1. Safeguarding Adults Board
Bournemouth & Poole
Safeguarding Adults Board
Sally Newell and Nicky Simpson
26 January 2017

2. About CQC: our purpose
The Care Quality Commission is the independent regulator of health and adult social care in England.
We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.
Independent of politics and the system
Regulate across all sectors
Clinically driven with expert teams
Evidence-based judgement, not regulatory compliance
Highlight excellence and expose poor care with transparent ratings
Always on the side of people who use services
Strategy Slides - 24 May MASTER

3. About CQC: our role We register health and adult social care providers
We monitor and inspect services to see whether they are safe, effective, caring, responsive and well-led, and we publish what we find, including quality ratings
We use our legal powers to take action where we identify poor care
We speak independently, publishing regional and national views of the major quality issues in health and social care, and encouraging improvement by highlighting good practice
Strategy Slides - 24 May MASTER

4. England’s population is 53m
Scope of CQC’s remit
Hospitals and clinics
245 NHS trusts
1,500 independents
Ambulances
10 NHS trusts
250 independents
Care homes and domiciliary care
12,500 providers
25,500 care homes
1.75 million people use adult social care
11 million NHS and 1.6 million independent inpatients
22 million dental patients per year (15m NHS, 7m private)
Primary medical services
9,000 providers
Primary dental care
8,000 providers
England’s population is 53m
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5. Is it responsive to people’s needs? Is it good enough for my Mum?
Ambition for social care: The Mum Test (or Anyone You Love test)
Is it responsive to people’s needs?
Is it good enough for my Mum?
Is it
effective?
Is it safe?
Is it
well-led?
Is it caring?
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6. Our 5 key questions

7. What do the overall ratings mean?
Outstanding The service is performing exceptionally well.
Good The service is performing well and meeting our expectations.
Requires improvement The service isn't performing as well as it should and we have told the service how it must improve.
Inadequate The service is performing badly and we've taken action against the person or organisation that runs it.

8. So far we have found..
Adult Social Care covers all service types - residential, community, hospices
Source: CQC – 11 January 2017

9. …and by key question
1. Over 2/3 locations are rated good or outstanding
2. Safe is the key question showing most concern, with the lowest proportion of ratings of good or outstanding
3. Well led and effective also have higher proportions of inadequate and requires improvement
5. Caring is the best rated, with the highest proportion of good or outstanding
6. Figures above the columns are numbers of locations rated, with percentages of all locations rated in brackets). Figures on bars are percentages
Source: CQC – 5 September 2016

10. How do CQC determine the rating?
There are characteristics for each rating, with separate characteristics for residential and community services.
Is the service responsive? Good rating
People describe the service as good.
People receive consistent, personalised care, treatment and support.
People are involved in developing their care and support plans.
Care is focused on people’s whole life, including their goals, skills and how they wish to be supported.
People are protected from the risks of social isolation and supported to keep relationships with people who matter to them.
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11. How do CQC determine the rating?
Is the service responsive? Outstanding rating
There are additional characteristics that make the service exceptional and distinctive. People describe the service in these terms.
People tell us staff have outstanding skills and excellent understanding of their social, cultural, values and beliefs and how this may influence how they wish to receive support.
People’s care and support is planned proactively in partnership with them. Staff use innovative and individual ways of involving people.
Professionals tell us the service achieves exceptional results.
Staff find creative ways to enable people to live as full a life as possible.
The service takes a key role in the local community. People are supported to attend events outside of the service.
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12. Themes from services with an overall rating of Outstanding
People are at the centre and staff want to give them a life not just a service
Good leadership extends beyond the manager and those values are cascaded to inspire staff
Open culture – people who use services/ staff/ relatives shared views and issues
Strong links with local community
75% have registered manager in post
A can do, will do attitude – staff dedication
Safe care actively promoted – effective oversight of care and staff communication

13. Common themes from ‘well-led’: Outstanding
“This place is brilliant, management care so much, as do the staff, everybody knows their role and the atmosphere is amazing.”
“I’m made to feel important, I’m constantly encouraged to always better myself.”
Passion Excellence Integrity Cooperation
CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

14. management inspire confidence and lead by example
Prince of Wales House, Ipswich
innovative and creative
‘My Story’ booklets give detailed biography of a person – with the clear message that their lives do not stop when they move into
care
commitment by managers to continually improve
vibrant and friendly environment
staff are motivated by a
strong culture of inclusivity
considers individuals and their
views and preferences
care is person-centred
management inspire confidence and lead by example
strong and visible leadership

15. Themes from Well-Led– Inadequate
Unawareness of best practice and notifications not being made to CQC
Lack of supervision and training opportunities
Ineffective systems to identify and manage risks / no process to assess lessons learned
Regular management changes / no registered manager
Poor care planning / lack of personalised care
Closed culture – views not listened to or acted on
Underdeveloped partnership working and community links
CQC Published reports – sampled for data on well-led. Sample size 177, 50 services with outstanding ratings (all outstanding ratings for well-led when the sample was extracted) for and 127 for services with inadequate ratings for well-led.

16. Being open Transparent When things go wrong with care and treatment
Duty of Candour
Being open
Informing people about the incident
Providing reasonable support
Providing truthful information
An Apology when things go wrong
Transparent
To meet the requirements of Regulation 20 a registered provider has to
ensure they are open and transparent with people who use services and other ‘relevant persons’ (people acting lawfully on their behalf) in general in relation to care and treatment.
meet some specific requirements following when things go wrong with care and treatment, including informing people about the incident, providing reasonable support, providing truthful information and an apology when things go wrong.
Some specifics include:
Tell the relevant person in person as soon as reasonably practicable after becoming aware that a notifiable safety incident has occurred, and provide support to them in relation to the incident, including when giving the notification.
Provide an account of the incident which, to the best of the health service body’s knowledge, is true of all the facts the body knows about the incident as at the date of the notification.
Advise the relevant person what further enquiries the health service body believes are appropriate.
Offer an apology.
Follow this up by giving the same information in writing, and providing an update on the enquiries.
Keep a written record of all communication with the relevant person.
When things go wrong with care and treatment 16
Duty of Candour (June Final)

17. Death Severe / moderate harm Psychological harm When things go wrong
Regulation 20 sets out what constitutes a notifiable safety incident for health service bodies and other providers.
It includes incidents that, in the reasonable opinion of a healthcare professional, could result in, or appear to have resulted in:
the death of the person using the service or
severe harm, moderate harm, or prolonged psychological harm.
These terms are defined in the regulation - paragraph 8 for health service bodies and paragraph 9 for other providers. 17
Duty of Candour (June Final)

18. Guidance for providers to display ratings
Purpose
Public able to see rating of service quickly and easily
Actions for providers
Display ratings in service and website
Suggest accompany with additional information
CQC
Will provide template
Inspection – check that rating is displayed
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19. Display of ratings
Why? Public able to see rating of service quickly and easily
Where? Providers should display in prominent area in public view and on website
CQC will send a template for completion and display
CQC will check this during inspections
A Provider
From 1 April 2015, if you have been awarded CQC ratings you must display them in each and every premises where a regulated activity is being delivered, in your main place of business and on your website(s) if you have any. This includes community premises and other premises which might not necessarily be registered with CQC (for example, premises from which you provide occasional clinics and therefore may not be registered with us as separate locations). You must always display your most up-to-date ratings.
Ratings must be displayed legibly and conspicuously to make sure the public, and in particular the people who use your services, can see them.
We also encourage you to raise awareness of your most recent ratings when communicating with people who use your services, by letter, or other means.
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20. Why do we place a service in special measures?
Service is rated inadequate
Inspection
Service is rated inadequate for one of 5 key questions
Service is placed in special measures
Service is given up to 6 months to improve
Second inspection
Service has improved and is rated requires improvement or above
Service has not demonstrated sufficient improvement
What are ‘special measures’? People who use adult social care services have the right to expect high-quality, safe, effective and compassionate care. Where care falls below this standard and is judged to be inadequate it is essential that the service improves quickly for the benefit of people who use it. The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Its purpose is to: • Ensure that providers found to be providing inadequate care significantly improve. • Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. • Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example to cancel their registration. Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration. Special measures will give people who use the service the reassurance that the care they get should improve. Special measures do not replace our existing enforcement powers: it is likely that we will take enforcement action at the same time as placing a service in special measures. In some cases, it may be more appropriate to take urgent enforcement action rather than placing the service in special measures.
Service is placed in special measures
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21. Our enforcement powers
Requirements (formerly known as compliance actions)
Warning notices
S.28 warning notices
Civil enforcement powers
Impose, vary or remove conditions of registration
Suspension of registration
Cancellation of registration
Urgent procedures
Failing services
Immediate action to protect from harm
Time-limited ‘final chance’
Coordination with other oversight bodies
Criminal powers
Penalty notices
Simple cautions
Prosecutions
Holding individuals to account
Fit and proper person requirement
Prosecution of individuals
Protect people who use services by requiring improvement
Hold providers to account for failure
Severity
Protect people who use services by requiring improvement
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22. Ambition Our ambition for the next five years:
A more targeted, responsive and collaborative approach to regulation, so more people get high-quality care
We’re on the way to completing inspections of all the services we regulate, giving us a unique baseline understanding of quality.
When we’ve finished, the next step isn’t simply to start again, but to use what we’ve learned (and what people tell us) to target our inspections where poor care, or a change in quality, is more likely.
So 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. It has been developed based on what thousands of people, providers, staff and partners have told us and what we have learned from over 22,000 inspections. 22

23. Four priorities to achieve our strategic ambition
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.

24. Remember why we do this……
Copyright: Community Care

25. Reviews of care 2015/16 My diabetes, my care (September 2016)
Celebrating good care, championing outstanding care
What underpins good and outstanding care?
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
Building bridges, breaking barriers
Building bridges, breaking barriers looks at how well care for older people is integrated across health and social care, as well as the impact on older people who use services and their families and carers.
Widespread commitment to delivering integrated care.
Still many organisational barriers that made it difficult for services to identify older people who were at risk of deterioration or an unplanned emergency admission to hospital.
Examples of joint working in delivering health and social care, but these were often inconsistent, short-term and reliant on partial or temporary funding and goodwill between different providers. They were not a mainstream part of the way in which services were planned or delivered around older people.
Monitoring and evaluation was often not carried out locally or was insufficient.
The lack of connection between services often resulted in older people and their families or carers needing to take responsibility for navigating complex local services. This could result in people 'falling through the gaps' and only being identified in response to a crisis.
Older people often had multiple care plans because professionals did not routinely link together and share information.
Older people were not routinely involved in decision making about their needs and preferences.
Older people and their families or carers did not routinely receive clear information about how their health and social care would be coordinated, in particular if there were changes in their circumstances or if there was an unplanned or emergency admission to hospital.
Local leaders achieved integrated person-centred care by working closely across health and social care services to share information, reduce duplicated efforts and use resources more effectively.
Not seen, not heard
Right here, right now
National report looking at people’s experiences of help, care and support during a mental health crisis.
We found that the quality of care experienced by a person in crisis can vary greatly depending on where they are and what help they require. Many people also experienced problems getting help when they needed it, and found that healthcare professionals sometimes lack compassion and warmth when caring for people who are having a crisis
Many people will go to see their local GP first when they are having a mental health crisis. The majority (60%) of people who visited their GP during a crisis were satisfied with the experience.
Most people reported that they came into contact with at least three different services when they had a mental health crisis. One in twelve (12%) said that they had come in to contact with between six and ten services, which indicates a need for them to work more closely together in areas.
The use of police cells as a ‘place of safety’ for people in crisis has fallen significantly, but we found that people under 18 can have problems accessing suitable places of safety. In 2013/14, nearly a third of people under 18 who were detained, were taken into police custody.
A different ending – addressing inequalities in end of life care
People from certain groups in society are experiencing poorer quality care at the end of their lives than others because providers and commissioners do not always understand or fully consider their specific needs.
Some commissioners and providers might not be fulfilling their duties under the Equality Act 2010 as all public bodies have a legal duty to consider the needs of a range of equality groups when carrying out their day-to-day work.
Health and care staff are not always having conversations with people early enough about their end of life care. This means they don’t have the opportunity to make plans and choices with their loved-ones about how and where they would prefer to die.
We identified examples of good practice, but found that action is needed to make sure everyone has the same access to high quality, personalised care at the end of their lives, regardless of their diagnosis, age, ethnic background, sexual orientation, gender identity, disability or social circumstances.
Better care in my hands – how people are involved in their care
People’s right to being involved in their own care is enshrined in law in the fundamental standards of care. It is an essential part of person-centred care and leads to better and often more cost effective outcomes.
Just over half of people asked say they feel definitely involved in decisions about their health care and treatment.
Women who use maternity services are particularly positive about how well they are involved in decisions about their care.
We found examples of good practice of people’s involvement in their care in our inspections over the last year.
There has been little change in people’s perceptions of how well they are involved in their health or social care over the last five years.
Some groups of people are less involved in their care than others. They are:
Adults and young people with long term physical and mental health conditions.
People with a learning disability.
People over 75 years old.
We have also reported a lack of progress over the last six years in involving people in their care when they are detained under the Mental Health Act.
My diabetes, my care (September 2016)

26. More to come…. Reviews of care 2015/16 Integrated urgent care
The state of care report 2015/16
We've used inspection findings and data from other sources to build a picture of what care is like for the people who use health and social care services in two local areas.
What these reports show
The purpose of the reports is to:
inform the public about the quality of their local services and how well they work together
show care providers and commissioners of health and care where they need to improve to serve local people better
highlight findings that show where good joint working has benefited people who use health and care services.

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28. Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm
Sally Newell
Inspection Manager
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