1. Croydon Registered Managers
Helen Wells
13 September 2017 1
Generic ASC deck (June Final) 1

2. 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.
Strategy Slides - 24 May MASTER

3. Monitor, inspect and rate
Our current model of regulation
Register
Monitor, inspect and rate
Enforce
Independent voice
We register those who apply to CQC to provide health and adult social care services
We monitor
services, carry out expert
inspections, and judge each service, usually to give an overall rating, and conduct thematic reviews
Where we find poor care, we ask providers to improve and can enforce this if necessary
We provide an independent voice on
the state of health and adult social care
in England on issues that matter to the
public, providers and stakeholders
In 2013 we introduced fundamental changes to our model of regulation.
We know we still have work to do to deliver this approach consistently and to a high standard.
Over the next five years we will continue to focus on the aspects of our model that people have said make the greatest difference – taking action swiftly when we find poor care and publishing independent expert ratings of quality.
Our core operating model will stay the same and we will ensure we continually improve how we deliver our four main functions.

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

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. 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
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8. 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.

9. Overall ratings….
Adult Social Care covers all service types - residential, community, hospices
Source: CQC – 1 February 2017

10. …and by key question
Source: CQC – 1 February 2017

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

12. 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.
More information can be found here:
Service is placed in special measures
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13. 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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14. 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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15. 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
New guidance entirety replaces, from April 2015, CQC’s current Guidance about compliance: Essential standards of quality and safety and current enforcement policy.
Our inspections will focus on rating providers on the five key questions for identifying good care, but where we identify poor care this guidance will help us to also determine whether there is a breach of regulations and, if so what action to take.
Hold providers to account for failure
Severity
Protect people who use services by requiring improvement
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16. Change in overall rating following inspection

17. And the breakdown?

18. 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.

19. Themes from Well-Led– Outstanding
People who use services, relatives and staff
speak highly of the service
Effective monitoring and quality assurance
75% of services had a registered manager in post consistently
Open culture – people who use services/ staff/ relatives shared views and issues
Good leadership extends beyond the manager and includes the provider
A can do, will do attitude
Strong links with local community
Safe care actively promoted – effective oversight of care and staff communication
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.

20. Outstanding characteristics
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 consistently
A can do, will do attitude – staff dedication
Safe care actively promoted – effective oversight of care and staff communication
LAs –
How can you commission for these outstanding qualities?
How can you manage existing contracts to reach and value services which demonstrate these qualities?
The better the relationship between LA and CQC, and the more a LA works proactively in partnership with local providers, the better the quality of care.

21. 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.

22. What does this mean for individuals?
“I feel safe, I can live the life I want and I am supported to manage any risks”
“I am in control of planning my care and support”
“I have care and support that is directed by me and responsive to my needs”
“I can plan ahead and keep control in a crisis”
think local act personal – MAKING IT REAL Marking progress towards personalised, community–based support

23. ‘Outstanding’ can be achieved
"We didn't think we were outstanding. And perhaps that's why we were – I think it's because we see every single person as an individual. It is our privilege to support them to live the last years of
their life with as much happiness, love and security as we can give them."
Suzanne, Prince of Wales House, Ipswich
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24. 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

25. Influencers of quality
The public - who use services
Professionals - all undertake a personal commitment to deliver safe high quality care when they register
Providers – from the Board to the front line
Commissioners – what they do and how they do it
Regulators - this includes quality regulators, system regulators but also professional regulators
The overall improvement system = 5 influences on quality (plus the sixth of research)
In “Health Regulators” (the 2014 CQC and our independence publication) we set out who influences quality in health and social care along with how our role and purpose as a regulator influences improvement. Broadly there are five major influencers of quality:
Public voice
Professionals
Providers
Commissioners
Regulators
Improving the quality of services that people use relies on these influencers working together.
We have a responsibility to provide good judgements of quality. It is up to providers to use our judgements to help them improve the quality of their services. Commissioners should use our judgements to celebrate good care and commission for quality, not just price. For professionals, our judgements should enable them to take action where care is not good enough and to learn from good and outstanding care where we find it.
Finally, consumers have an opportunity to use our judgements to make better informed decisions about the care they and their loved ones receive.

26. Stand up for adult social care
What should we do?
Stand up for adult social care
Celebrate the good
Challenge the bad
Be positive and honest
Work together
Stand up for adult social care. The public is so much more aware of what adult social care is, why it’s important, who pays for it, whether or not it is high quality. There is more awareness, higher expectations and much criticism. Stand up for social care, be proud of what’s good, be positive and fight for it to be better.
I know that finances are increasingly squeezed, but commissioners should celebrate the good and commission for quality, not just price. Like I said, good care has the power to change people’s lives. Be positive and honest, and work together.
Use our information to change lives. Use our information to take action, to argue for more resources, to encourage choice, to encourage providers to raise standards. Use the findings in State of Care, in Cracks in the Pathway and on our website (all these can be found on our exhibition stand).
Celebrate the good, challenge the bad.
And …. as you lead services from the top, remember why we – and all our colleagues and staff – do this.
With thanks to Community Care – these images can be found on their stand in their 2015 charity calendar.
And…always remember why we do this 9

27. A wise woman once said…
“People will forget what you said, people will forget what you did, but people will never forget how you made them feel”
Maya Angelou 27

28. Our next phase of regulation: a more targeted, responsive and collaborative approach

29. 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.

30. Consultations on our proposed changes to inspections
Closes 8 Aug
nextphase
20 December 2016 – 14 February 2017
New care models and complex providers
Cross sector changes to assessm ent framewor ks
Updated guidance for registratio n of learning disability services
Changes to Hospital s inspectio n methodol ogy
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 registrati on
Updating guidance on Fit and Proper Person Requirem ents
Closed
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

31. The updated well-led framework: Key Lines of Enquiry
Does the leadership have
capacity and capability to deliver high quality,
sustainable care?
Is there a culture
of high quality,
Is there a clear vision and credible strategy to deliver
high quality sustainable care to people, and robust plans to deliver?
Are services
well-led?
Are there clear responsibilities, roles and systems of accountability to support good governance and management?
Is robust and appropriate information being analysed
and challenged?
Are there clear and
effective processes for managing risks, issues and performance?
Are the people who use
services, the public, staff and external partners engaged and involved to ensure high quality sustainable services?
Are there robust systems, processes for learning, continuous improvement
and innovation?
Hospitals

32. Thank you To keep up-to-date with developments:
For providers only
To keep up-to-date with developments:
Subscribe to receive our monthly bulletin:
Follow us on Twitter:
@CQCProf
Join our provider online community to share your views: involved/join-our-online-communities-providers

33. Thank you www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm
Helen Wells
Inspection Manager
Generic ASC deck (June Final)