – frequency to be decided but
Approach to surveillance – better data and indicators – helps us target and direct our activity – e.g. in domiciliary care timeliness of visits and number of zero hours contracts
local teams will improve their surveillance, supported by Intelligence 10

9. Adult Social Care Vision
The Mum Test
Is it good enough for my Mum?

10. It takes two to tango …. CQC and Local Healthwatch
Local Healthwatch and CQC want people to get the services they deserve
To do this, we work together
We need to share information, co-ordinate local work and listen to each other 10 10

11. CQC has a statutory duty to work with local Healthwatch
CQC and the Healthwatch Network
CQC has a statutory duty to work with local Healthwatch
We respond to issues raised with us by Healthwatch England
We are establishing local relationships and involving local Healthwatch in national CQC developments
The basics: the relationship is both national and local, it is with both Healthwatch England and with each local Healthwatch. CQC has a statutory duty to take account of the views of local Healthwatch

12. Local relationships and information sharing
Each Local Healthwatch has regular contact with a named CQC manager
Sharing information about people’s experiences of care is vital
We want local Healthwatch to share concerns, trends in people’s comments, and reports
It is important that Local Healthwatch talk to us about plans to enter and view services – particularly in Adult Social Care
Our managers, currently compliance managers, are expected to have contact with each Healthwatch at least every 3 months. Sometimes this is done with groups of Healthwatch – it is up to each area how they arrange meetings and phone calls.
We have worked closely with Healthwatch England and the Local Government Association to build up our list of Healthwatch contacts. Local compliance managers meet Healthwatch at least every 3 months.

13. Sharing information
CQC managers will share details of registered services in your area, and discuss recent local inspection findings and forthcoming inspection programmes
They will tell you how we have been able to use your information and what difference it has made
When we inspect services we are also contacting Local Healthwatch to find more information you have about a service and to involve you where appropriate
It is not always easy to share inspection programmes, but we do where we can: this is so that you can direct us to useful information and also that we can coordinate what we do.
The new local area profile is particularly useful for local Healthwatch and other bodies.
An example of local Healthwatch being involved in inspection processes in the new methodology : local Healthwatch being invited to attend quality summits, and also to advise us on listening events

14. Sharing information All local Healthwatch receive:
Monthly e-bulletins from CQC
Local press releases prior to publication
You are invited to:
Attend quarterly CQC Healthwatch advisory conferences - the next is 11 December, Bristol, on monitoring adult social care
Take part in teleconferences to give us advice
Advise us on CQC projects – e.g. planning themed inspections in dementia care and emergency mental health care
Our communications teams will let you know when we release new national reports – by sending you press releases with links to the reports
They will also send any press releases to your local Healthwatch about the findings from inspections of local services in your area.
This is usually when we want to alert you to concerns that may be reported in the local press. We send information to you at the same time as the press receive it – with a deadline for when it can be made public.
The advisory conferences and telecons are open to all local Healthwatch staff and volunteers and we advertise them through the bulletin.

15. Moving forward We aim to:
hear more from local voluntary and community groups about experiences of care
improve work with local volunteers, family carers and advocacy organisations – with local Healthwatch reaching these groups
work with other voluntary sector networks e.g. Regional Voices
work on sharing information with Healthwatch England – particularly information from local Healthwatch

16. Next steps
Open and inclusive engagement with people from October to Spring 2014 so they shape and improve the new approach:
External advisory groups and other working groups on particular aspects of work
Round table events and workshops on specific topics and issues
On line forums and discussions, surveys and social media
Events and workshops on regulatory approach, standards, ratings
Public focus groups and engagement through our network of local groups, including Local Healthwatch

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

18. More information
Read the new CQC strategy on our website Telephone to speak to someone at CQC to send us your information the Involvement team to get involved in national CQC developments

19. Thank you Andrea Sutcliffe Chief Inspector of Adult Social Care
@crouchendtiger7