Rona McCandlish National Professional Advisor 20 January 2015 1
Our 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 We will be a strong, independent, expert inspectorate that is always on the side of people who use services 2
The landscape of care General public 53 million (35 million adults) Private hospital 1.4 million people receive treatment in a private hospital / year Dentists 22 million on a dentist list 15 million NHS 7 million private Health & social care staff 1.7m NHS staff 1.5m in adult social care Care homes 565,000 residents 165,000 going into care per year 39,000 people with learning disabilities in residential care 18,000 in a care home or care in their own home with no kith or kin GP practices 52 million registered with a GP 150m appointments / year Home-care 700,000 people receiving home-care support per year NHS hospitals 90 million outpatient appointments / year 11 million inpatients / year 18 million A&E attendances 5 million emergency admissions / year 600k maternity users 42,000 detained and treated against their will Stroke 1m Diabetes 3m Arthritis 8.5m Cancer 2m Dementia 0.7m 25% by 2020 67% by 2025 100% by 2030 100% by 2032 100% by 2040 NB There is overlap between our different audiences none are wholly distinct from the others
What kind of regulator? Independent of politics and the system Covers all sectors Clinically driven with expert teams, no guarantees Evidence-based judgement, not regulatory compliance Highlight excellence and expose poor care with transparent ratings Always on the side of people who use services Critical friend Consistent and fair 4
Recent facts and figures 5
Our new approach 6
What are we doing differently? Larger inspection teams including specialist inspectors, clinical experts, and Experts by Experience Intelligent monitoring to decide when, where and what to inspect Inspections will focus on five key questions about services We have developed services/groups and pathways that we focus on in each sector KLOEs (key lines of enquiry) form the overall framework for a consistent and comprehensive approach Ratings compare services and highlight where care is outstanding, good, requires improvement or inadequate 7
Who should be responsible for quality? Clinicians Providers/Boards Commissioners Consumers/patients/residents 8
Our new approach We ask these questions of services: Is it safe? Is it effective? Is it responsive? Is it caring? Is it well-led? all 9
Our new approach Inspection frameworks for NHS acute hospital core services published 15 th January 2015 http://www.cqc.org.uk/content/inspectionframeworks-nhs-acute-hospital-coreservices 10
Building a judgement Questions to answer Gather and record evidence Make judgements and build ratings Write report and publish with ratings Key lines of enquiry (mandatory plus additional KLOEs identified from information held) Intelligent monitoring and local information Preinspection information gathering On-site inspection Speak to staff and people using the service Apply consistent principles, build ratings from the recorded evidence Outstanding Good Requires improvement Inadequate 11
Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 12
Ratings 13
Important issues Integration and new models of care Consistency of care Identifying risk Money, and using it well 14
Leading indicators of failure Finance Staff engagement (and clinical alignment) Defensive, inward looking culture Isolation geographic and intellectual Weak and changing leadership 15
Improvement: drivers of change Intelligent transparency Ratings Benchmarking Consumer choices 16
Ratings: being clear about what good looks like High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve 17
Leadership (1) Visibility and transparency Humility (learning and listening) Courage (just culture) Aligned values and behaviour Priorities (high quality, safe care) Board to ward 18
Leadership (2) 19
People first Robert Francis They are husbands, wives, sons, daughters, fathers, mothers, grandparents. People must always come before numbers. Individual patients and their treatment are what really matters. 20
Thank you www.cqc.org.uk Rona McCandlish rona.mccandlish@cqc.org.uk National Professional Advisor 21