The role of the Regulator, Registration and the impact on paediatric anaesthetic services Andrea Holder Strategy Manager Children & Maternity Services Tuesday 24 th November 2009

From April 2009 – a Merged Commission

CQC in England - Structure nine regions 150 local areas national processing centre national contact centre:

Vision and values of CQC Vision of High Quality Health and Social Care which Supports people to live healthy and independent lives Helps individuals, families and carers make informed decisions about their care Responds to individual needs High Quality care should Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people who use it Help prevent illness and promote healthy independent living Be available to those who need it when they need it Represent good value for money

‘We make sure people get better care’

We make sure people get better care’

Registration

Aim of Registration Aim of Registration: People experience services that meet essential quality standards, protect their safety and respect their dignity and rights CQC’s role is to: Work with providers in consistently meeting essential common quality standards Ensure that the rights of people who use services are protected and promoted Identify potential issues early and act swiftly where services are failing people

Guidance about Compliance

Involvement and information. Personalised care, treatment and support. Safeguarding and safety. Suitability of staffing. Quality and management. Suitability of management A summary of each area and the regulations that it includes The text of the regulation The definition of the outcome Detailed guidance to help providers achieve this outcome, divided into sub- sections to make it easier to follow.

Guidance about compliance: an example Plain English People-focused Outcome-based OUTCOME 7 What should people who use services experience? People using the service: Are protected from abuse, or the risk of abuse, and their human rights are respected This is because providers who are compliant with the law will: Take action to prevent abuse from happening in a service Respond appropriately when it is suspected that abuse has occurred Ensure that Government and local guidance about safeguarding people from abuse is accessible to all staff and put into practice Make sure that any means of restraint or management of disturbed behaviour that is used is appropriate, reasonable, proportionate and justifiable for that individual Protect others from the effect of the person’s disturbed behaviour Safeguarding vulnerable people who use services

Why will providers need to apply to be registered? 1. New registration requirements will replace the National Minimum Standards and the Standards for Better Health 2. The types of services that trigger the need to register are set as new “regulated activities” 3. Providers will need to be registered for each regulated activity they carry out, rather than for the locations in which they are carried out (as is currently the case under the CSA 2000) So, providers will need to supply CQC with information to make sure we have accurate data about who is registering, and about the regulated activities that are being carried out

What does a regulated activity mean for anaesthetic services? Appendix C: Health and Social Care Act 2008 (Regulated Activities ) Regulations 2009 (Draft) Treatment of disease, disorder or injury 5.—(1) Subject to sub-paragraph (2), the provision of treatment for a disease, disorder or injury by or under the supervision of— (a) a health care professional, or a multi-disciplinary team which includes a health care professional; or (b) a social worker, or a multi-disciplinary team which includes a social worker, where the treatment is for a mental disorder. (2) The activities set out in sub-paragraph (3) are excepted from sub-paragraph (1). (3) The activities referred to sub-paragraph (2) are— (a) assessment or medical treatment for persons detained under the 1983 Act; (b) the provision of treatment by means of surgical procedures; (c) diagnostic and screening procedures; (d) services in slimming clinics; (e) the practice of alternative and complementary medicine, with the exception of the practice of osteopathy or chiropractic; (f) the provision of treatment in a sports ground or gymnasium (including associated premises) where it is provided for the sole benefit of persons taking part in, or attending, sporting activities and events; (g) the provision of treatment (not being first aid for the purposes of paragraph 14 of Schedule 2) under temporary arrangements to deliver health care to those taking part in, or attending, sporting or cultural events; (h) the provision of hyperbaric therapy, being the administration of oxygen (whether or not combined with one or more other gases) to a person who is in a sealed chamber which is gradually pressurised with compressed air, where the primary use of that chamber is— (i) pursuant to regulation 6(3)(b) of the Diving at Work Regulations 1997(a) or regulation 8 or 12 of the Work in Compressed Air Regulations 1996(b), or (ii) otherwise for the treatment of workers in connection with the work which they perform; and (i) the carrying on of any of the activities authorised by a licence granted by the Human Fertilisation and Embryology Authority under paragraph 1 of Schedule 2 to the Human Fertilisation and Embryology Act 1990(c).

What does a regulated activity mean for anaesthetic services? Appendix C: Health and Social Care Act 2008 (Regulated Activities ) Regulations 2009 (Draft) Surgical procedures 7.—(1) Subject to sub-paragraphs (2) to (5), surgical procedures (including all pre-operative and post-operative care associated with such procedures) carried on by a health care professional for— (a) the purpose of treating disease, disorder or injury; (b) cosmetic purposes, where the procedure involves the use of instruments or equipment which are inserted into the body; or (c) the purpose of religious observance. (2) Subject to sub-paragraph (3), the following procedures are excepted from sub-paragraph (1)— (a) nail surgery and nail bed procedures carried out by a health care professional on any area of the foot; and (b) surgical procedures involving the curettage, cautery or cryocautery of warts, verrucae or other skin lesions carried out by— (i) a medical practitioner, or (ii) another health care professional on any area of the foot. (3) Sub-paragraph (2) only applies where the procedures are carried out— (a) without anaesthesia; or (b) using local anaesthesia. (4) The following cosmetic procedures are excepted from sub-paragraph (1)(b)— (a) the piercing of any part of the human body; (b) tattooing; (c) the subcutaneous injection of a substance or substances for the purpose of enhancing a person’s appearance; and (d) the removal of hair roots or small blemishes on the skin by the application of heat using an electric current.

15 What’s changing Private and voluntary healthcare (PVH) providers registered with Healthcare Commission Providers of adult social care (ASC) registered with CSCI NHS providers are not registered All providers of health and adult social care registered with CQC National Minimum Standards (ASC and PVH) – different regulation and NMS for each setting Standards for Better Health considered as part of Annual Health Check Single set of registration requirements for all settings CSCI enforcement action limited to statutory notices and closures Healthcare Commission has no enforcement powers for NHS providers Strengthened and extended range of enforcement powers for providers from all sectors Old System New System Organisations Standards/ requirements Enforcement

What difference will the new system make to people? All health and adult social care providers are meeting a wide range of essential common quality standards Standards are focussed on outcomes rather than policies, systems, processes A single regulatory framework across health and adult social care

17 Registration timeline Jan 2010 All NHS Providers apply to be registered April 2010 All NHS Providers registered Oct 2010 Adult social care, Private and voluntary healthcare Apr 2011 Private ambulance services, prison health services, independent midwifery services, dental practices and other new to registration groups Apr 2011/12Primary medical services

What will providers need to do? 1. Complete an (electronic) application form to confirm provider details, the regulated activities it provides 2. Compete a declaration form to confirm the extent to which they consider they are meeting the new registration requirements 3. Provide CQC with additional information that may be required to support the application or declaration

What will providers need to do?

What you have to do 1.Continue meeting registration requirements 2.Apply to extend or vary your registration if you change your services 3.Pay the appropriate fees 4.Notify us of certain events and changes Facilitating Voluntary Compliance Verifying Compliance Enforcement of Compliance Ongoing Monitoring Of Compliance

Level of checks Registration is at corporate level, but checks will be at the level of services that people actually experience Examples will include: Individual care homes within a corporate group Main types of mental health and learning disability services, such as dementia service, high secure etc Selected specialties or departments in acute hospitals

How we check that requirements are met Declaration Notifications Local intelligence Data Cross-checking Validation What? Who? How? Compliant/ non-compliant Profile of each provider

Paediatric Anaesthetic Services – What do we know today?

What should you be doing now? Trusts should be planning their:  Core standards declaration  Applications Registration Requirements ment.cfmhttp:// ment.cfm Compliance Guidance Your anaesthetic service

Andrea Holder Strategy Manager Children & Maternity Services Care Quality Commission e.mail: Tel:

Any Questions?