Trade Associations meeting Adult social care Trade Associations meeting 8 June 2016 1 1

Agenda No. Agenda item Lead Time Welcome and introductions   Welcome and introductions Andrea Sutcliffe 10.00 Minutes and actions from last meeting Andrea Sutcliffe/ Arti Luther 10.05 Next phase review: Effective and Responsive Simon Spoerer 10.15 Ratings and updates Andrea Sutcliffe/ Deborah Westhead 10.35 Issues raised by Trade Associations 10.55 Housing with Care 11.05 AOB 11.25 2

Welcome and introductions

Minutes and actions from last meeting

Responsive and Effective key lines of enquiry, prompts and characteristics

Key Feedback, Learning and Suggested Improvements From our inspections Learning between sectors National reports/thematics From our stakeholders Lots of evidence gathering and engagement

Effective & Responsive: The questions Do the following topics tell us more about whether a service is Effective or Responsive: Ability and needs assessment, care planning, choice and control, and health and wellbeing outcomes. Pathways are a significant part of CQC’s proposed strategy for 2016-2021; should the pathway question become mandatory? Should we strengthen prompts & evidence re condition & people-specific needs, or should we provide separate guidance?

Co-production feedback Key lines of enquiry and Characteristics should be simplified in both presentation and content. Effective: How well a service organises and manages something (abilities/needs and planning; meeting Mental Capacity Act) Clinical outcomes Responsive How well a service responds to individuals and their particular circumstances Personal outcomes - Individual choice and control

Key changes for Effective and Responsive Pathways Majority: Make pathways KLOE mandatory BUT ‘Pathways’ mean something else in ASC: Pathways need to be about personal experience and individual needs, preferences and wellbeing, NOT service focused

Condition and group-specific needs Prompts need to help inspectors look for evidence about particular needs Opinion varied about where the detailed information should be: Prompts Sources Additional brief guides Links / access to external good practice guides Specialist professional advisors / inspectors

Ratings and updates

Current ratings overall and by key question for active locations Current ratings up to 31 May 2016 Note: Figures in chart are percentages Source: CQC ratings data

Current overall ratings by service type Source: CQC ratings data

Current overall ratings by size of care home Note: One inadequate rated residential home has been omitted due to data quality issue Small = 1-10 beds, Medium = 11-49, Large = 50-99, Extra large = 100+ Source: CQC ratings data

Current overall ratings by size of domiciliary care agency The chart to the right presents data we have for DCA locations that have been rated and the number of people using the service. There is a trend suggesting that locations providing care to a smaller number of people are performing better than larger services. This analysis is only based upon 3,790 rated DCA locations so the findings should be treated with caution. This is an area of analysis we will continue to look at as we gather more information, including exploring possible reasons for the differences, such as source of funding. The chart to the left provides an overview of 3,790 DCA locations, just over 45% of the services registered with CQC, and the number of people using the service. Note: The grouping on the x axis is as follows; 25 is 1 to 25 people, 50 is 26 to 50 people and so on. Source: CQC ratings data and CQC community PIR data from May 2016

Overall ratings by publication quarter Community based adult social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 19 63 186 5 2015 Q2 27 154 313 2015 Q3 153 387 3 2015 Q4 28 183 470 2 2016 Q1 30 226 728 13 2016 Q2 23 198 585 7 Residential social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 186 666 1,048 7 2015 Q2 192 896 1,304 4 2015 Q3 174 927 1,277 15 2015 Q4 164 878 1,514 13 2016 Q1 190 979 1,816 18 2016 Q2 127 678 1,254 Source: CQC ratings data

Overall ratings by region (rated locations) Figures in chart are percentages of rated locations Source: CQC ratings data

Learning disability ratings analysis February 2016

Overall Ratings and Key Questions Specialist learning disability services appear to perform markedly better than the rest of adult social care. Whilst a small number of services provide care to a wider service user population, for the purposes of this analysis only those that solely support people with a learning disability or autism have been included. Note: Figures in chart are percentages Source: CQC Ratings Data 01/02/2016

Ratings by type of service Although specialist learning disability services clearly outperform their generic counterparts, they do not show any tangible lead in terms of ‘Outstanding’ care home provision. What is perhaps most noticeable from these charts is the much smaller proportions of Inadequate and RI ratings for LD locations. Source: CQC Ratings Data 01/02/2016

Update: Strategy launch CQC Strategy launched – Tuesday 24 May 2016. Key messages for adult social care: This is about evolution not revolution, we are building on the work and the methodology we have developed in the last three years; registration will be strengthened and inspection will remain a fundamental part of what we do. For us to become more efficient and effective, we need to focus our activity where risk is highest and to encourage improvement. How important it is that the shared view of quality includes local authority commissioners (as well as providers and the NHS) as this will make more sense for the public and reduce unnecessary duplication. This is about evolution not revolution, we are building on the work and the methodology we have developed in the last three years; registration will be strengthened and inspection will remain a fundamental part of what we do. For us to become more efficient and effective, we need to focus our activity where risk is highest and to encourage improvement and key to this is getting better information consistently about adult social care services. How important it is that the shared view of quality includes local authority commissioners (as well as providers and the NHS) as this will make more sense for the public and reduce unnecessary duplication. 21

Update: ASC improvement story Published – Wednesday 25 May 2016 Exclusive BBC Breakfast package Print and online by Society Guardian Wider press release and news story Sector endorsement Sector endorsement – Care England, National Care Forum and VODG 22

Issues raised by trade associations

Housing with Care

Update: Housing with Care Plan: 30 locations in the Quarter 4. Losses due to risk, Regulated Activity issues, sick leave, closed locations. 14 supported living, 8 Extra Care Housing, January to April 2016. Planning, sampling, giving notice, consent. Additional Provider Information Return (PIR) content. Guidance on Housing with Care market, service models, regulated activities, safety. Currently evaluating in detail. Products/ processes being tested: Guidance on: Scope of inspection/ reporting for different services and settings (personal care/ wider adult social care). Creating samples – people and settings. Impact of inspecting services for people in their own homes. Specific impact of Mental Capacity Act 2005. Specific Provider Information Return (PIR) questions (for example, on number of schemes supported and where they are to support inspection planning). 25

Update: Housing with Care – Findings Inaccurate service type records. Diversity of sector. Impact of scope of ‘Personal Care’/ ‘Housing Related Support’ and wider social care. Unit of registration / inspection – huge variations. Planning issues. Mental capacity and consent to inspection. Unclear reports. 26

Update: Housing with Care – Next steps Report June/July 2016 Shorter term improvements Future strategy The future Extra care housing Department for Work and Pensions, Department for Communities and Local Government Stakeholder engagement 27

Key timelines – what happens next Share initial findings May 2016 Final Findings shared June - July 2016 Feed into next phase inspection work and review of KLOEs Summer 2016 Jan–Mar 2017 Sign off for new handbook March 2017 Publish revised inspection framework and handbooks November 2016 Field test/consultation

AOBs