The Care Quality CommissionFinnish Government Study Group –21st May 2010

Gary Needle, Director of Methods, Care Quality Commission

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Content

This presentation will cover:

• The role of CQC

• The new registration and compliance system

• The challenge facing the health and adult social care system

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Our role

The independent regulator of the quality of health and adult social care services in England.

We also protect the interests of people detained under the Mental Health Act.

We make sure that people get a good standard of care - whether services are provided by the NHS, local authorities or by private or voluntary organisations

As the first regulator to work across health and social care we have a unique opportunity to look at how well health and social care work together to bring people integrated care

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Our objective

The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services.

The Commission is to perform its functions for the general purpose of encouraging:

(a) the improvement of health and social care services, (b) the provision of health and social care services in a way that

focuses on the needs and experiences of people who use those services, and

(c) the efficient and effective use of resources in the provision of health and social care services.

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5. Regulating effectively, in partnership

3. Acting swiftly to help eliminate poor quality care

4. Promoting high quality care

1. Making sure care is centred on people’s needs, and which protects their rights

2. Championing joined-up care

Our five priorities

Publishing information to support people making decisions

Mental Health Act visits

Assessments of qualityRegistration and ongoing monitoring and enforcement

What we do to achieve our priorities

-Involve users to focus our assessments on what is important to them-Are expert and independent -Promote equality, diversity and human rights-Engage with those providing and commissioning care to inform our work

The way we work

...on a page

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CQC well placed to make strong contribution

• Statutory Remit Covering ‘consumer protection’ (registration) and tackling ‘information asymmetry’ (assessments of quality)

• Particular powers for inspection, data gathering, enforcement• ‘Whole system’ statutory remit – covering health, mental health,

adult social care; commissioning & provision• Trust and credibility driven by independence from government and

commercial relationships

• Intelligent data analysis and risk assessment • Gathering in and responding to user voice• Local intelligence, insight & local relationship from field force• National influence, drawing on comparative view of quality &

safety of care

• User Groups & Regulated bodies• Other regulatory and oversight bodies (incl, Govt. Offices, SHAs,

Monitor, AC, Ofsted, NPSA• Secretary of State & DH

Privileged Assets

Specific Competencies

Special Relationships

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Improving the quality of care

Enforcement action

- requires providers to ‘improve or exit’

RegistrationAssessment of

Quality

Below essential standards

Essential standards

Above essential standards

Quality of care

Publish information to reinforce other levers

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How we will go about our work

Informationand Intelligence

about quality of care

Judgements on quality Analysis

of risk

Activities in response To view of risk

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How we will go about our work

People who use services, families

and carers

New information can come from a variety of sources:

Other regulatory bodies and Information

Centre

Other bodies e.g. Ombudsman, commissioners

Providers

Staff and other professionals

CQC Assessors and

Inspectors

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Other players in the field

PCTs

SHAs

Professional accreditation

National Quality Board NHS Litigation Authority

3rd Sector

NPSA

Audit Commission

NICE

NHS Institute

GSCC

ADASS

GMC

DCLGDH

Quality observatories

NHS Choices

SCIE

Providers

Professional regulationNHS Information Authority

Monitor

Co-operation & Competition Panel

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The aim of registration

People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights.

Registration

Single system of registration

Single set of standards

Strengthened and extended enforcement powers

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Adult social care

NHS

Independent healthcare

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Registration timeline(subject to legislation)

NHS trustsApril2010

Oct2010

April2011

April2012

Adult social care and independent healthcare providers (CSA)

Primary dental care (dental practices) and independent ambulance services

Primary medical services (GP practices and out of hours)

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Benefits of registration

Outcomes - More outcome-based registration that protects and promotes equality, diversity and human rights and makes providers accountable

Information - Improved access to timely, relevant and reliable information enabling consistent comparisons and promotion of joined up care

Enforcement - Earlier identification and swifter action to follow up concerns including enforcement action where necessary

Burden - Reduced unnecessary regulatory burden and associated costs of demonstrating compliance

Compliance - Increased compliance by health and adult social care providers

Process - Improved transparency, speed, consistency and reliability of registration

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Guidance about compliance

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Registration: the cycle

Ongoing monitoring of compliance

Application made

Application assessed

Judgement made

Judgement published

Regulatory judgement

Regulatory response

Judgement on risk

Information capture

Information analysis

Registration application Information capture

Information analysis

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A national trend for improved performance

Overall performance has steadily improved right across the health and social care sector

However, a minority of NHS trusts, adult social care services, independent healthcare providers, and councils have under-performed

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Hospital waiting times have been driven right down• 89% of hospital trusts achieved the 18-week waiting

time target from referral to start of treatment

Rates of MRSA and Clostridium difficile have reduced by 34% and 35% respectively

More people are living independently at home• 2.1% of people aged 65 and above were living

in care homes (council-supported) in 2009, compared to 2.5% in 2005

Real improvementsfor people using services

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Common concerns

There are three areas where we have concerns about performance right across the health and social care sector:

• Building a safety culture

• Protecting people from harm

• Workforce training

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Number of incidents reported to the NPSA improved to 1.06 million incidents last year, compared with 920,000 incidents the year before

In some organisations reporting levels are low• Reporting from PCTs with hospital beds varied over 20-fold

We are not seeing the full picture in primary care• In 12 months, primary care services across the country reported

under 3,500 incidents, compared with 693,700 from hospitals

Building a safety culture

Keeping people safe

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• 9% of NHS organisations did not comply with the minimum standard on child safeguarding

• Although the majority of social care providers fully met standards relating to safeguarding procedures,

383 (2%) failed with major shortfalls

Protecting people from harm

Keeping people safe

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Good services rely on good, well-trained people

12 % of NHS trusts did not meet the core standard on mandatory training

– the lowest compliance rate of all standards

Workforce training

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86% or less of adult social care services (such as care homes and home care agencies) meet minimum standards on training

Staff training and qualifications were a strength in only 16% of councils

Workforce training

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An increasing challengefor health and social care

By 2026, the Government expects there to be

1.7 million more adults needing care and support

There will be greater pressure on public finances

Rightly, people are expecting more choice and control over their care

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• Work better together to join up services

• Ensure people have clear information and understand their options

• Support people in maintaining their independence

Services mustaccelerate efforts to

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Major steps forward

More people are supported to live independently at home

In five years, the number of people with access to council-funded services helping them avoid emergency hospital admission has risen from

In five years, the number of people with access to services helping them return home quickly from hospital has risen from

80,000 to 148,000

112,000 to 157,000

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3-fold variation in the extent to which councils place older people in long-term residential care

4-fold variation in the rate of occupied bed-days associated with repeated emergency admissions of older people in hospital

Over 30-fold variation in the proportion of people whose discharge from hospital is delayed

But, people face high levelsof local variation

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Our estimates suggest

If all areas in the country were able to reduce the number of people admitted repeatedly as emergencies and the length of their hospital stay to the low levels seen in the best performing five areas of the country, this would:

Result in 8 million fewer days in hospital

Free up 2 billion from hospital budgets

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Only 53% of GPs reported that discharge summaries sent by acute trusts arrived in time to be useful

In our review of actions taken by health bodies in relation to Peter Connelly (Baby P), it was clear that communication between organisations was poor

Sharing of information between organisations must improve

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The NHS has greatly improved waiting times for acute care

The percentage of people who can get an appointment with a GP within 48 hours varied by PCT (between 76% and 92%)

Only half of trusts provided adequate access to out-of-hours mental health support

Access to healthcare: a mixed picture

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Not all people receive useful information on their care

• Some people do not receive enough information about their care, e.g. 21% of people discharged from hospital said they were not given sufficient information about their condition or treatment

• Information is sometimes given in a way thatpeople cannot understand, e.g. 29% people with disabilities using social care services felt communication did not help them to understand things properly

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Choice and control hasimproved, but progress is mixed

• Nearly half of people (47%) recall being offered a choice of hospital at their first outpatient appointment,a big improvement compared with 30% in 2006

• Yet 1 in 4 people using acute mental health carewere not as involved in their care as they wanted

• And councils are not doing enough to give people full control of their care with direct payments

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Summary

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What does the analysis tell us?

• Overall steady improvement in performance in all parts of the sector

• We see some real improvements that matter to people

• Some organisations lag behind the pack

• Common issues where improvement is needed, including keeping people safe and training

• Some people are supported in having choice, control and independence, but variation is high

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Leadership challenges

• Right across the system, an approach that focuses on the individual, carers, and families is needed

• How can services best strategically commission in order to deliver the benefits of joined-up care?

• Against the backdrop of future pressures, how can services continue to work in partnership to deliver person-centred care?

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We will play our part

We will…

• Focus on the people who use services and their carers• Set clear expectations of providers through registration• Identify serious issues by responsive and vigilant

assessment • Act swiftly, using our enforcement powers where needed • Drive improvements through performance assessment

and our special reviews and studies

A new regulatory system − centred on registration − keeping the spotlight on outcomes the public wants to see

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Where to find out more

Read our full report or summary booklet

Visit our website:• Watch videos of

people telling their stories

• Browse key findings

• Get accessible versions