1. Our next phase of regulation: a more targeted, responsive and collaborative approach
21 September 2017
Amanda Partington-Todd
Inspection Manager

2. The purpose of the consultations
How we propose to update our approach and our assessment framework to reflect the changing provider landscape
more integrated approach that enables us to be flexible and responsive to changes in care provision
more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality
greater emphasis on leadership, including at the level of overall accountability for quality of care
closer working and alignment with NHS Improvement and other partners so that providers experience less duplication
Our strategy for 2016 to 2021, published in May 2016, set out an ambitious vision for a more targeted, responsive and collaborative approach to regulation. We have four strategic priorities, which are to:
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.
The accompanying ‘sector by sector’ publication described how we would regulate and encourage improvement in each sector.
The first consultation looked at further detail about how we propose to update our approach and our assessment framework to reflect the changing provider landscape which was aimed at achieving;
A more integrated approach that enables us to be flexible and responsive to changes in care provision
A more targeted approach that focuses on areas of greatest concern, such as safety, and where there have been improvements in quality.
A greater emphasis on leadership, including at the level of overall accountability for quality of care
closer working and alignment with NHS Improvement and other partners so that providers experience less duplication 
This consultation sought views on specific proposals for:
how we will regulate new and complex types of providers 
changes to our assessment framework, including an updated well-led key question, which has been developed jointly with NHS Improvement
how we will regulate NHS trusts from April 2017
how we will aggregate ratings for complex providers, including NHS trusts.
A further consultation in the Spring will focus on how we will regulate adult social care and primary medical services, and will include further detail on the changes we want to make to how we register providers.
When we publish our final assessment frameworks we will make them available as online information, as well as documents. This will mean you can find the information you need by searching or navigating our website on whichever devices you use, as well as printing or saving the information to share with colleagues. The information will be in sections of the website for each type of service we regulate. We will clearly show which information is generic to all services.

3. Consultations on our proposed changes to inspections
20 December 2016 – 14 February 2017
New care models and complex providers
Cross sector changes to assessment frameworks
Updated guidance for registration of learning disability services
Changes to Hospitals inspection methodology
12 June – 8 August 2017
Changes to Adult Social Care regulation
Changes to Primary Medical Services regulation
Clarifying how we define registered providers and improving the structure of registration
Updating guidance on Fit and Proper Person Requirements
Closed
Winter 2017
Changes to Independent Acute inspection methodology
Since December 2016 we have undertaken a series of consultations about ‘Our Next Phase of Regulation’
Consultation 1 (December Feb 2017). The outcome of this was published in June We sought views in relation to
--Regulating new models of care
--Changes to assessment frameworks across sectors
--Registration guidance for learning disability services
--Hospitals inspection methodology
In addition to publishing the details of the consultation findings, we also published ‘Registering the Right Support: CQC’s policy on registration and variations to registration for providers supporting people with a learning disability and/or autism’
We also published the updated ASC KLOEs, KLOE Prompts and Ratings Characteristics which will be implemented in November This includes a helpful document which indicates which KLOEs have changed and how
Consultation 2 (June – August 2017) Due for publication in October We sought views in relation to
--Regulation of ASC and PMS services
--Improving the structure of registration
-- Encouraging improvements in quality of care in local areas
--Guidance on Fit and Proper Person requirements
Consultation 3 (Expected Winter 2017) will be focussed on changes to the independent acute inspection methodology (Hospitals) as well as a joint consultation on use of resources with NHS Improvement
A joint consultation on Use of Resources with NHS Improvement is expected in Winter 2017

4. Helpful Updates to Share Today
New shared inspection handbook
Changes to Key Lines of Enquiry and Ratings Characteristics
The future of provider information requests
Signposting to updated guidance

5. Shared Handbook for Providers
In November 2017 we will be publishing a shared handbook for providers, inspectors and the public.
This replaces the current provider and inspector handbooks and ensures that inspection guidance is transparent and clear for all who use it

6. Assessment Framework Key Lines of Enquiry (KLOEs)
Evolution, Not Revolution—Structure of Assessment Framework remains the same
Strengthen and Simplify
Applying learning from our inspections and changes in sectors
Enabling providers to demonstrate how they are developing and adapting
Aligning questions we ask of different sectors and service types
Promoting single shared view of quality
Simpler process to reduce regulatory burden
You will be happy to know that the changes coming in November are not revolutionarily different but ‘fine tuning’ our assessment framework based on what we have learned since the ‘Fresh Start’
The goal is to strength and simply our assessment framework rather than proposing major changes to how we inspect
Single assessment framework for all ASC services and now better aligned with Health assessment frameworks

7. Assessment Framework Key Lines of Enquiry (KLOEs)
KLOEs Key Changes (Important Themes)
CARING strengthened to include resources, time and support for staff to work with people in a compassionate way
KLOE questions are more ‘open’ (HOW? Rather than Do/Are?)
Information sharing, governance and data security
Technology (risk and opportunities)
Medicines KLOEs strengthened
EDHR strengthened
Bigger focus on personalisation
Supporting people to live healthier lives

8. Assessment Framework Key Lines of Enquiry (KLOEs)
There are 5 new KLOEs introduced and 11 KLOEs have been amended/moved in light of consultation feedback and aligning wording with Health assessment framework
Examples of KLOEs moved to other domains:
SAFE—Supporting people with behaviour changes (formerly in EFFECTIVE)
EFFECTIVE—Processes to ensure people are protected from discrimination (formerly in SAFE domain)
EFFECTIVE—How organisations work together(formerly in RESPONSIVE)
RESPONSIVE—Supporting people at the end of their life (formerly in CARING)

9. Preparing for updated assessment framework
These changes come into effect from 1 November 2017 so there’s plenty of time to prepare
The updated KLOEs and Characteristics are already on our website for you to review and ask questions now:
providers/residential-adult-social-care#care- standards
The handbook will also be shared on our website in the coming weeks
It’s important to remember that, by and large, our inspection processes remain the same but it’s useful for providers to equip themselves with the information about changes to our KLOEs and characteristics so you are prepared when inspectors ask for evidence on inspection.

10. Preparing for Pre-Inspection Information Requests
21 September 2017
Amanda Partington-Todd
Inspection Manager

11. Preparing for Information Requests
From November, the way we ask you to provide information about your services will be changing
Following our consultation process, we will be launching a ‘Provider Information Collection’ which is an electronic system developed and tested with providers
One PIC replaces the multiple PIR forms formerly sent to providers requesting information
Some key changes to share with you that will be coming in relation to the PIR
Through consultation and speaking with providers, we will be launching a ‘Provider Information Collection’ service which is a new digital solution which has been developed and tested with providers
Providers will be required to update their PIC accounts at least once a year but encouraged to provide certain information more frequently and providers are able to update it at any time

12. Provider Information At a minimum the information you send should:
Tell us about key information related to your service and how it operates
How it is meeting the five questions
What improvements you plan to make to the service and how you plan to make them
Remember that the inspector will use your response in the planning of their inspection so consider what it is that you want to inspection team to know about your service, what your team has achieved and what you are most proud of
It is important that you are familiar with the five key questions and the KLOEs so you are able to tell us how you are meeting or exceeding the standards in these areas.
The PIR helps us to understand the provider’s perspective and, when necessary, challenge it constructively. This will allow us to assess how providers view themselves in terms of quality against the five key questions and to understand how their improvement plans reflect this, ahead of an inspection.
We expect providers to be open and honest with us, sharing all appropriate information. A lack of openness and transparency will be taken into account when we assess the well-led question.

13. Published Guidance for PIRs
There will be further information and guidance published in the coming months about the launch of the PIC
In the meantime, we have guidance published on our website for completing the current format of the PIR:
care-services
care-services
services

14. Questions?