1. CQC’s New Regulatory Approach: The Turn of the Screw
Peter Grose
Head of Healthcare

2. Is the sector one horror after another?
“Over these last 30 years, it feels to me that we have stumbled from crisis to crisis, from one Panorama programme to the next, from inquiry report to inquiry report.”
JRF – John Kennedy’s Care Home Inquiry October 2014

3. October 2014: CQC Begins to Turn the Screw
“There is much excellent care but the variation in the quality and safety of care in England is too wide and is unacceptable
Safe services occur where effective leadership builds a culture of safety
By looking at CQC’s reports on outstanding and good care, other services can learn and improve
CQC’s ratings provide transparent information that allow people to make choices”
CQC Fifth Annual Report October 2014

4. The Turn of the SCREW Safe? Caring? Responsive? Effective Well led?
The ‘Five Questions’ now form the basis of CQC’s new operating model

5. CQC’s New Operating Model
Provider Handbook: ‘How CQC regulates Residential Adult Social Care Services’ March 2015
Registration – more rigorous
Intelligent Monitoring
Provider Information Return
Feedback from service users and the public
Inspection by experts
Ratings
Holding poor care providers to account, eg direct focus on directors; “Special Measures”

6. Inspections and KLOES Provider Handbook Appendix A
16 mandatory KLOES, each with “prompts” spread across the five questions
Will inspections be more professional?

7. Ratings Outstanding; Good; Requires Improvement; Inadequate
Legal requirement to display rating prominently: CQC Template
Characteristics: set out in Appendix B of Provider Handbook
“We need to be as consistent as we possibly can so that our ratings are reliable and provide accurate information. This will also help reduce the number of requests for review.”
CQC Provider Handbook

8. Ratings Principles
Level 1 – rating for each key question; Level 2 – aggregate overall location rating
Outstanding – two Os and three Gs
Good – only one RI
Requires Improvement – two RIs
Inadequate – two Is

9. Limiters on Ratings
There will always be a rating of “Requires Improvement” if:
No registered manager and no satisfactory steps to recruit within a reasonable timescale
Other conditions of registration not met “without good reason”
Not returning PIR

10. Inspection Frequencies
“Subject to available resources within the following periods”:
Outstanding – two years
Good – 18 months
Requires Improvement – 12 months
Inadequate – 6 months

11. Challenging Ratings
Factual accuracy check (and completeness of evidence)
Warning Notice – representations that are upheld may improve rating
Request for rating review:
only ground is that inspector did not follow published process for making ratings decision
can only be made when report is published
single opportunity for review
review conducted by inspectors not involved in original inspection with access to independent reviewer
noted on CQC website entry
Parliamentary and Health Service Ombudsman
Judicial review

12. New Regulations and Fundamental Standards
CQC ‘Guidance for providers on meeting the regulations’ March 2015
HSCA 08 (Regulated Activities) Regulations 2014
In force for private healthcare and social care providers from April 2015
Contains 11 Fundamental Standards plus:
Fit and Proper Requirement for Directors
Duty of Candour

13. Criminal Offences – Part 1
Prosecution without warning notices for certain offences:
Reg 11 - Consent to care and treatment
Reg 16(3) - Receiving and Acting on Complaints - Summary to CQC within 28 days
Reg 17(3) - Good governance - Report to CQC within 28 days
Reg 20(2)(a) - Duty of Candour - Duty to inform re notifiable safety incidents
Reg 20(3) - Duty of Candour - Notifications must meet specific requirements
Reg 20(A) - Requirement to display Performance Assessment

14. Criminal Offences – Part 2
CQC can prosecute for the following offences, but only if the breach of the regulation results in people who use services being exposed to avoidable harm, a significant risk of such harm occurring or suffering a loss of money or property as a result of theft, misuse or misappropriation:
Regulation Safe care and treatment
Regulation 13 (1) to (4) Safeguarding service users from abuse and
improper treatment
Regulation Meeting nutritional and hydration needs
For breaches of the remaining regulations not listed on these slides, CQC can take regulatory action other than prosecution.

15. Criminal Justice & Courts Act 2015
S.20….ill treatment or wilful neglect: care worker offence
S.21….ill treatment or wilful neglect: care provider offence
S.21 Ill-treatment or wilful neglect: care provider offence
(1) A care provider commits an offence if-
(a) an individual who has the care of another individual by virtue of being part of the care provider’s arrangements ill-treats or wilfully neglects that individual
(b) the care provider’s activities are managed or organised in a way which amounts to a gross breach of a relevant duty of care owed by the care provider to the individual who is ill-treated or neglected, and
(c) in the absence of the breach, the ill-treatment or wilful neglect would not have occurred or would have been less likely to occur
Penalties:
Fine
Remedial order
Publicity order

16. Good Governance Regulation 17
Systems and processes to assess, monitor and improve quality and safety of services provided inc assessing and reducing risk
Evaluate and improve practice re processing information relating to the above
Produce a report to CQC on demand within 28 days

17. Duty of Candour Regulation 20
CQC states “significant room for improvement in under-reporting incidents and failing to learn from things that go wrong”
Breach will be used “to encourage good practice through ratings” rather than prosecution
Notifiable Safety Incidents: death; physical or mental impairment 28 days; prolonged pain or psychological harm; shortening of life expectancy
Providers must:
Inform the person and provide reasonable support as soon as reasonably practicable
Provide a true account of the incident on the facts provider aware of
Advise on further enquiries
Offer an apology
Written notification including details of enquiries to be undertaken and an apology
Keep a secure written record - produce to CQC on demand within 28 days

18. Fit and Proper Requirement for Directors Regulation 5
Currently corporate “fitness” assessed by testing the fitness of the “nominated individual”
From April 2015 all directors (inc non-execs and trustees) will be held accountable if care standards fail
CQC will be able to exclude from office those responsible for “serious misconduct or mismanagement (whether unlawful or not) in discharging any office or employment with a registered provider”
CQC will require Chairman to confirm fitness of all directors as above and sign a declaration
Enforcement through imposing conditions

19. And finally…..
The Five Questions demand greater professionalism from Providers and Inspectors
Cost: higher inspection fees
Ratings: commercial consequences of a lower rating; purchase a re-inspection?
Time is limited for inadequate providers
Surveillance?

20. Thank you Peter Grose 01202 786163 peter.grose@LA-law.com
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