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

2. 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

3. Welcome and introductions

4. Minutes and actions from last meeting

5. Responsive and Effective key lines of enquiry, prompts and characteristics

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

7. 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 ; should the pathway question become mandatory?
Should we strengthen prompts & evidence re condition & people-specific needs, or should we provide separate guidance?

8. 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

9. 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

10. 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

11. Ratings and updates

12. 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

13. Current overall ratings by service type
Source: CQC ratings data

14. 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

15. 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

16. 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

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

18. Learning disability ratings analysis
February 2016

19. 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

20. 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

21. 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

22. 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

23. Issues raised by trade associations

24. Housing with Care

25. 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

26. 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

27. 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

28. 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
Sign off for new handbook
March 2017
Publish revised inspection framework and handbooks
November 2016
Field test/consultation

29. AOBs