Quality regulation in the future Deanna Westwood National Commissioning and Contracting Training Conference 25 November 2016 1 1

Five influences on quality 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

CQC: encouraging improvement with hard and soft levers Recognise Force – where people are at risk of harm and urgent action is needed. Inform – share findings, analysis and insights (passive) and encourage national and local partners/improvement bodies to act on our findings (active). Model – ‘well-led’ mirrors conditions for improvement, methods encourage organisations to embed good practices within their own ways of working. Recognise – celebrate good and outstanding, ratings reward high-quality, potential earned autonomy for good and outstanding. Forces of need, complex conditions, recruitment and retention, rising costs and restricted public funding continue to endanger quality levels in ASC. CQC can play its part in eradicating inadequate care through improvement or market exit so that more providers are delivering good and outstanding care. We can force improvement, and encourage improvement. But everyone must play their part in quality.

CQC’s strategy 2016 to 2021 Our ambition for the next five years: A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care 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 new strategy sets out the next stage of our journey - it sets out an ambitious vision for a more targeted, responsive and collaborative approach to regulation so more people get high quality care. Care providers, the public and other stakeholders have been positive about our new approach; they agree we are asking the right questions and have confidence in our methodology – but we know there are still improvements to be made with fewer resources. We will build on what we’ve done– there won’t be a radical shift but an evolution. We’ll do more to help providers understand and report on their own quality; work with national and local partners to formalise the definition of quality and agree how we should measure it; and work towards a shared data set so providers are only asked for information once.

Regulating new care models As new care models develop, we aim to: support services to innovate, collaborate and improve - while ensuring high quality care continues build our capability to assess new care models adapt our regulatory approach to support innovation Consulting on regulatory changes in December and March

Supporting change Supporting health and care services to make future vital changes Increasingly nimble – developing our approach to support, not obstruct, change Will not compromise our focus on high quality care New care models work based on three intentions: Listening and learning Supporting innovation Working with partners to align what we do and reduce duplication CQC has an important role in supporting organisations to make the changes vital to the future of health and care services and to the people who use them. We will become increasingly nimble and develop our approach to support, not obstruct, change. In doing so, we will not compromise our focus on high quality care. In the December 2016 consultation we will set out principles for novel and complex providers. This includes novel and complex organisational forms across health and social care, not just those adopting NHS England new models or those in the Vanguard programmes. The draft principles are: We will hold those ultimately accountable for the quality and safety of care to account. We will always take action to protect and promote the health and wellbeing of people using services. We will be proportionate, and will take into account each organisation’s form, governance and track record to determine when and how to inspect. We will align steps throughout the inspection process where possible, in order to minimise the burden on providers. We will be transparent about our approach and about how we make regulatory decisions. We will rate and report in a way that is meaningful to the public, people using services and providers. We will be fair. We will not penalise providers through ratings or fees where they have taken on challenged providers or services. Each provider of new care models will have a single contact person or route to CQC, and we will work across our directorates where needed. We will deliver a comparable assessment for each type of service, regardless of whether it is inspected on its own or as part of a combined provider, and will consider the benefits of service integration in our assessments. We will bring together inspectors with the specialist knowledge and skills of our teams in different sectors to inspect jointly where this is most appropriate for the provider.

Dear…… Who is accountable? Understanding accountability is key to regulation of new models. Some crude questions can help flush out who is really accountable, such as “Who gets the Reg 28 (Prevention of Future Death) letter from the coroner if things go wrong?” Getting this right means we can register organisations to hold the right people to account for quality. This is where our approach to novel and complex organisational forms and new models meets our Registration Improvement Programme. Examples: Northumbria – here, an existing outstanding trust is leading development of an Acute Care Collaboration (hospital group) and a PACs. This continues a long history of local collaboration between providers and commissioners in this area. We know a number of areas are developing MCP (multi-speciality community provider) models. We cannot talk about specific providers in advance of competitive processes to win contracts but we are expecting MCPs in e.g.: Dudley Whitstable Birmingham Some of these may emerge from existing GP Federations or other providers. Accountability in these models will be influenced by whether a “fully integrated” or “partially integrated” model is adopted and how regulated activity is actually delivered. Each MCP will need to consider the accountability in their specific care model. Dear……

What does this mean in practice? Registering providers at the level of the ‘controlling mind’ to hold those genuinely responsible to account Evolving our model, strengthening key lines of enquiry and increasing focus on leadership at the level of accountability Consulting on changes to aggregation for large and complex organisations so our ratings are fair, proportionate and meaningful Exploring where innovation or change leads to poor quality care – not all change is successful Building on place-based reports and thematic reviews looking at integration to understand CQC’s role beyond reporting on individual providers/locations Our approach will be increasingly integrated. We are consulting on a proposed move from eleven separate assessment frameworks covering different service types to just two – one for health services and one for adult social care. This will reduce complexity and confusion for providers who deliver more than one service type. Flexible and evolving, but not ‘light touch’.

Issues we are considering Registration – How do we register new organisational forms to hold those responsible for quality to account? Monitoring – What information should we collect about new care models that is different to individual providers? Inspection and rating – How should we inspect and rate new care models when they cross traditional health and social care boundaries? Enforcement – How do we make sure we are holding the right people to account for the care that is delivered?

Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm David Behan Chief Executive