1. 1 The new world of regulation – October 2014 and beyond Rachael Dodgson - Head of Adult Social Care Policy October 2014

2. 2 Our purpose and role 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 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 2

3. 3 Timeline for adult social care Co-production and development to shape consultation proposals Oct 2013 – March 2014 Consultation on regulatory approach, ratings and guidance April 2014 Wave 1 pilot inspectionsApril – May 2014 Evaluation; guidance and standards refined. July – Sept 2014 Provider guidance consultation. Wave 2 pilot inspections, initial ratings of services June 2014 Oct 2014 New approach fully implemented and indicative ratings confirmed March 2016 Every adult social care service rated October: First ratings

4. 4 Building a culture of co-production Communication

5. 5 The Mum Test Is it good enough for my Mum? Is it safe? Is it caring? Is it effective? Is it responsive to people’s needs? Is it well-led?

6. 6 Key features of the new approach Robust and rigorous test at registration Intelligent monitoring information to help determine the timing and focus of inspections Provider Information Return Thorough inspections by specialised adult social care inspectors with experts by experience and specialist advisers Rating services as Inadequate, Requires Improvement, Good or Outstanding Inspection frequencies Encouraging services to improve or holding services to account

7. 7 The new approach

8. 8 New approach Intelligent monitoring and local information Pre- inspection information gathering On-site inspection Speak to staff and people using the service Key lines of enquiry (mandatory plus additional KLOEs identified from information held) Gather and record evidence from all sources Define the questions to answer Write report and publish alongside ratings Outstanding Good Requires improvement Inadequate Apply consistent principles, build ratings from the recorded evidence Make judgements and build ratings

9. 9 Ratings

10. 10 Being clear about quality High level characteristics of each rating level Innovative, creative, constantly striving to improve, exceptional Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve

11. 11 Key Question - Caring By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect. In residential care, this means that people, their families and carers experience care that is empowering and provided by staff who treat people with dignity, respect and compassion.

12. 12 Caring: Key Lines of Enquiry C1 - How are positive caring relationships developed with people using the service? C2 - How does the service support people to express their views and be actively involved in making decisions about their care, treatment and support? C3 - How is people’s privacy and dignity respected and promoted? C4 - How people are supported at the end of their life to have a comfortable, dignified and pain free death?

13. 13 Caring – outstanding characteristics The service has a strong, visible person centred culture and is exceptional at helping people to express their views so they understand things from their points of view. People value their relationships with the staff team and feel that they often go ‘the extra mile’ for them, when providing care and support. Staff are exceptional in enabling people to remain independent and have an in-depth appreciation of people’s individual needs around privacy and dignity. Staff will be highly motivated and inspired to offer care that is kind and compassionate and will be determined and creative in overcoming any obstacles to achieving this.

14. 14 Encouraging improvement

15. Our enforcement powers Not an escalator – more than one power can be used

16. 16 Cracks in the pathway - Variable quality and transitions The quality of dementia care is variable – not everyone is meeting the standards we expect Across more than 90% of care homes and hospitals visited, we found some variable or poor care – this is unacceptable Transitions between services should be improved People are likely to experience poor care at some point

17. 17 What will we do? Find poor dementia care and take action Appoint a new national specialist adviser for dementia care to provide advice across all relevant teams Train inspectors across all teams to understand what good dementia care looks like so their judgments are consistent and robust add a section to hospital inspection reports that shows how well the hospital cares for people living with dementia

18. 18 Why does this matter? People are at the heart of it

19. 19 Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm Rachael Dodgson Head of Adult Social Care Policy