1. Maintaining quality in regulated services
Kent RM conference 2 April 2019
Maintaining quality in regulated services
Kim Rogers, Jo Wallace
Inspection managers, Adult Social Care 1 1

2. Our purpose and 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
Register
Monitor and inspect
Use legal powers
Speak independently
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.
Our role
We register care providers.
We monitor, inspect and rate services.
We take action to protect people who use services.
We speak with our independent voice, publishing regional and national views of the major quality issues in health and social care.
People have a right to expect safe, good care from their health and social care services
Strategy Slides - 24 May MASTER

3. Ambition Our ambition for the next five years:
A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care
This is from our Strategy – now year 2. using information (including what people tell us) to target our inspections where poor care, or a change in quality, is more likely.
So the new strategy sets out the next stage of our journey - it sets out an ambitious vision for a more targeted, responsive and collaborative approach to regulation so more people get high quality care. It has been developed based on what thousands of people, providers, staff and partners have told us and what we have learned from over 22,000 inspections. 3

4. Four priorities to achieve our strategic ambition
Encourage improvement, innovation and sustainability in care
Deliver an intelligence-driven approach to regulation
Promote a single shared view of quality
Improve our efficiency and effectiveness
1. Encourage improvement, innovation and sustainability in care – we will work with others to support improvement, adapt our approach as new care models develop, and publish new ratings of NHS trusts’ and foundation trusts’ use of resources.
2. Deliver an intelligence-driven approach to regulation – we will use our information more effectively to target our resources where the risk to the quality of care provided is greatest and to check where quality is improving, and we will introduce a more proportionate approach to registration.
3. Promote a single shared view of quality – we will work with others to agree a consistent approach to defining and measuring quality, collecting information from providers, and working together towards a single vision of high-quality care.
4. Improve our efficiency and effectiveness – we will work more efficiently, achieving savings each year, and improving how we work with the public and providers.
Today I want to have a look at two specific areas – Human rights approach in care (which is about the first priority) and an intelligence based approach (3) – these are both about how we will regulate but also about how you can maintain and evidence quality in your services.

5. Our strategic approach to human rights
Paying attention to equality and human rights improves care for people using services because it gives people the outcomes that they want
People will only receive safe, effective, responsive, and caring services if providers address equality and human rights
Using human rights principles helps us to regulate services by looking at care from the perspective of people using the service, than at ‘what services should deliver’
CQC has a crucial role in protecting the basic human rights of people using health and social services 5

6. Human rights approach in regulation
Our human rights approach
Is integrated into the inspection process,
Was used to check that inspection guidance, KLOEs, ratings descriptors and other methods cover human rights topics
Will help develop intelligence to inform inspections

7. Why have a human rights approach to regulation?
People will only receive safe, effective, responsive, and caring services if providers address equality and human rights
Using human rights principles helps us to regulate services by looking at care from the perspective of people using the service, than at ‘what services should deliver’
CQC has a crucial role in protecting the basic human rights of people using health and social services
Important approach – bring HR into regulation
we apply the FREDA principles – Fairness Respect, Equality, Dignity, Autonomy, PLUS Right to Life, rights of staff to our 5 key questions and this forms a framework to bring human rights into our inspection practice.
Staff using – part of an NOP
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
Regulation 10: Dignity and respect
 We carried out a home visit to a person who was physically disabled and living with a visual impairment. This meant they required written information to be presented on yellow paper with black lettering. written information had never been provided in an alternative format. This meant the person was not able to read care planning documentation and this made them feel disempowered and not in control. Care plan was provided on plan white.
CQC viewed your equality and diversity policy and customer guide which outlined commitments and asked you for any tangible example of how the equality and diversity policy had been implemented in practice, but no examples could be given. In particular, it was not clear how the ethos and culture of the service, sought to ensure people received care that was non-discriminatory. For example, how the needs of service users with a protected characteristic were considered.
 The evidence outlined above demonstrates a failure to treat service users with dignity and respect and that insufficient consideration had been given to service users with a protected characteristic.

8. Equally Outstanding:
How can a focus on equality and human rights improve the quality of care in times of financial constraint?
A good practice resource developed with outstanding providers
Encouraging health and social care services to improve through a focus on equality and human rights – for people using services and staff
New provider interactive site imminent? 8 8

9. Common success factors
1. Committed leadership
Key role of leaders who are enthusiastic and committed to equality and human rights
2. Principles into action
Equality & human rights as a thread from organisational values, through leadership behaviours and actions to frontline staff and their work
3. Culture of staff equality
Broad work to develop an open and inclusive culture and work to tackle specific workforce inequalities
These are the drivers for delivering good or excellent HR based care
Do you have committed leadership – is this integral to your business?
What might that look like? How would you make sure your tem know that this is important?
2. Does EDHR run through as a thread from Principles to actions of frontline staff?
If you have clearly outline your commitment what do you expect staff to do? how do you follow that through and check it is happening?
3. Is your culture Inclusive?
How good is your recruitment? Have you developed a culture that is open and people can raise issues and discuss concerns?
4. Do you apply EDHR thinking to the issue rather than thinking we must do something about EDHR? Quality improvement starting with your commitment. If we are to find a solution to this issue how can we do it making sure peoples rights are fully protected?
4. Apply equality & human rights thinking to quality improvement
Start with the improvement issue - make space to innovate & think about equality and human rights as a solution 9
Strategy Slides - 24 May MASTER

10. Common success factors
5. Staff as improvement partners
In planning & delivering change to improve care quality through equality & human rights
6. People who use services at centre
Listening carefully – including to their “life outside services” and to future aspirations
7. Use external help
Reach out to others – and be prepared to have a mirror shone on their work
8. Courage
Honesty, positive risk-taking, tackling difficult problems
5. Do you Involve staff as partners from thinking to delivery with a no blame culture of learning. Getting those difficult conversations going, making sure people feel they can ask then leading on to the solution.
6. How do you serve this person a life outside and beyond the service. Person centered care isnt about fitting people into the options avilable.
7. Do you keep looking outside – search for good practice. Reflective practice – with external scrutiny.
8. Are you Courageous and bold? Do you tackle or leave the difficult problems?
9. Are you Curious and humble? We are not experts when we start these journeys – but be curious and learn?
9. Continuous learning and curiosity
Start somewhere, learn from mistakes, always look for the next thing to work on 10
Strategy Slides - 24 May MASTER

11. What are equality objectives?
CQC is required by law to set equality objectives at least every four years.
This is because despite progress being made on equality, some people from particular groups are still less likely to receive good quality health and social care.
Alongside the human rights approach we set equality objectives which help us direct our inspection activity.
CQC is required by law – The Equality Act – to set objectives relating to equality.
Despite progress on equality, some people from equality groups are still less likely to receive good quality health and social care
These new objectives cut across health and social care
We chose them because we think that they can help us make a significant impact on care quality over the coming two years
We have chosen to set objectives every two years because we are ambitious to work for change on equality.
Strategy Slides - 24 May MASTER

12. CQC’s equality objectives
We choose our objectives based on where they can help us make an impact on care quality.
Our objectives for are:
Person-centred care and equality
Accessible information and communication
Equality and the well-led provider
Equal access to pathways of care
Continue to improve equality of opportunity for CQC staff and those seeking to join CQC
In September / October 2017, all inspectors and managers received training in EDHR linked to the new KLOE,
Developed national ASC network to share best practice ie some regions have surgeries staff can dial into for advice and support
LGBT presentations for all staff / reviewing impact in this quarter
Developed what does outstanding LGBT care look like for our staff
Leadership is needed to make person-centred care a reality for people in some equality groups:
Some equality groups are less likely to say that they are involved in their care across a range of sectors.
There is strong evidence of poorer health outcomes for people with some protected characteristics.
Strategy Slides - 24 May MASTER

13. Person-centred care and equality – our focus on LGBT+ (1/2)
Over the last two years we have focused on how providers ensure person-centred care for lesbian, gay, bisexual and transgender (LGBT+) people who use services.
Over the last year we have focused on how providers ensure person-centred care for lesbian, gay, bisexual and transgender (LGBT+) people who use services.
Action
LGBT presentations for all staff / reviewing impact in this quarter
Developed what does outstanding LGBT care look like for our staff
More inspection reports now include how providers support the needs of LGBT people
On an inspection of a care home for older people, the inspection team asked the registered manager whether they had considered how the care home would meet the needs of lesbian, gay and bisexual people who might want to use the service. The registered manager had not considered this issue before. The care home belonged to a large provider with several care homes in the area. The area manager was also sitting in on the conversation. As a result of the inspection, the area manager arranged for all their care homes in the area to have training on issues for older LGB people and what this meant for their service provision. The provider was also looking into ways to enable lesbian, gay and bisexual people to be open about their sexual orientation, if they wished, through the care planning process. When we then inspected another care home in the same ownership, the registered manager of that home then confirmed that changes were underway.
We will be reviewing the impact of this additional support over the coming months.
Strategy Slides - 24 May MASTER

14. Person-centred care and equality – our focus on faith, beliefs and religion
Support inspectors to examine these issues when inspecting services
Identify, promote and share outstanding practice
Communicate our expectations to providers and to people who use services, and gather their views
So what's next..
Over the next year our focus will be on how providers ensure person-centred care for people related to their faith, beliefs and religion in person centred care.
Why – quality and improvement
How do we encourage services to improve and support people to lead the lives they want? Must recognise human rights in care.
Strategy Slides - 24 May MASTER

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16. Remember why we do this……
Copyright: Community Care

17. Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm
Generic ASC deck (June Final)