1. Focussing on Outcomes: Challenges and Drivers Marilyn Hansford Compliance Manager East Sussex

2. 2 Purpose of presentation What do we mean by optimum health? Outcomes based Guiding legislation How do we check that requirements are met? Quality Risk Profile What is a Provider Compliance Assessment? Drivers for change Quality

3. 3 DEFINITION OF HEALTH W.H.O. IN 1998 famously defined health as a ‘state of complete physical, mental and social well-being, not merely the absence of disease and infirmity’ A holistic view of health takes into account a vast range of interacting factors relating to people and the environment within which they exist.

4. 4 THE WHEEL OF HEALTH David Seedhouse 2002 CQC will work with partner organisations taking into account the key determinates of health

5. 5 Psychological PhysicalSocial Every individual has a life long need for Health and Social stability Individuals at times in their lives may have a health and/or social need that requires a service response Shape and Form to Health Psychological

6. 6 What is the impact of compromises? Cancer Coronary heart disease Chronic ill health Poor quality institutionalised care Psychological Social Physical

7. 7 What is the impact of outcome focussed care? Person Centred Outcome Focussed Commissioning and Delivery Psychological Social Physical

8. 8 Outcome focussed because…….

9. 9 Status - Hierarchy of Instruments Health and Social Care Act Establishes the overall system of regulation Registration Requirements Regulations What services have to do to become registered Regulated Activities Regulations Which services are required to be registered by virtue of what they do Compliance Guidance Tells providers about compliance with the regulations Further Advice for Implementation Gives providers more detail that they might find helpful when implementing the guidance Primary legislation set by Parliament Secondary legislation set by Parliament Prescribed by primary legislation written by CQC and subject to consultation No status in legislation written by CQC

10. 10 Outcomes based The regulations mapped to six outcome headings: Involvement and information Personalised care, treatment and support Safeguarding and safety Suitability of staffing Quality and management Suitability of management Plain English People focussed Outcome based

11. 11 Why Outcome Focussed? Reviews will be focussed on outcomes rather than systems and processes By outcomes we mean – the experiences we expect people to have as a result of the care they receive This takes our review of care to the person centred level – to understand the daily experience of people who play out their lives for a period of time in receipt of care services either at a domiciliary or residential level.

12. 12 How we check that requirements are met Declaration Notifications Local intelligence Data Cross-checking Validation What? Who? How? Compliant/ non-compliant Profile of each provider

13. 13 Quality and Risk Profile (QRP) Gathers all we know – from other regulators, people who use services, whistle blowers etc Not a rating, ranking or league table Assesses risk of a provider becoming non-compliant Inspectors make judgements based on information in the QRP Prompts front line regulatory activity Constantly updated, builds over time

14. 14 QRP – how it will look

15. 15 QRP – how it will look

16. 16 Compliance Reviews Responsive A responsive review of compliance: Is triggered when information, or a gap in information raises concern about compliance Is not a full check of all 16 key 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 of all the 16 key quality and safety outcomes Will take place at intervals of between 3 months and 2 years Will be proportionate, with additional activities focused on gaps on information May include a site visit All findings will be published

17. 17 Planned Review Starts with a review of all information we currently hold on a provider against the 16 outcomes Assess what we know and identify what we do not know Contact the provider to gain further information only against those outcomes where information is limited A Provider Compliance Assessment may be asked for to fill in the gaps

18. 18 What is a Provider Compliance Assessment? A PCA is a self assessment tool designed to help providers assess their level of compliance on an ongoing basis You may collate evidence to demonstrate compliance in a different format but you must submit such evidence within the specified time frame when we ask for it. The focus is not on systems, processes and policies but what comes directly from people who use services, relating directly to their experience

19. 19 Example Evidence: Outcome 2 Consent to care and treatment The registered person must have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them. Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010

20. 20 Outcome 2: Consent to Care and Treatment What should people who use services experience? ● Where they are able, give valid consent to the examination, care, treatment and support they receive. ● Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed. ● Can be confident that their human rights are respected and taken into account. This is because providers who comply with the regulations will: ● Have systems in place to gain and review consent from people who use services, and act on them. Outcome ➜ What should people who use services

21. 21 Self assessing outcome 2 What self assessment questions might you ask? Do you routinely use effective consent procedures? What are the knowledge and skills of your staff? How do you know procedures are followed in practice, monitored and reviewed? What about people who cannot make all or some of the decisions about their care, treatment and aspects of their lives? What about people who choose to withhold consent? What about meeting the requirements of the Mental Capacity Act 2005, the Mental Health Act 1983 and Deprivation of Liberty Safeguards

22. 22 How do CQC see safe and effective care Effective Care A person using services receives evidence based care that is appropriate to their need and achieves a positive outcome - delivered by the right person, with the right skills and expertise, in the right place, at the right time, taking into account the views and wishes of the person. Safety Safety is freedom for people who use and deliver services from unnecessary harm or potential harm associated with health or social care services, where harm can be physical, psychological and/or emotional

23. 23 Drivers for change Public services in the future: 1. Demographic driven demand – increased demand for public services because of ageing population. 2. Shifting identities – individuals are geographically more mobile and create new identities and communities across neighbourhood, local and national levels 3. Meeting diverse demands – increasingly diverse demands make it difficult to find consensus on some policy areas, especially where there are fundamental differences in value and priorities between sections of society. A ‘one size fits all’ approach is unlikely to suffice.

24. 24 Drivers for change 5. Technology – a driver of change, a solution and as a problem, technology is changing the way we live, work and interact with each other in fundamental ways. This has implications both for the types of public services that will be needed and the ways that they are delivered. 6. Rising citizen expectations – expect more from private sector services, demanding service standards that meet the best equitously across the country. 7. Economic Climate – a testing climate of economic constraints

25. 25 Challenges going forward Change! Change! Change! Change! Change is the only constant. BUT…………………..

26. 26 Challenges present opportunity Opportunity is NOWHERE Opportunity is now Here

27. 27 Quality Quality is never an accident, it is a result of high intention, sincere effort, intelligent direction and skilful execution. William A Foster Quality is not an act, its is a habit. Aristotle Quality means doing it right when no-one is looking. Henry Ford

28. 28 Final Thoughts Quality, Safe, Personalised health and social care must be a way of thinking and not a discrete task whatever the prevailing economic or political climate

29. 29 Thank you for your attention