Care Quality Commission Our next phase of regulation: a more targeted, responsive and collaborative approach Jo Govett and Lella Andrews, CQC June 2017  Confidential

Four priorities to achieve our strategic ambition 2016 - 2021 Encourage improvement, innovation and sustainability in care Deliver an intelligence-driven approach to regulation Promote a single shared view of quality Improve our efficiency and effectiveness 1. Encourage improvement, innovation and sustainability in care – we will work with others to support improvement, adapt our approach as new care models develop, and publish new ratings of NHS trusts’ and foundation trusts’ use of resources. 2. Deliver an intelligence-driven approach to regulation – we will use our information more effectively to target our resources where the risk to the quality of care provided is greatest and to check where quality is improving, and we will introduce a more proportionate approach to registration. 3. Promote a single shared view of quality – we will work with others to agree a consistent approach to defining and measuring quality, collecting information from providers, and working together towards a single vision of high-quality care. 4. Improve our efficiency and effectiveness – we will work more efficiently, achieving savings each year, and improving how we work with the public and providers.  Confidential  Confidential

Overall ratings by service type Source: CQC – 1 February 2017  Confidential

The purpose of the consultations How we propose to update our approach and our assessment framework to reflect the changing provider landscape There are three consultations on these changes: one in Winter 2016/17, one in Summer 2017 and one in Autumn 2017. more integrated approach that enables us to be flexible and responsive to changes in care provision more targeted approach that focuses on areas of greatest concern, and where there have been improvements in quality greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication Our strategy for 2016 to 2021, published in May 2016, set out an ambitious vision for a more targeted, responsive and collaborative approach to regulation. We have four strategic priorities, which are to: Encourage improvement, innovation and sustainability in care Deliver an intelligence-driven approach to regulation Promote a single shared view of quality Improve our efficiency and effectiveness. The accompanying ‘sector by sector’ publication described how we would regulate and encourage improvement in each sector. The first consultation looked at further detail about how we propose to update our approach and our assessment framework to reflect the changing provider landscape which was aimed at achieving; A more integrated approach that enables us to be flexible and responsive to changes in care provision A more targeted approach that focuses on areas of greatest concern, such as safety, and where there have been improvements in quality. A greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication  This consultation sought views on specific proposals for: how we will regulate new and complex types of providers  changes to our assessment framework, including an updated well-led key question, which has been developed jointly with NHS Improvement how we will regulate NHS trusts from April 2017 how we will aggregate ratings for complex providers, including NHS trusts.   A further consultation in the Spring will focus on how we will regulate adult social care and primary medical services, and will include further detail on the changes we want to make to how we register providers. When we publish our final assessment frameworks we will make them available as online information, as well as documents. This will mean you can find the information you need by searching or navigating our website on whichever devices you use, as well as printing or saving the information to share with colleagues. The information will be in sections of the website for each type of service we regulate. We will clearly show which information is generic to all services.  Confidential

Consultations on our proposed changes to inspections 20 December 2016 – 14 February 2017 New care models and complex providers Cross sector changes to assessment frameworks Updated guidance for registration of learning disability services Changes to Hospitals inspection methodology 12 June – 8 August 2017 Changes to Adult Social Care regulation Changes to Primary Medical Services regulation Clarifying how we define registered providers and improving the structure of registration Updating guidance on Fit and Proper Person Requirements Winter 2017 Changes to Independent Acute inspection methodology We want to hear your views on these proposals, which are aimed at achieving more integrated approach that enables us to be flexible and responsive to changes in care provision more targeted approach that focuses on areas of greatest concern, such as safety, and where there have been improvements in quality. greater emphasis on leadership, including at the level of overall accountability for quality of care closer working and alignment with NHS Improvement and other partners so that providers experience less duplication  There will be three consultations on these changes: one in Winter 2016/17, another in Spring 2017, and a third in Winter 2017 The first consultation is now closed, which included the joint consultation with NHS improvement on use of resources and well-led. We will be reporting on responses to our consultation mid year. NHS Improvement are leading on the joint consultation response. We will also be issuing our updated guidance for registration of learning disability services. A further joint consultation is expected with NHS Improvement on our approach to assessing Use of Resources, in Winter 2017. A joint consultation on Use of Resources with NHS Improvement is expected in Winter 2017  Confidential

Changes to Well Led KLOES from consultation W1 Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person-centred, open, inclusive and empowering, which achieves good outcomes for people? W2 Does the governance framework ensure that responsibilities are clear and that quality performance, risks and regulatory requirements are understood and managed? W3 How are the people who use the service, the public and staff engaged and involved? W4 How does the service continuously learn, improve, innovate, and ensure sustainability?  Confidential  Confidential

Defining registered providers and improving the structure of registration Outlines the principles for registering providers at the level of greatest accountability Provider-level assessments for all sectors to help encourage improvement Changes to how the register will record the services that providers are registered to deliver Describes what this means for new models and complex providers  Confidential

Improving the structure of registration Current structure We know that good leadership and accountability are crucial in ensuring that people receive safe, high-quality care in a way that is sustainable. This is not just about leadership at the local level but about recognising that leaders at the top of organisations also play a vital role in ensuring the quality of care. Our current approach to registration means that we have not been able to fully take account of this influence on quality, or to reflect the ways that many providers structure themselves and run their businesses.  Confidential

Improving the structure of registration Proposed structure Any providers that are currently registered with us will remain registered. We will also register any related organisations, such as parent companies, that also have accountability for quality. This means that these organisations will also appear on the CQC register, and the public will be given information about who is accountable for the care being provided.   By making changes to who is required to register, we will be able to monitor and inspect at provider level and, if necessary, require organisations to take action to improve quality using our enforcement powers (see the following table).  Confidential

Improving the structure of registration We propose to use the information that providers record in their statement of purpose so that the register will include what type of services are provided, who the service is for, what type of setting it is provided in, where the service can be found and, where relevant, how much care is provided. By collecting this more detailed information we will be able to describe services in a way that is meaningful to the people who use them and to providers themselves. It will also enable us to be more responsive to innovation, as this approach will allow us to register new types of services in line with changes in health and social care.  Confidential

Fit and Proper Person Requirement Details the changes we are making to the way we triage information and work with providers following a notification of concern by a third party Clarifies how we will interpret serious misconduct and serious mismanagement Proposal to require providers to review and respond to the information we receive  Confidential

Adult social care regulation – what we are proposing to change Focus on how we will encourage improvement in services that are repeatedly rated as Requires Improvement Improved processes for inspecting services providing care to people in their own homes Our effectiveness and consistency of how we use our enforcement powers Promoting a single shared view of quality by developing our PIR requests 12  Confidential

Update on consultation (2) - proposals We propose to: Register all organisations at the level of ultimate accountability for quality as well as at provider and location level, and make sure they improve quality across their services Develop the register to clarify the services that are provided, to whom and where, and links between providers Implement a more consistent approach to working with providers and other stakeholders to understand the quality of care and encourage improvement  Confidential  Confidential

Update on consultation (2) proposals cont’d Introduce an online provider information collection and share information with key stakeholders Develop a new Insight model that brings together information about all the locations of a provider to help inspectors see the broader performance context Increase the period between comprehensive inspections for services rated good (from 2 to 2.5 years) and outstanding (from 2 to 3 years), as our monitoring improves  Confidential  Confidential

Update on consultation (2) proposals cont’d Make more use of focused inspections, which will always include an assessment of the well-led key question Remove the ‘six month limit’, which only allows us to change an overall rating if a focused inspection is carried out within six months of the last comprehensive inspection report being published Extend the time in which to gather views about the quality of services that provide care to people in their own homes Increase our focus on services rated requires improvement to drive improvement  Confidential  Confidential

Get involved Respond to the latest consultation on our next phase of inspections until 8 August 2017 Please respond via our online webform: www.cqc.org.uk/nextphase For queries, please contact: nextphase@cqc.org.uk @CareQualityComm using #CQCnextphase  Confidential

Quality Matters Celebrating Good, Championing Outstanding Care 17  Confidential  Confidential 17

Regulation to inspire improvement What we do: Set clear expectations Monitor and inspect Publish and rate Celebrate success Tackle failure Signpost help Influence debate Work in partnership  Confidential  Confidential

Quality: Collective effort The public – people who use services, families and carers Staff – capable, confident and supported Providers – culture, organisation, expectations Commissioners and funders – expectations of quality Regulators – monitor, inspect, rate, take action, celebrate  Confidential

Celebrating Good, Championing Outstanding – Published April 2017 Everybody has a right to good care. Much attention is rightly focused on poor care, but it's also important to recognise where care is good and to celebrate the services that are getting it right. Some care providers do things well through innovative ways of working or by doing the basics well. Others can learn from them and solutions should be shared across the system.  Confidential  Confidential

Celebrating Good, Championing Outstanding What we found Our State of Care report 2016 shows there is considerable variety in the quality of care provided in England. Among the best care we have found is in services that acknowledge there is always room for improvement – they are proactive, seeking feedback on their services and learning from concerns and complaints. Our report includes a collection of short case studies illustrating some of the qualities shown by care providers that are rated good or outstanding overall. It also shares the views of some people responsible for care quality and what they do to drive improvement.  Confidential  Confidential

Celebrating Good, Championing Outstanding What underpins good and outstanding care? Good strong leadership is a central part of improvement, and that improvements in the quality of care people are receiving are happening despite tight financial constraints and increased demand across the sectors. Also important is the way care services in an area work together – our inspections look at this, and the NHS England Five Year Forward View has recognised that the country is too diverse for a one-size-fits-all care model to apply everywhere.  Confidential  Confidential

Celebrating Good, Championing Outstanding New technology is influencing the way health and care services are delivered – and so health and care services are changing too. Technology is transforming care for some people, and no doubt this will continue to develop. In this report and via other reporting methods, we will share good practice where we find it and signpost excellence for other providers. We don’t hear enough about that good care — the commitment and dedication of skilled staff, the innovation and creativity that can transform people’s lives, the heart-warming stories of comfort and support. Engagement with all staff to capture enthusiasm and harness shared ownership/responsibilities.  Confidential  Confidential

Outstanding care at home ‘Staff were given the opportunity to build meaningful relationships with people and ample time to meet people’s needs and provide companionship’ Home Instead Senior Care, West Lancashire and Chorley ‘People felt care workers treated them with kindness and respect’ ‘The registered manager delivered dementia training to the public – including bank and shop staff – to help them understand how to help people with dementia’  Confidential  Confidential

An outstanding and creative care home ‘We observed Zumba. One person decided to get up and dance – staff assisted the person to kick their legs and move their arms. We saw them laughing as they had their photograph taken. This person was almost 100 years old.’ Peregrine House, Whitby ‘A varied programme of activity: Zumba, Motivation, large drafts or Connect 4, film events, afternoon tea, pampering sessions, and music. The home supported them to run clubs such as poetry, walking, reading, gardening, Scrabble and singing.’  Confidential  Confidential

Outstanding – Key Question – Effective Supporting Living “The provider’s written promise to people using their service was to recruit care workers, ‘with positive energy, and nurture it amongst’ existing care workers to ensure, ‘A happy team’. It was also to support them through ‘ongoing training, coaching,’ and commitment to the following values; respect, learning, integrity, encouragement, adaptability and recognising equality and diversity. Systems were in place to monitor how this was embedded in practice. This had resulted in developing motivated, dedicated, trained care workers providing quality care” “….where a person had complex needs they had used many different approaches to find the one which worked for them. The impact on the person was significant and enabled them to spend time in a meaningful way, reducing their anxiety and improving their wellbeing. Care workers demonstrated they used this learning and experience to help in similar situations”  Confidential  Confidential

People's specific support needs were met in a responsive manner People's specific support needs were met in a responsive manner. The registered manager and staff had recognised that there were a number of people who due to their physical support needs and the pain they experienced needed to remain seated in their wheelchair and could not use alternative sofas or armchairs. The registered manager told us that in response the company had purchased several specialist seating chairs which enabled people to sit in comfort and not be dependent on their wheelchairs. On the day of our visit we saw people sitting and using this alternative seating. This enabled them to spend time out of bed in comfort  Confidential  Confidential

The registered manager did not employ specific staff to carry out activities with people; instead they recognised that staff had the skills to carry out this role. In response, some staff had received specific training around the provision of meaningful activities for people. Staff told us this enabled them to develop their own knowledge and skills for the benefit of people living at the home. A member of staff said, "I have received additional training, it has taught me how to involve people in activity planning."  Confidential  Confidential

Remember why we do this…… Copyright: Community Care  Confidential

Remember why we do this…… Copyright: Community Care  Confidential

Remember why we do this…… Copyright: Community Care  Confidential

Feedback, discussion and any questions? Thank you Thank You! Feedback, discussion and any questions? www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm 32  Confidential

Next: Networking over lunch 12:15pm to 1:30pm Thank you all for attending Please hand in any feedback forms  Confidential  Confidential