Addressing the new CQC requirements: the well-led organisation

Addressing the new CQC requirements: the well-led organisation Stephen J Collier Chair, NHS Partners Network 19 January 2015

CQC consultation closes this Friday. DO respond this week if you have something to say.

ORGANISERS ADVICE TO TODAY S SPEAKERS:- When preparing your presentation please avoid making comments about specific organisations that you do not and have not worked for that have experienced scandals to avoid causing distress to delegates in the audience that may be from the organisations in question.. So apologies in advance for any distress caused to anyone who would rather not talk about it

Structure Regulatory change a constant Themes underpinning that change From compliance to outcomes Healthcare, rather than NHS vs IS Performance ratings If endpoints the same, where is the IS right now? Specific NEW issues:- Ratings The well-led organisation Duty of Candour Special measures Actions required Conclusion

Regulatory change a constant Care Standards Act, 2000 National Minimum Standards Regulations 2001 Health and Social Care Act 2008 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2011 Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2012 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Themes underpinning that change Francis Report - massive impetus for CHANGE, from box-ticking compliance to assessment of outcomes; from process to culture CHANGE in the way CQC operates, and the basis on which it marks performance first for NHS then for IS. CHANGE so that will be broadly the same system, same success criteria, and same calibration for NHS and IS Experience of education CHANGE to focus on service ratings Fundamental standards and OFSTED-style ratings at the heart of the new regime

If endpoints the same, where is the IS right now? In transition Regulatory framework vs CQC approach Pilots Not the NHS, but very similar Hard questions will be asked of us but also a real opportunity to demonstrate differentiated quality Specific NEW issues for us:- Ratings The well-led organisation Duty of Candour Special measures

Adopted from education To every complex question. BUT easily comprehensible, and will have a massive impact on reputation Much tougher than previously So we move FROM NEW ISSUES 1.Ratings TO something very different

OUTSTANDING GOOD REQUIRES IMPROVEMENT INADEQUATE

NEW ISSUES 1. Ratings The rule of worst two

NEW ISSUES 2. The Well-Led Organisation Exactly the same test as in the NHS Easy to see in a stand-alone hospital; but more complicated for private hospitals in groups / chains CQC has given a clear indicator of what is required:-

The well-led organisation CASE STUDIES GOVERNANCE STRUCTURE Governance - clear and understood lines of responsibility and accountability Resourcing of quality and safety embedded time commitment, not simply dedication of the few Clear and demonstrable focus on safety, and quality with feedback loops PROCESSES Self-critical Confirm and challenge actively undertaken Reflective - review of a quality dashboard with appropriate coverage. Challenge and assurance within management. Lessons applied. Feedback loops closed promptly Senior management awareness of safety and quality issues through early identification process Policies reflected in practice e.g. Stop the Line CULTURE Should support candour, openness and honesty Staff ability to influence Disconnect between the senior team and the staff Staff not to feel bullied and harassed or unsupported by managers Attendance at meetings actually being there Focus on prevention of recurrence, not blame e.g. Swarm meeting

The well-led organisation - CHECKLIST Is there a clear governance structure that includes the operational head of the organisation Are responsibilities and accountabilities clear and effective; is there a pro-active approach Does the organisation breathe quality and safety or is it just lip-service Do things change in response to experience Is the culture positive and open are staff supported and do they feel so

The fit and proper persons test Individual responsibility, not just company s Applies to the IS from April 2015 Parallels requirement in the NHS, but for IS will probably operate at Group level rather than simply at hospital level Will probably apply to Directors or their equivalents.. If so, due diligence pre-appointment and then a continuing responsibility to monitor, performance manage, and develop / train One facet of the well-led organisation FINAL POSITION UNCLEAR but new Nominated individual may be taking all this on see reg 6 of the new 2014 regs.

NEW ISSUES 3. The Duty of Candour Already applies to private hospitals working under contract with NHS commissioners Current enforcement therefore via the contract, for those providers who have signed up From April, will apply to all private hospitals as an operating standard, enforced directly by the CQC More than simply complaints management

What does the duty of candour mean?

The Duty of Candour - CHECKLIST Complaints policy (as a start) Open culture Volunteer information Policy to manage incidents clearly shows focus on providing information to those affected and where appropriate an early apology Incident log assures that policy followed

NEW ISSUES 4. Special Measures

ACTIONS REQUIRED Read the new regulations +++ Read the latest CQC inspection reports, and assess how you would fare Check policies and implementation at sharp end Check levels of challenge and assurance in practice Check front line what is the care really like? Communicate with staff what do they think? nobody ever listens around here.. run for profit, not for patients Assess your culture is it in fact open and fair, does it support learning and innovation?

CQC consultation closes this Friday. Respond if you have something to say.

Conclusion System in transition, and moving very fast Major opportunity for good practice to be externally verified Also major opportunity for smug complacency to be identified; poor practice to be named and shamed; and dangerous units to be closed Effective clinical governance - and a pro-active focus on safety and quality - needs to be at the core of service delivery (this is not an optional bolt-on for already busy people)

Thank-you

The new fundamental standards (as set out in the 2014 regulations)

2013 2015

Sources, further reading Regulations Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 SI 2014 No 2936 available at http://www.legislation.gov.uk/uksi/2014/2936/pdfs/uksi_20142936_en.pdf CQC publications:- A new start consultation on changes to the way CQC regulates, inspects and monitors care, (June 2013) A fresh start for the regulation of independent healthcare (April 2014, CQC 233) How CQC Regulates NHS acute hospitals provider handbook, (September 2014) Response to our consultation on the fit and proper persons requirement and the duty of candour, (NHS bodies), (November 2014) Consultation our approach to regulating the acute healthcare acute sector, (November 2014) Case Studies BMI Mount Alvernia, CQC Report, April 2013 Hinchingbrooke Hospital, CQC Report, January 2015

stephenjohncollier@gmail.com 0771 484 4832