1. CQC – an update on developments and how we involve people in our work Karen Culshaw Vision 2020 Conference May 2012

2. 2 Registration timeline NHS trusts April 2010 Oct 2010 April 2011 April 2013 Adult social care and independent healthcare providers (CSA) Primary dental care (dental practices) and independent ambulance services Primary medical services (GP practices, walk-in centres and others) April 2012 Primary medical services (providing out of hours services)

3. 3 Scale of CQC regulated care Primary medical services 10,000 locations NHS Trusts 2,300 locations Independent healthcare 2,500 locations Adult social care 25,000 locations Independent ambulances 300 locations Primary dental care 10,000 locations Outpatient appointments 70 million People using adult social care services 1 million Dental treatment – courses of treatment in 2011/12 10 million

4. 44 In September 2011 we consulted widely with providers, stakeholders, people who use services and our own staff on proposed changes to the way we regulate. We have now published the results of our consultation and confirmed the changes that will simplify our regulatory model. The changes also ensure that we focus on our core job: to inspect providers to make sure that the essential standards of quality and safety are being met, and to take swift action where they are not. Improvements to our model do not change the fact that responsibility for the delivery of care rests with the organisations and professionals that provide it. Refining our regulatory model

5. 5 Principles of inspection New approach to inspections Timely At least once a year or once every two years depending on the provider Focused Inspections will focus on outcomes that are important to people using services Flexible We can use different types of inspection to respond to concerns Unannounced We do not notify providers before we carry out inspections

6. 66  To support unannounced inspections, we will no longer ask providers to send us information in advance of an inspection  Providers must be aware that they can be inspected at any time  Inspectors will focus on identifying non-compliance when they are inspecting, but they will also describe what they find, including care that is meeting the essential standards  We will follow a clearer, more transparent process to enforce compliance with the regulations. We will always be proportionate in the action that we take What the changes mean for providers

7. 7 How we involve people who use services The SpeakOut network The Service User Reference Panel eQuality Voices Webforms Acting Together LINKs (Healthwatch)

8. 8 Acting Together Experts by Experience for inspections Other activities: Consultations Events Methods and guidance development Reviews and special studies Reference panels Staff induction training Reviewing public information materials

9. 9 Support Organisations Age UK The Choice Support Consortium Voiceability Living Options Devon Skills for People Inclusion North Hersov Associates The Challenging Behaviour Foundation Addiction Dependency Solutions/Oxfordshire User Team

10. 10 Experts by Experience The ranges of people currently employed as experts by experience are: People with experience of detention under the Mental Health Act People with learning disabilities/autism People with physical and sensory impairments People with mental health needs Older People/family carers of older people People with Dementia and their family Carers People with experience of Substance misuse services Family Carers of people with High Support Needs

11. 11 Why do we work with Experts by Experience? We work in partnership with Experts by Experience to increase the scope of our evidence gathering. Experts by Experience can help us to get a clearer picture of what it is like to live in or use the service. They may have a better understanding of how the needs of people who use services could be met based on their personal experience. Some people who use services feel more able to talk openly to Experts about what it is like to live in or use their service.

12. 12 Experts by Experience Trained and authorised to accompany inspectors Can take part in inspections of all health and adult social care services Not used on all inspections, but we are looking at increasing the number of visits with Experts

13. 13 Experts by Experience In the year 201/12 Experts by Experience took part in 505 inspections. This included 150 learning disability themed inspections. As well as ‘business as usual’ inspections, in 2012/13 we will also have: 550 Dignity and Nutrition themed inspections 250 home care themed inspections.

14. 14 Short Observational Framework for Inspection (SOFI 2)  for use in acute & mental health care and residential care settings – not for use in domiciliary care or hospices  compulsory training for all compliance inspectors

15. 15 Short Observational Framework for Inspection (SOFI 2) Understanding each person as an individual is very important. Good practice recognises and uses a ‘person-centred’ approach. The SOFI 2 framework is based directly on a model of person-centred care - a unique tool for inspectors to capture, in a systematic way, the experience of care by people who have great difficulties in communicating their feelings and views supports evidence collection for a number of outcomes, but particularly outcomes 1, 4, 5, 7, 9, 12-14

16. 16 Getting clinical and professional advice into CQC’s regulatory model Background CQC recognised that we needed to improve how we engage clinicians and professionals and use their advice and support more effectively. We also understood the value their input could bring to delivering a high-quality regulatory model. In 2010 the Board commissioned work to explore this - led by Professor Deirdre Kelly Set up Specialist Advice Advisory Group Made 3 key recommendations November 2011 – the Board accepted the recommendations and asked CQC to progress this

17. 17 Three recommendations  We should review how we deliver our regulatory model and present our findings to make them as relevant as possible to clinicians and professionals.  We should extend the use of clinical and professional ‘expertise’ in our regulatory activity.  We need to develop a variety of way to communicate more effectively with clinicians and professionals.

18. 18 What have we done to date Recommendation 1  We are implementing the revised regulatory model (as above)  We need to consider feed back given to staff within an organisation on the day of the inspection (currently only very high-level feedback is provided to senior management).

19. 19 What have we done to date Recommendation 2  we have undertaken a review of how the National Professional Advisor resource and role is progressing to ensure it meets business delivery needs  we are developing a 'bank' of specialist advisors to support investigations, thematic inspections and compliance monitoring. This will help improve the scope and depth of inspection activity, judgements and reporting  we are developing a model for accessing Second Opinion Advisory Doctors (SOADs).

20. 20 Recommendation 2 continued – focus on specialist advisors  Advertised for specialist advisors through our clinical and professional newsletter and through our networks  Shortlisted and interviewed against a set criteria – still going through this process  We are working with our Operations staff to develop clear criteria for accessing specialist advisors  The bank will be up and running by July 2012

21. 21 What have we done to date Recommendation 3 improved stakeholder management structure - wider range of stakeholders 'Stakeholder Committee' has clinical and professional membership Set up advisory groups to advise on individual pieces of work Stakeholders' forums will be set up to engage with a particular sector developing regional relationships with Royal Colleges developed a monthly e-newsletter for frontline clinicians and professionals intend to create a ‘clinical’ online community that will provide a forum to engage with clinicians and professionals on specific issues. It will also allow us to test out the proposed content and language used in various documents and guidance prior to publication

22. 22  A library of supporting information  A team of National Professional Advisors – we employ 8 covering a range of specialities. They can provide email and telephone advice and, in some complex cases, support undertaking visits  Access to a ‘bank’ of specialist advisors – we are currently recruiting clinicians and professionals to the bank – staff will be able to request advice and support – this could be email or telephone advice or support on an inspection visit  Access to CQC staff with up to date clinical and professional knowledge – we have undertaken a survey of staff to find out which staff have up to date registration and whether they would be prepared to be contacted by colleagues to provide advice about their areas of expertise Clinical and professional advice and support to operations staff

23. 23 Thank You Karen Culshaw Karen.culshaw@cqc.org.uk CQC website – www.cqc.org.ukwww.cqc.org.uk National Contact Centre Telephone: 03000 616161