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Fundamental Standards: Improving services through regulation

Jo Walsh

CQC purpose and role

Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve

Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care

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The Mum (or anyone you love) Test

Is it good enough for my Mum?

Is it safe?

Is it caring?

Is it effective?

Is it responsive to people’s needs?

Is it well-led?

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What we do: !   Set clear expectations !   Monitor and inspect !   Publish and rate !   Celebrate success !   Tackle failure !   Signpost help !   Influence debate !   Work in partnership

Regulation to inspire improvement

How we do it: !   Five questions !   Respond to concerns !   Key lines of enquiry !   Specialist inspectors !   Experts by experience !   Ratings characteristics !   Reports !   Enforcement !   Co-production

Regulation to inspire improvement

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Implementing the new approach

KLOES & Ratings

published September

2014

New approach inspections rolled out

October 2014

New regulations including Fit and Proper Person

and Duty of Candour

Introduced April 2015

All ASC services rated by 2016

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New for April 2015

! Fundamental standards ! Duty of candour ! Fit and proper person requirement

! Special measures ! Scores on the doors ! Market oversight

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Duty of candour

! Purpose ! Promotes adoption of openness and transparency in

services ! Supports development of safety culture

! Actions required ! Inform people when things go wrong ! Provide support, truthful information & apology

! CQC ! Registration ! Inspection – existing key lines of enquiry

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Fit and proper person requirement

•  A provider cannot appoint an individual as a director unless the individual: •  Is of good character, has necessary qualifications and experience, is in good health,

is not linked to serious misconduct or mismanagement in the course of the provision of regulated activities

•  Is not an undischarged bankrupt, on a barred list, or prohibited from holding the office by statute

•  Has not been convicted of an offence or removed from a professional regulator’s register

•  The provider must make available to CQC specified documentary proof of the above and relevant employment history

•  If a director no longer meets these requirements, the provider must replace the director and inform the director’s professional regulator if the director is a registrant.

•  CQC must refuse to register a provider unless it is satisfied this requirement is met.

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Fit and proper person requirement

! Purpose ! Ensure directors or equivalents are held accountable

for the delivery of care and ! They are fit and proper to carry out this role

! Actions required ! Ensure recruitment of ‘directors’ tests whether

candidates meet the requirement ! CQC ! Registration ! Respond to concerns raised

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Special measures

! Purpose ! Ensure failing services improve or close

! Actions required ! Use time available to improve service

! CQC ! Services rated as inadequate will go into special

measures ! Time limited period to improve ! If improvements made – out of special measures ! If no improvement – move to cancel registration

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Scores on the Doors

! Purpose ! Public able to see rating of service quickly and easily

! Actions required ! Use CQC template to 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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CQC and market oversight

! Clear relationship between quality of care and finances

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What will market oversight do?

Purpose: ! Protect people in vulnerable circumstances by spotting if a

provider may fail – and make sure right action is taken

! CQC will: !   Monitor finances of ‘difficult to replace’ providers

!   Provide early warning to local authorities !   Assist with system response if failure occurs

It will not: ! Either ‘bail out’ struggling providers, or pre-empt failure

through inappropriate disclosure of information

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Proposed model for market oversight

Entry to scheme

Regular monitoring

Further risk analysis

Provider engagement

on risk

Regulatory action &

engagement

Formal notification

to LAs

1 2 3 4 5 6Step

Activity

If concerns identified and addressed

Key: Assessment of risk to financial sustainability (all provisional) no cause for concern/very low risk possible risk/medium risk

likely risk/high risk risk clearly identified/very high

risk

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Delivering market oversight

!   New capacity and capability internally:

!   New team with expertise and experience in

!   judging business failure risk

!   managing restructuring and insolvency processes

!   Supplemented by:

!   Access to external advice where needed, e.g. Independent Business Reviews

!   Advisory Group to scrutinise and challenge delivery of market oversight function

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So what are we finding now?

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Latest ASC inspections and ratings

Outstanding

Good

Requires improvement

Inadequate

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1863

1046

2802

80

28028

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As at 27 April 2015

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An outstanding care home

‘Relatives and friends visiting the home told us they only had positive experiences and praise for this service’

‘Staff told us that they would not like to work anywhere else’ Vida Hall, Harrogate

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Another outstanding care home

"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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Latest ASC inspections and ratings

Outstanding

Good

Requires improvement

Inadequate

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791

353

93 As at 23 February 2015

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www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm

Andrea Sutcliffe Chief Inspector of Adult Social Care

@CrouchEndTiger7 22

Thank you

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