Mr. Gary Needle, Director of Methods - Quality control system - Incentives and sanctions used - Public and private workin side by side for high standard services.

1. The Care Quality Commission
Finnish Government Study Group –
21st May 2010
Gary Needle, Director of Methods, Care Quality
Commission

2. Content
This presentation will cover:
• The role of CQC
• The new registration and compliance system
• The challenge facing the health and adult social care
system
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3. Our role
The independent regulator of the quality of
health and adult social care services in
England.
We also protect the interests of people
detained under the Mental Health Act.
We make sure that people get a good
standard of care - whether services are
provided by the NHS, local authorities or by
private or voluntary organisations
As the first regulator to work across health
and social care we have a unique
opportunity to look at how well health and
social care work together to bring people
integrated care
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4. Our objective
The main objective of the Commission in performing its
functions is to protect and promote the health, safety and
welfare of people who use health and social care services.
The Commission is to perform its functions for the general
purpose of encouraging:
(a) the improvement of health and social care services,
(b) the provision of health and social care services in a way that
focuses on the needs and experiences of people who use
those services, and
(c) the efficient and effective use of resources in the provision
of health and social care services.
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5. ...on a page
Our five priorities
1. Making sure care is centred on people’s needs, 3. Acting swiftly to help eliminate poor quality care
and which protects their rights
2. Championing joined-up care 4. Promoting high quality care
5. Regulating effectively, in partnership
What we do to achieve our priorities
Registration and ongoing Assessments of quality Mental Health Act
monitoring and enforcement visits
Publishing information to support people making decisions
The way we work
-Involve users to focus our assessments on what is important to them
-Are expert and independent
-Promote equality, diversity and human rights
-Engage with those providing and commissioning care to inform our work
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6. CQC well placed to make strong
contribution
• Statutory Remit Covering ‘consumer protection’ (registration) and
tackling ‘information asymmetry’ (assessments of quality)
• Particular powers for inspection, data gathering, enforcement
Privileged Assets • ‘Whole system’ statutory remit – covering health, mental health,
adult social care; commissioning & provision
• Trust and credibility driven by independence from government and
commercial relationships
• Intelligent data analysis and risk assessment
Specific • Gathering in and responding to user voice
Competencies
• Local intelligence, insight & local relationship from field force
• National influence, drawing on comparative view of quality &
safety of care
• User Groups & Regulated bodies
Special • Other regulatory and oversight bodies (incl, Govt. Offices, SHAs,
Relationships Monitor, AC, Ofsted, NPSA
• Secretary of State & DH
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7. Improving the quality of care
Enforcement Publish
action Assessment of information
Registration
Quality to reinforce
- requires
other levers
providers to
‘improve or
exit’
Below essential Essential Above essential standards
standards standards
Quality of care
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8. How we will go about our work
Information
and Intelligence
about quality of care
Judgements
Analysis
on quality
of risk
Activities in response
To view of risk
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9. How we will go about our work
New information can come from a variety of sources:
People who use
services, families Providers
and carers
Other regulatory
bodies and Staff and other
Information professionals
Centre
Other bodies CQC
e.g. Ombudsman, Assessors and
commissioners Inspectors
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10. Other players in the field
National Quality Board NHS Litigation Authority
PCTs
ADASS
Monitor SHAs
NPSA GMC
3rd Sector Providers GSCC
DCLG
Audit Commission
DH
NHS Institute
Quality observatories
SCIE
NHS Information Authority NICE
Co-operation & Professional regulation
NHS Choices
Competition Panel Professional accreditation
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11. The aim of registration
People can expect services to meet essential standards of quality,
protect their safety and respect their dignity and rights.
Adult social care Single system of
1 registration
Single set of standards
NHS Registration 2
Strengthened
3 and extended
Independent
healthcare enforcement powers
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12. Registration timeline
(subject to legislation)
April NHS trusts
2010
Oct Adult social care and independent healthcare
2010 providers (CSA)
April Primary dental care (dental practices)
2011 and independent ambulance services
April Primary medical services
2012 (GP practices and out of hours)
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13. Benefits of registration
Outcomes - More outcome-based registration that protects and promotes
equality, diversity and human rights and makes providers accountable
Information - Improved access to timely, relevant and reliable
information enabling consistent comparisons and promotion of joined up
care
Enforcement - Earlier identification and swifter action to follow up
concerns including enforcement action where necessary
Burden - Reduced unnecessary regulatory burden and associated
costs of demonstrating compliance
Compliance - Increased compliance by health and adult social care
providers
Process - Improved transparency, speed, consistency and reliability
of registration
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14. Guidance about compliance
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15. Registration: the cycle
Registration application Information
Information
capture
capture
Application
made Judgement
on risk
Information
Information
Application Judgement analysis
analysis
assessed published
Judgement Regulatory Regulatory
made judgement response
Ongoing monitoring of compliance
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16. A national trend for improved
performance
Overall performance has steadily improved right across the
health and social care sector
However, a minority of NHS trusts, adult social care services,
independent healthcare providers, and councils have under-
performed
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17. Real improvements
for people using services
Hospital waiting times have been driven right down
• 89% of hospital trusts achieved the 18-week waiting
time target from referral to start of treatment
Rates of MRSA and Clostridium difficile have
reduced by 34% and 35% respectively
More people are living independently at home
• 2.1% of people aged 65 and above were living
in care homes (council-supported) in 2009,
compared to 2.5% in 2005
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18. Common concerns
There are three areas where we have concerns
about performance right across the health and social
care sector:
• Building a safety culture
• Protecting people from harm
• Workforce training
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19. Keeping people safe
Building a safety culture
Number of incidents reported to the NPSA improved to
1.06 million incidents last year, compared with 920,000
incidents the year before
In some organisations reporting levels are low
• Reporting from PCTs with hospital beds varied over 20-fold
We are not seeing the full picture in primary care
• In 12 months, primary care services across the country reported
under 3,500 incidents, compared with 693,700 from hospitals
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20. Keeping people safe
Protecting people from harm
• 9% of NHS organisations did not comply with
the minimum standard on child safeguarding
• Although the majority of social care providers fully
met standards relating to safeguarding procedures,
383 (2%) failed with major
shortfalls
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21. Workforce training
Good services rely on good, well-trained people
12 % of NHS trusts did not meet the core standard on
mandatory training
– the lowest compliance rate of all standards
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22. Workforce training
86% or less of adult social care services (such as
care homes and home care agencies) meet minimum
standards on training
Staff training and qualifications were a strength in only 16%
of councils
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23. An increasing challenge
for health and social care
By 2026, the Government expects there to be
1.7 million more adults needing care and
support
There will be greater pressure on public finances
Rightly, people are expecting more choice and control
over their care
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24. Services must
accelerate efforts to
• Work better together to join up services
• Ensure people have clear information and
understand their options
• Support people in maintaining their independence
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25. Major steps forward
More people are supported to live independently at home
In five years, the number of people with access to council-funded services
helping them avoid emergency hospital admission has risen from
80,000 to 148,000
In five years, the number of people with access to services helping them
return home quickly from hospital has risen from
112,000 to 157,000
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26. But, people face high levels
of local variation
3-fold variation in the extent to which councils place older
people in long-term residential care
4-fold variation in the rate of occupied bed-days associated
with repeated emergency admissions of older people in hospital
Over 30-fold variation in the proportion of people whose
discharge from hospital is delayed
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27. Our estimates suggest
If all areas in the country were able to reduce the
number of people admitted repeatedly as emergencies
and the length of their hospital stay to the low levels
seen in the best performing five areas of the country,
this would:
Result in 8 million fewer days in hospital
Free up 2 billion from hospital budgets
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28. Sharing of information between
organisations must improve
Only 53% of GPs reported that discharge summaries sent by acute
trusts arrived in time to be useful
In our review of actions taken by health bodies in relation to Peter
Connelly (Baby P), it was clear that communication between
organisations was poor
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29. Access to healthcare: a mixed picture
The NHS has greatly improved waiting times for acute care
The percentage of people who can get an appointment with a
GP within 48 hours varied by PCT (between 76% and 92%)
Only half of trusts provided adequate access to out-of-hours
mental health support
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30. Not all people receive useful
information on their care
• Some people do not receive enough information about their
care, e.g. 21% of people discharged from hospital said they were
not given sufficient information about their condition or treatment
• Information is sometimes given in a way that
people cannot understand, e.g. 29% people with disabilities
using social care services felt communication did not
help them to understand things properly
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31. Choice and control has
improved, but progress is mixed
• Nearly half of people (47%) recall being offered a
choice of hospital at their first outpatient appointment,
a big improvement compared with 30% in 2006
• Yet 1 in 4 people using acute mental health care
were not as involved in their care as they wanted
• And councils are not doing enough to give
people full control of their care with direct
payments
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32. Summary
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33. What does the analysis tell us?
• Overall steady improvement in performance in all parts
of the sector
• We see some real improvements that matter to people
• Some organisations lag behind the pack
• Common issues where improvement is needed, including
keeping people safe and training
• Some people are supported in having choice, control and
independence, but variation is high
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34. Leadership challenges
• Right across the system, an approach that focuses on
the individual, carers, and families is needed
• How can services best strategically commission in
order to deliver the benefits of joined-up care?
• Against the backdrop of future pressures, how can
services continue to work in partnership to deliver
person-centred care?
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35. We will play our part
A new regulatory system − centred on registration
− keeping the spotlight on outcomes the public wants to see
We will…
• Focus on the people who use services and their carers
• Set clear expectations of providers through registration
• Identify serious issues by responsive and vigilant
assessment
• Act swiftly, using our enforcement powers where needed
• Drive improvements through performance assessment
and our special reviews and studies
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36. Where to find out more
Read our full report or
summary booklet
Visit our website:
• Watch videos of
people telling their
stories
• Browse key findings
• Get accessible
versions
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