1. Care Quality Commission: ‘A New Start’ Consultation (England) June 2013 Full details on the CQC Consultation are available here: http://www.cqc.org.uk/sites/default/files/media/documents/cqc_consultation_2013_tagged.pdf

2. Introduction  This slide deck presents key points and emerging issues on the consultation ‘A New Start’ from the Care Quality CommissionA New Start  Please use it to share with your colleagues and feedback to leela.barham@rcn.org.uk by mid July as the RCN develops our response leela.barham@rcn.org.uk

3. Background to the consultation  Prompted by:  Francis, Winterbourne View, Morecambe Bay  Implementing new strategy under new leadership of David Behan and David Prior  Widespread criticism of ‘old’ CQC (and new reports emerging all the time of problems at CQC in the past)

4. New operating model Informed by 6 C’s Chief Inspector of Hospitals can request Monitor/TDA to take action

5. Simplification to focus on 5 questions  When CQC inspect they will ask the following questions about care services:  Are they safe?  Are they effective?  Are they caring?  Are they responsive to people’s needs?  Are they well-led?

6. Proposed changes and initial RCN view ✔ ✔ ✔ ✔ ✔ ✔ RCN View* ? ? *RCN based on previous consultation responses and member engagement. Subject to discussion and due process to reach final position(s)

7. Other encouraging signs  Staffing highlighted in registration: “They must show us that they focus on the right things when they employ staff, such as their qualifications, clinical supervision and continuing professional development” (p11)  Approach inspections from the perspective of peer review  Co-ordination with existing inspections and visits e.g. Royal College visits  Inspect at night and at weekends and talk more to frontline staff  Can ask NMC to act or HSE  Will include concerns raised by staff as part of indicators looked at  Will consider avoidable morbidity

8. Tier 1 Indicators for an Acute Trust RCN view that staffing is both an indicator for safety and a well-led organisation

9. ‘Well led’ indicators RCN looking at indicators and exploring whether there are preferred indicators for staffing that can act as a trigger for further investigation

10. Areas where there may be tension with RCN view  Ratings  Intention for overall rating  But devil in the detail  Setting is relevant; makes more sense for care homes than for hospitals  Further consultation later this year on the details of this  But just what will this mean for public, patients, carers, staff?  Frequency of inspection  In 2011 our members told us that they wanted annual inspections  Not sure of view about ‘earned autonomy’ which will mean an unannounced inspection once every 3 to 5 years for those rated as ‘outstanding’  ‘Reasonable’ fundamental standards  Organisational not individual?  Complementary to code or duplicatory?  Realistic or setting up organisations to fail? CQC Examples “I will be helped to use the toilet and to wash when I need it” “There will always be enough members of staff available to keep me safe and meet my health and welfare needs”

11. Areas we’re unsure about  How will CQC work with Monitor and others? Will it work?  Will CQC be able to staff this new model?  But intention to make work at CQC an attractive career option but concerns of workload, lack of support voiced by our members working at CQC  Sufficient focus on staffing (numbers and skill mix)?

12. What could it mean to practicing nurses?  See CQC less often but when they do it will be for longer (6-7 days on site) and it should be more clinically credible  May be asked by public and patients and carers about their organisations’ rating  May be less work in preparing for CQC inspection  Opportunities for members to get involved:  Directly - as part of expert team  Indirectly - their comments will be looked at by CQC and as part of peer review?

13. Timeline  Consultation response due 12 th August but your thoughts by mid July please to allow for sign off  Implementing changes will take 2 years

14. Tell us your thoughts Contact: Leela Barham leela.barham@rcn.org.uk 020 7647 3901 By mid July