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A New Start National Advocacy Conference 24th October 2013
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 regulations and guidance, fundamentals of care, approach to adult social care Co-development, engagement and further consultation throughout Stress focus of this consultation is on high level model. We are taking a step by step approach – a lot to consult on, so doing it in progressive stages Nigel Thompson Head of Involvement Equalities and Human Rights 1 1
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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 Published in April 2013 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 We will be strong, independent, expert inspectorate that is always on the side of people who use services 2
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Scale of CQC regulated care
GP practices 9,000 locations Private healthcare 2,500 locations Independent ambulances 350 locations Care homes 18,000 locations Dental practices 10,000 locations NHS hospitals 2,800 locations Outpatients and inpatients 77.4 million People using adult social care services 1.75 million Home-care agencies 6,800 locations
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Asking the right questions about quality and safety
Is the care: Safe? Effective? Caring? Responsive to people’s needs? Well-led? These underpin the entire model. Safe - People are protected from physical, psychological or emotional harm. Effective - people’s needs are met, and their care is in line with nationally-recognised guidelines and relevant NICE quality standards , or effective new techniques are being used which give people the best chance of getting better or living independently. Caring - People are treated with compassion, respect and dignity and that care is tailored to their needs. Responsive to people’s needs - treatment and care at the right time, without excessive delay, and people are listened to in a way that responds to their needs and concerns. Well-led - effective leadership, governance and clinical involvement at all levels. Open, fair and transparent culture. Using people’s views to make improvements. 4
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Our new approach Model shows the different stages: Registration
Surveillance Model shows the different stages: Registration Surveillance Standards Expert inspection Judgement and publication – ratings Action where needed
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Named leaders held accountable
Registration A more rigorous test to deliver safe, effective, compassionate, high- quality care Legally binding Named leaders held accountable Registration Making sure those we register make a commitment to deliver safe, effective, compassionate, high-quality care Making sure that named directors or leaders of organisations are personally held to account for that commitment, and that they are suitable for the job Making sure those we register show us that they have good plans for how they will provide care, including an effective system for spotting and dealing with problems Building efficient digital services that will transform the way providers get involved and communicate with us 6
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Surveillance Continuous monitoring to identify failures and risk of failure “Smoke alarms” Use local and national information sources Use qualitative information from people Surveillance Surveillance We will monitor information and evidence continuously to predict, identify and respond more quickly to services that are failing, or are likely to fail We will continue to gather information from national and local data and intelligence sources, past inspections, Quality Surveillance Groups, Clinical Commissioning Groups, and from groups such as local Healthwatch, local overview and scrutiny committees and local voluntary groups Information from people who use care services and from whistleblowers will be two of our most important sources of information to make sure we understand the reality of people’s care Smaller number of more focused indicators that will trigger action by us when a certain level of concern is reached. These ‘triggers’ will be different for different types of services 7
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Expert inspections Chief Inspectors of Hospitals, Social Care, and General Practice Expert inspection teams Longer inspections, more time talking to people Intelligence used to decide when, where and what to inspect Inspectors using professional judgement Expert inspections Expert inspection teams led by the Chief Inspectors and including independent clinical experts How often we inspect, how long we spend on an inspection, and the size and membership of the inspection team will be based on the ‘risk’ of the service - the type of care being offered, the vulnerability of people who use it, the information we have about a service, and its current rating 8
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Expected standards of care High-quality care.
Clear standards Three levels: Fundamentals of care Expected standards of care High-quality care. By law services must meet fundamentals of care and expected standards Clear standards to judge quality and safety These standards will help us to judge whether or not services are safe, effective, caring, well-led and responsive to people’s needs. These standards will have three levels: Fundamentals of care Expected standards of care High quality care. All services will be required by law to meet the fundamentals of care and the expected standards. Less guidance, some examples to avoid box ticking Senior inspectors will use data and evidence, including information from the public and care staff, and from our partners such as NHS England, Monitor and the NHS Trust Development Authority, to help them decide where, when and what to inspect 9
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Ratings for providers, and for separate services as well?
Ratings to help people choose between services and to encourage improvement Ratings for providers, and for separate services as well? Ratings for each question? Safe Effective Caring Responsive to people’s needs Well-led Ratings Ratings will be a dynamic process. We will make clear on our website when a service is being inspected so that the public understands that our judgement and rating might change. We will publish the information on which the rating is based. Should we provide ratings for individual services (e.g., emergency services, maternity) as well as at hospital level and for the overall trust? What are the pros and cons? Should we provide ratings for each of our key questions: is the service safe, effective, caring, well-led and responsive to people’s needs? Our reports of our inspections will explain the reason for the inspection and describe our findings, assessment and judgments on whether a service is safe, effective, caring, well-led, and responsive to people’s needs. 10
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Listening to, and acting on, people’s experiences of care
People’s individual experiences of care are very valuable to CQC We use this information to help inform where, when and what we inspect Outside our inspections we try to make it as easy as possible for people to tell us about their care If people have experienced poor care, or know that poor care is being provided somewhere we want them to tell us, anonymously if they wish. We welcome positive experiences of care too Timescales June Named individuals at Board level held to account for the quality and safety of care of people with learning disabilities Consultation on principles of new operating model, ratings system and detail of, fundamentals and expected standards of care, detailed proposals for NHS monitoring and inspection. October New way of monitoring and inspecting NHS acute hospitals begins Clear programme for failing NHS trusts begins Ratings of NHS acute hospitals begins Named individuals at Board level held to account for quality and safety of care of people in all new care services Consultation on regulations underpinning fundamental expected standards December First ratings of NHS acute hospitals begin 11
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Listening to, and acting on, people’s experiences of care
People can tell us about their experiences of care direct: Online Via a paper form Telephone Timescales June Named individuals at Board level held to account for the quality and safety of care of people with learning disabilities Consultation on principles of new operating model, ratings system and detail of, fundamentals and expected standards of care, detailed proposals for NHS monitoring and inspection. October New way of monitoring and inspecting NHS acute hospitals begins Clear programme for failing NHS trusts begins Ratings of NHS acute hospitals begins Named individuals at Board level held to account for quality and safety of care of people in all new care services Consultation on regulations underpinning fundamental expected standards December First ratings of NHS acute hospitals begin 12
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Tell Us Your Experience form…
Captures information about the service from members of the public Urgent concerns are directed to inspectors for swift action All other concerns are directed to inspectors for evaluation
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Listening to, and acting on, people’s experiences of care
We want to increase the amount of valuable feedback we receive about people’s experiences of care Tell us about your care projects with third sector organisations Patients Association Relatives and Residents Association Carers UK (due to start December 2013) Actively seeking new partners R&RA and PA complete CQC ‘Share Your Experience’ webforms on behalf of callers to their helplines. They also actively promote CQC and the standards of care people have a right to expect through a jointly branded leaflet We track and trace the information we receive and report back on what action we have taken in response Timescales June Named individuals at Board level held to account for the quality and safety of care of people with learning disabilities Consultation on principles of new operating model, ratings system and detail of, fundamentals and expected standards of care, detailed proposals for NHS monitoring and inspection. October New way of monitoring and inspecting NHS acute hospitals begins Clear programme for failing NHS trusts begins Ratings of NHS acute hospitals begins Named individuals at Board level held to account for quality and safety of care of people in all new care services Consultation on regulations underpinning fundamental expected standards December First ratings of NHS acute hospitals begin 14
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CQC and Advocacy Services
Getting feedback from advocacy organisations to contribute to our acute hospital inspections Dementia Review Learning Disability Review How can we find you? How can w engage with you? What do you need from us?
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