CQC – an update on developments and how we involve people in our work

Karen Culshaw

Vision 2020 Conference

May 2012

2

Registration timeline

NHS trustsApril2010

Oct2010

April2011

April2013

Adult social care and independent healthcare providers (CSA)

Primary dental care (dental practices) and independent ambulance services

Primary medical services (GP practices, walk-in centres and others)

April2012

Primary medical services (providing out of hours services)

3

Scale of CQC regulated care

Primary medical services

10,000 locations

NHS Trusts

2,300 locations

Independent healthcare

2,500 locations

Adult social care

25,000 locations

Independent ambulances

300 locations

Primary dental care

10,000 locations

Outpatient appointments

70 million

People using adult social care services

1 million

Dental treatment – courses of treatment in 2011/12

10 million

44

In September 2011 we consulted widely with providers, stakeholders, people who use services and our own staff on proposed changes to the way we regulate.

We have now published the results of our consultation and confirmed the changes that will simplify our regulatory model. The changes also ensure that we focus on our core job: to inspect providers to make sure that the essential standards of quality and safety are being met, and to take swift action where they are not.

Improvements to our model do not change the fact that responsibility for the delivery of care rests with the organisations and professionals that provide it.

Refining our regulatory model

5

Principles ofinspection

New approach to inspections

Timely

At least once a year or once every two years depending on the provider

Focused

Inspections will focus on outcomes that are important

to people using services

Flexible

We can use different types of inspection to respond to concerns

Unannounced

We do not notify providers before we carry out inspections

66

To support unannounced inspections, we will no longer ask providers to send us information in advance of an inspection

Providers must be aware that they can be inspected at any time

Inspectors will focus on identifying non-compliance when they are inspecting, but they will also describe what they find, including care that is meeting the essential standards

We will follow a clearer, more transparent process to enforce compliance with the regulations. We will always be proportionate in the action that we take

What the changes mean for providers

7

How we involve people who use services

The SpeakOut network

The Service User Reference Panel

eQuality Voices

Webforms

Acting Together

LINKs (Healthwatch)

8

Acting Together

Acting Together

Experts by Experience for inspections

Other activities:

• Consultations

• Events

• Methods and guidance development

• Reviews and special studies

• Reference panels

• Staff induction training

• Reviewing public information materials

9

Support Organisations

Age UK

The Choice Support Consortium

• Voiceability

• Living Options Devon

• Skills for People

• Inclusion North

• Hersov Associates

The Challenging Behaviour Foundation

Addiction Dependency Solutions/Oxfordshire User Team

10

Experts by Experience

The ranges of people currently employed as experts by experience are:

• People with experience of detention under the Mental Health Act

• People with learning disabilities/autism

• People with physical and sensory impairments

• People with mental health needs

• Older People/family carers of older people

• People with Dementia and their family Carers

• People with experience of Substance misuse services

• Family Carers of people with High Support Needs

11

Why do we work with Experts by Experience?We work in partnership with Experts by Experience to increase the scope of our evidence gathering.

• Experts by Experience can help us to get a clearer picture of what it is like to live in or use the service.

• They may have a better understanding of how the needs of people who use services could be met based on their personal experience.

• Some people who use services feel more able to talk openly to Experts about what it is like to live in or use their service.

12

Experts by Experience

• Trained and authorised to accompany inspectors

• Can take part in inspections of all health and adult social care services

• Not used on all inspections, but we are looking at increasing the number of visits with Experts

13

Experts by Experience

In the year 201/12 Experts by Experience took part in 505 inspections. This included 150 learning disability themed inspections.

As well as ‘business as usual’ inspections, in 2012/13 we will also have:

550 Dignity and Nutrition themed inspections

250 home care themed inspections.

14

Short Observational Framework for Inspection (SOFI 2)

for use in acute & mental health care and

residential care settings – not for use in domiciliary

care or hospices

compulsory training for all compliance inspectors

15

Short Observational Framework for Inspection (SOFI 2)

Understanding each person as an individual is very important. Good practice recognises and uses a ‘person-centred’ approach.

The SOFI 2 framework is based directly on a model of person-centred care -

• a unique tool for inspectors to capture, in a systematic way, the

experience of care by people who have great difficulties in

communicating their feelings and views

• supports evidence collection for a number of outcomes, but particularly

outcomes 1, 4, 5, 7, 9, 12-14

16

Getting clinical and professional advice into CQC’s regulatory model

Background

CQC recognised that we needed to improve how we engage clinicians and professionals and use their advice and support more effectively. We also understood the value their input could bring to delivering a high-quality regulatory model.

In 2010 the Board commissioned work to explore this - led by Professor Deirdre Kelly

Set up Specialist Advice Advisory Group

Made 3 key recommendations

November 2011 – the Board accepted the recommendations and asked CQC to progress this

17

Three recommendations

We should review how we deliver our regulatory model and

present our findings to make them as relevant as possible to

clinicians and professionals.

We should extend the use of clinical and professional ‘expertise’

in our regulatory activity.

We need to develop a variety of way to communicate more

effectively with clinicians and professionals.

18

What have we done to dateRecommendation 1

We are implementing the revised regulatory model (as above)

We need to consider feed back given to staff within an organisation on the day of the inspection (currently only very high-level feedback is provided to senior management).

19

What have we done to dateRecommendation 2

we have undertaken a review of how the National Professional Advisor resource and role is progressing to ensure it meets business delivery needs

we are developing a 'bank' of specialist advisors to support investigations, thematic inspections and compliance monitoring. This will help improve the scope and depth of inspection activity, judgements and reporting

we are developing a model for accessing Second Opinion Advisory Doctors (SOADs).

20

Recommendation 2 continued – focus on specialist advisors

Advertised for specialist advisors through our clinical and

professional newsletter and through our networks

Shortlisted and interviewed against a set criteria – still going

through this process

We are working with our Operations staff to develop clear criteria

for accessing specialist advisors

The bank will be up and running by July 2012

21

What have we done to dateRecommendation 3

• improved stakeholder management structure - wider range of

stakeholders

• 'Stakeholder Committee' has clinical and professional membership

• Set up advisory groups to advise on individual pieces of work

• Stakeholders' forums will be set up to engage with a particular sector

• developing regional relationships with Royal Colleges

• developed a monthly e-newsletter for frontline clinicians and

professionals

• intend to create a ‘clinical’ online community that will provide a forum to engage with clinicians and professionals on specific issues. It will also allow us to test out the proposed content and language used in various documents and guidance prior to publication

22

A library of supporting information

A team of National Professional Advisors – we employ 8 covering a range of specialities. They can provide email and telephone advice and, in some complex cases, support undertaking visits

Access to a ‘bank’ of specialist advisors – we are currently recruiting clinicians and professionals to the bank – staff will be able to request advice and support – this could be email or telephone advice or support on an inspection visit

Access to CQC staff with up to date clinical and professional knowledge – we have undertaken a survey of staff to find out which staff have up to date registration and whether they would be prepared to be contacted by colleagues to provide advice about their areas of expertise

Clinical and professional advice and support to operations staff

23

Thank You

Karen Culshaw

Karen.culshaw@cqc.org.uk

CQC website – www.cqc.org.uk

National Contact Centre Telephone: 03000 616161