Airedale NHS Foundation Trust Council of Governors: 28 th January 2016 Title: CQC Inspection Briefing Author: Jane Downes, Company Secretary As you will be aware, the Care Quality Commission ( CQC ) have just published a Guide for Governors of Foundation Trusts about the CQC and its Inspections of NHS Foundation Trusts. The guide and accompanying letter from Professor Edward Baker, Deputy Chief Inspector, CQC was issued to all Governors on 21 st December 2015 with a covering letter from the Chairman. A copy is enclosed for ease of reference. The Chairman s letter stated that the CQC have confirmed the inspection date for Airedale NHSFT as Tuesday 15th March to Friday 18th March 2016. As part of the inspection process the CQC will wish to meet with the Council of Governors prior to the inspection. The guidance document explains how the CQC will engage with the Council of Governors, and in particular suggests how the Council of Governors may organise their meeting with the CQC (see page 9). The Chairman explained in his letter that it is important that the Council of Governors has the opportunity to consider and agree where and when the meeting will take place and the information they will share with the CQC. The Trust is meeting with the CQC on a regular basis up to the time of the inspection. The Medical Director and Assistant Director, Healthcare Governance will brief Governors further at the Council of Governors meeting. Action required: To agree the process by which Governors will meet with the inspection team. 1
Airedale General Hospital Skipton Road Steeton KEIGHLEY West Yorkshire BD20 6TD Telephone: 01535 294540 Facsimile: 01535 655129 email: fiona.page@anhst.nhs.uk 21 December 2015 Dear Governor As you will be aware, the Care Quality Commission ( CQC ) have confirmed our inspection date as Tuesday 15 th March to Friday 18 th March 2016. As part of the process the CQC will wish to meet with the Council of Governors prior to the inspection. This will be the Council s opportunity to meet with the inspection team to share the Council s assessment of the leadership and quality of care in the foundation trust. The CQC have just published a guide for Governors of foundation trusts (enclosed), which I would encourage you to read at your earliest convenience. The guidance document explains how the CQC will engage with the Council of Governors. I would draw your attention to page 9 which suggests how the Council of Governors may organise their meeting with the CQC. It is important that the Council of Governors has the opportunity to consider and agree where and when the meeting will take place and the information they will share with the CQC. I will therefore ensure that Governors have the opportunity to discuss this further at the January Council of Governors meeting. In the meantime it would be helpful if you could reflect on this prior to the meeting so you can participate fully in the discussion on the 28 th. Should you have any questions or require further information prior to the January Council of Governors could you please contact either me or Jane Downes, Company Secretary. Yours sincerely Michael Luger Chairman Encs.
December 2015 Letter and briefing to Councils of Governors from the Care Quality Commission Dear governor, This letter and the attached briefing have been written for all governors of NHS foundation trusts by the Care Quality Commission, working closely with Monitor and NHS Providers. The briefing explains CQC s role, our inspections of NHS foundation trusts alongside the role of Monitor, and how we engage with councils of governors in our regulatory work. It provides links to a range of information that we hope you will find useful in your role. This includes in particular, the fundamental standards of care that the public and service users have a right to expect, and which no service should fall below. We also provide details of the questions we ask on our inspections to judge whether services are outstanding, good, requires improvement or inadequate and the actions we can take where we find services need to improve. Links to our monitoring data for all trusts and are inspection reports are also available from this briefing. We hope you find the briefing helpful in developing your governor role and responsibilities, and in holding your foundation trust board to account for the care it provides and the resources it uses. We also hope that you can use the information to understand the roles of the regulators, alongside your own, in ensuring the leadership of your foundation trust is effective and that the trust provides care that meets the standards of quality and safety set by Parliament. The briefing is available on the Care Quality Commission s website and on NHS Providers website. If you have any questions or comments about the briefing please contact engagementandinvolvement@cqc.org.uk. We would like to thank you for your continued contribution to the governance of NHS foundation trusts. You may also be interested in the consultations taking place from January 2016 to develop our new strategy, improvements to our inspections and how we assess a trust s use of resources which we will introduce from April 2016. Yours sincerely Professor Edward Baker, Deputy Chief Inspector, Care Quality Commission
CQC and foundation trust councils of governors A guide for governors about the Care Quality Commission and our inspections of NHS foundation trusts November 2015
About this guide This guide aims to support foundation trust councils of governors in encouraging improvements in the quality of healthcare in their foundation trust by explaining the work of the Care Quality Commission (CQC), our inspections, and the new fundamental standards. It describes our inspections of NHS foundation trusts and how we engage with councils of governors. People using services are at the heart of quality improvement and councils of governors play a key role in representing the public interest and holding trust services to account on their behalf. The guide is supported by Monitor, NHS Providers and the Department of Health. We are working with these partner organisations to ensure our work with councils of governors is coordinated and supports governors in their role. The guide explains: Our purpose and role Principles of our contact with councils of governors How we work Our inspections of NHS foundation trusts What this means for your council of governors Using CQC information Fundamental standards of care Comments and questions about this guide are welcome and should be sent to engagementandinvolvement@cqc.org.uk. CQC s purpose and role The Care Quality Commission is the independent regulator of health and adult social care in England. Our purpose is to 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 is to monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety. We publish what we find, including performance ratings to help people choose care. We are responsible for monitoring and reporting on the use of the Mental Health Act and our findings inform our ratings of services. We protect the interests of people whose rights are restricted under the Act, including handling individual CQC and foundation trust councils of governors guide 2
complaints about its use. We provide the second opinion appointed doctor service which safeguards the rights of patients detained under the Mental Health Act who either refuse the treatment prescribed to them or are deemed incapable of consenting. We also monitor and report on the use of the Deprivation of Liberty Safeguards (DoLs) across England. We have additional powers to carry out special reviews looking at how care is provided for people with particular health needs or across different services for example reviews about the quality of end of life care and integrated care for people over 75. We gather and use the experiences of patients, people who use services, their families and carers and local communities about their care to identify concerns and to celebrate outstanding care. Working with public representatives, including foundation trust councils of governors, is an important way in which we do this. We work closely with Monitor, which makes sure: Providers of NHS care are well-led so that they can provide quality care on a sustainable basis. Essential services are maintained if a provider gets into serious difficulties. The NHS payment system promotes quality and efficiency. Procurement, choice and competition operate in the best interests of patients. Principles of our contact with councils of governors We recognise that the primary accountability for councils of governors is to local people using their trust s services, and their key relationships are with their members (recent patients, service users and the public of the trust) and with their trust board. We want to ensure that there is mutual understanding of our roles, and agreed lines of communication between councils of governors and CQC when we need them. We engage with foundation trust councils of governors and their boards across the country to exchange information that can help us recognise good and outstanding care, tackle poor care and encourage improvements in foundation trusts. We respect the independent status of councils of governors and take account of the different roles we play in holding health services to account for the care they provide. CQC and foundation trust councils of governors guide 3
How CQC works We register health and care services NHS foundation trusts, along with most of the health and adult social care services in your area, are required to register with us in order to provide care. There are regulated activities that we are required to monitor and inspect across health and care services. Go to www.cqc.org.uk/content/what-registration for details of who has to register with us. All service providers also have to inform us if they set up a service or vary a service to provide different sorts of care. The main types of services we regulate are set out below. Health and adult social care services that have to register with CQC Hospitals including maternity and children s services, medical and surgical care, end of life care, urgent care, outpatients and ambulance services Community health services including community hospitals, services for people with long-term conditions and district nursing services Clinics which offer services such as IVF, cosmetic surgery and advice or treatment to help with family planning or weight loss Services for people with mental health problems including hospital, community and crisis care, and drug or alcohol misuse services Healthcare services in the criminal justice system including prisons (with Her Majesty's Inspectorate of Prisons) Services for people with a learning disability Healthcare in children s services (with Ofsted) Care homes both with and without nursing care, extra care housing services, shared lives and supported living services including dementia care Services in your home such as home care agencies Hospice services GPs and doctors including GP practices, out-of-hours services and walk-in centres Dentists These services may be run by the NHS, private companies or charitable organisations. CQC and foundation trust councils of governors guide 4
We monitor and inspect services Our inspection programmes are led by three chief inspectors, responsible for monitoring and inspecting adult social care, primary and integrated care, and hospital care (which includes mental health, community, acute hospital and ambulance care in NHS trusts, NHS foundation trusts and the independent healthcare sector). Our inspection teams carry out inspections of all the services listed above. In a large foundation trust this will involve inspecting a wide range of services. We publicly announce inspections of NHS and independent healthcare services, community and mental health services in advance. Inspections of adult social care and primary care services take place on an ongoing basis and are not announced individually. Our Mental Health Act visits take place unannounced at any time to places where people are detained and are also part of our mental health service inspections. There are CQC inspection teams for each sector in every part of the country. Our registration teams work across all sectors to maintain an up-to-date picture of which services are being provided where and by whom. There is an inspection manager responsible for maintaining an ongoing relationship with each NHS foundation trust, who works with a team of inspectors. The following table shows the areas inspection teams cover and the main groups of services they inspect. CQC local inspection teams Hospital inspection teams: Work across NHS trust areas Inspect NHS acute, ambulance, mental health and community health trusts and independent healthcare, and monitor the use of the Mental Health Act Primary and integrated care inspection teams: Work across clinical commissioning group areas Inspect GP practices, outof-hours services, dentists, and healthcare in the criminal justice system and in children s services Adult social care inspection teams: Work across local authority areas Inspect care homes, home care agencies and hospices CQC and foundation trust councils of governors guide 5
We inspect and rate core services on every NHS foundation trust inspection In each sector, we have identified core services that we always inspect and rate. The core services we inspect in NHS foundation trusts (and other NHS trusts), are shown below. Our inspection teams may also visit other services at the trust if they have identified risks of poor care. We will inspect all of the relevant core services provided by integrated trusts. Type of NHS foundation trust NHS acute hospitals NHS community health trusts NHS ambulance trusts NHS mental health trusts Core services CQC inspection teams always inspect and rate Urgent and emergency services; medical care (including older people s care); surgery; critical care; maternity and gynaecology; services for children and young people; end of life care; outpatients; and diagnostic imaging. Community health services for adults; community health services for children, young people and families; community health inpatient services; and community end of life care. Emergency operation centres handling 999 calls, and emergency and urgent services responding to these calls; high dependency and intensive care transport; non-urgent and non-specialist patient transport services; resilience planning; and the NHS 111 service (which is included under our approach to inspecting and regulating NHS GPs and GP out-of-hours services). Acute wards for adults of working age and psychiatric intensive care units; long stay/rehabilitation mental health wards for working age adults; forensic inpatient/secure wards; child and adolescent mental health wards; wards for older people with mental health problems and for people with learning disabilities or autism; community-based mental health and crisis response services and services for adults of working age; mental health crisis services and health-based places of safety; specialist community mental health services for children and young people; and community-based mental health services for older people and for people with a learning disability or autism. CQC and foundation trust councils of governors guide 6
Inspection teams ask five key questions There are five questions we ask of all care services. They're at the heart of the way we regulate and they help us to make sure we focus on the things that matter to people. Are they safe: are people protected from abuse and avoidable harm? Are they effective: does people's care, treatment and support achieve good outcomes, help them maintain their quality of life and is it based on the best available evidence? Are they caring: do staff involve and treat people with compassion, kindness, dignity and respect? Are they responsive: are services organised so that they meet people's needs? Are they well-led: does the leadership, management and governance of the organisation: make sure it s providing high-quality care that's based around people s individual needs encourage learning and innovation promote an open and fair culture? From April 2016 we will also be assessing the trust s use of resources. All of our inspections, our inspection reports and the ratings we give services are structured around the answers to these five questions. Inspectors follow more detailed key lines of enquiry (or KLOEs) to help answer each of these questions. These are tailored for different types of services. Your foundation trust management board may refer to these questions when they are preparing for an inspection, or in the day-to-day running of their service as a benchmark (see Using CQC information for more details). CQC inspections of NHS foundation trusts The main stages of a comprehensive NHS foundation trust inspection are described briefly below. The same approach is followed in our inspections of NHS trusts. Details of the process can be found at: www.cqc.org.uk/handbooks CQC and foundation trust councils of governors guide 7
Main stages of a comprehensive NHS foundation trust inspection Our inspection managers and Monitor colleagues discuss the foundation trust inspection schedule, to ensure that the latest evidence about the quality and performance of each foundation trust (and trusts seeking foundation trust status) is used to identify any potential risks to consider on inspection. We inform the foundation trust management board of the inspection 20 weeks in advance and discuss making contact with the council of governors through the chair. We publicly announce the inspection shortly afterwards. The management team are expected to inform the council of governors in the most appropriate way. The management team is asked to provide information to help plan the inspection (a provider information request). This includes details of the trust s services and how it is run, along with data about the quality of care provided. Our analysts bring together national data held about the foundation trust. A pack of this data is shared with the foundation trust board. It includes a set of indicators that look at a range of information including patient experience, staff experience and performance. The indicators relate to the five key questions we ask of all services: are they safe, effective, caring, responsive, and well-led? Our inspection teams also request information from local commissioners, other providers, and patient and public groups, including Healthwatch. We encourage the public and people who use services to share their experiences of care through a range of activities leading up to an inspection. This includes contacting local stakeholders, promoting the inspection through local media and encouraging people to share their experiences of care online. Specifically for foundation trusts, we develop a bespoke landing page on the CQC website with information about the inspection and the relevant feedback forms for the trust. This is emailed to foundation trust members via the trust s communications teams and the experiences of care this generates are shared with the inspection teams before the start of the inspection. We also use drop-in sessions for people using services in mental health trusts. At the start of the inspection, the inspection team meet senior staff to introduce themselves, and discuss the scope and purpose of the inspection and how we will communicate our findings. This would usually include the chair of the trust board. Inspection teams include a chair for the inspection, an inspection manager, various inspection leads for different parts of the inspection along with their inspectors, specialist clinical advisors and Experts by Experience (people who have experience of using similar services). The teams vary in size depending on the size and geography of the trust s services. The foundation trust management are invited to present their view of the trust s performance (see box below). CQC and foundation trust councils of governors guide 8
Inspection meeting with the council of governors Before the inspection, the inspection manager approaches the chair to invite the council of governors to meet with the inspection team to share their assessment of the leadership and the quality of care in the foundation trust. This may include examples of good and outstanding practice and feedback the council has gathered from the public and people who use services. The council can suggest how it wishes to organise this meeting. For example, it may wish to invite members of the inspection team to a council of governors full meeting, a meeting of a specific governor committee, or to convene a specific meeting of a group of governors. It is a matter for the council as to how many governors and the mix of governors that meet with the inspection team and the arrangements for deciding any information they share with us. Governors who attend this meeting are there to bring evidence on behalf of the council of governors as a whole, not to represent their own individual views. If governors wish to submit their experiences as individual members of the public they can do this directly to CQC through www.cqc.org.uk/yourexperience or by ringing 03000 616161. The council s perspective on the leadership of the trust is particularly important, to inform our inspection teams assessment of whether the foundation trust is wellled. Any information shared by councils of governors will be used in conjunction with other national and local evidence, feedback from staff and local partners and critically from service users and the public. It will help our inspection teams to: Decide what to focus on during the inspection of the trust for example, the care for particular groups of people, wards or departments in the trust, aspects of leadership and governance in the trust or how the services links to other health and care services in the area. Identify and share areas of good practice. Spot any concerns in the trust that may need to be acted upon quickly. Make judgements about the ratings for the trust and its services. Decide if the trust should make improvements or needs to be placed in special measures. CQC and foundation trust councils of governors guide 9
The inspection team plans the inspection to focus on areas of concern or areas where the service is performing particularly well. The team collects evidence against the key lines of enquiry by: Gathering the views of people who use services. This includes speaking to people individually and in groups and placing comment cards (so that people can write down their views) in busy areas. Using information gathered from complaints and concerns from people who use services. Gathering information from staff. Observing care and the environment in which people are cared for. Looking at individual care pathways and reviewing records. Looking at documents and policies. Inspections usually last around to to five days. The inspection team may return for additional unannounced visits during the day or night where needed over a two week period. At the end of the inspection, senior members of the inspection team hold a feedback meeting with senior staff. The inspection team summarise what they have found and identify any action the trust needs to take immediately. They also explain how we will make our judgements and publish them. Once a foundation trust has had its first comprehensive inspection subsequent inspections may be shorter. A draft inspection report, describing a summary of our findings along with detailed findings for each of our five key questions, is shared with the trust senior management and board for factual accuracy. The board and senior management of the trust are also invited to attend a quality summit held with local commissioners, Monitor, NHS Trust Development Authority (if not a foundation trust), local partner organisations and public representative groups. We share the findings of the inspection report and the ratings. There is a discussion to agree any actions arising with the trust and its local partner organisations. Following the quality summit the inspection report is published with a press release around three months after the inspection. It includes the details of the inspection findings, highlighting examples of good and outstanding care as well as any areas for improvement. The report is available on our website and the foundation trust is required, as are all other services CQC inspects, to display the ratings in key locations and on their website to make sure the public see them, and they are accessible to all of the people who use their services. We have published guidance for providers about meeting this regulation at: www.cqc.org.uk/ratingsdisplayguidance. CQC and foundation trust councils of governors guide 10
We rate services We rate most of the health and care services we inspect. For NHS foundation trusts this includes the trust overall, its core services and the quality of care in relation to the five key questions we ask. The ratings tell you whether we have found the quality of care to be: Outstanding Good Requires improvement Inadequate Our inspection reports describe the good and outstanding care we have found during the inspection, as well as any concerns we may have, across any of the services we have inspected. We take action where we find poor care We have a number of powers we can use if we find services are not meeting the new regulations for care set out by the government. These set out the fundamental standards of care below which no service should fall (see page 14). Our powers to take action range from warnings and fines, through to prosecuting those responsible for the service. In some cases, CQC can move straight to prosecuting those responsible for providing services if fundamental standards are not being met. We have a specific power to issue warning notices where significant improvement is required in an NHS trust or NHS foundation trust. Significant improvement is not necessarily restricted to breaches of legislation but could be broader. Where we do issue a notice, we will Set a timescale for the significant improvements required. Allow the NHS body to make representations about the matters of the notice. Special measures for NHS foundation trusts A process called special measures has been introduced to ensure that services found to be providing inadequate care do not continue to do so. Special measures apply to NHS trusts and foundation trusts that have serious failures in quality of CQC and foundation trust councils of governors guide 11
care and where there may be concerns that existing management cannot make the necessary improvements without support. If a foundation trust is placed in special measures, the board can expect a set of specific interventions designed to improve the quality of care within a reasonable time. The trust will be allocated an improvement director from Monitor and offered access to additional support. Our focus is on identifying failures in the quality of care and judging whether improvements have been made. This is done through follow-up inspections where needed to re-inspect trusts within a given timescale. Where necessary, we use our enforcement powers to ensure that providers who are unable to meet required standards of quality and safety are not allowed to continue indefinitely. The NHS Trust Development Authority and Monitor (to become NHS Improvement from April 2016) use their respective powers to support improvement in the quality of care provided. A guide for NHS foundation trusts and NHS trusts about special measures has been produced jointly with Monitor and the Trust Development Agency and is available on our website at www.cqc.org.uk/content/special-measures. Special administration for NHS trusts and foundation trusts In very rare instances, where an NHS foundation trust is failing to deliver high quality care and appears to be financially unsustainable, we have powers to require Monitor to appoint a special administrator to make recommendations about the future of the trust. The administrator s recommendations are designed to ensure that the NHS body improves its standards so that it provides secure, sustainable and high quality services. What this means for your council of governors The outcome of a CQC inspection and the ratings given to your trust and its services will be critical to the board s activities and the council of governors assessment of the board s effectiveness. The inspection report should enable the council of governors to understand the quality of care the trust provides for patients and service users and help the council s understanding of leadership and staff morale and its recognition of good practice. It should support a culture of continuous learning, part of which will be to address any areas of improvement which the CQC inspection identifies. The board should use the CQC inspection findings to inform its quality strategy and other improvement plans. Councils of governors will need to take note of the CQC and foundation trust councils of governors guide 12
outcome of the inspection, and whether the findings raise new issues that the council is not aware of. Councils should seek assurance from the non-executive directors that the appropriate action plans are in place following an inspection. They should ensure that appropriate and accessible information about the quality of care is monitored so that they are confident that progress is being made where concerns or areas for improvement have been identified in CQC reports. Using CQC information Councils of Governors may find the following information from CQC useful to support their duty to hold the trust board to account: Acute, community, ambulance and mental health provider handbooks describe the inspection process for each type of trust and provide links to the national guidance trusts are expected to take into account. They also set out our five key questions, the detailed key lines of enquiry our inspection teams ask, and our characteristics of each rating level describing what outstanding, good, requires improvement and inadequate care looks like: www.cqc.org.uk/handbooks Intelligent monitoring data describes the data we use to produce a profile of your trust to help plan and inform our inspections. Individual trust s profiles are available here: www.cqc.org.uk/hospitalmonitoring CQC inspection reports for your own or other similar foundation trusts, or reports of inspections of any services in your local area. You can receive alerts about inspection reports in your area or look these up at www.cqc.org.uk/emailalerts National thematic reports and annual publications, like our State of Care report, and our reports monitoring the use of the Mental Health Act and Deprivation of Liberty Safeguards are available at: www.cqc.org.uk/publications Enforcement policy setting out the different powers we can use and the ways we can take action where we find services need to improve: www.cqc.org.uk/enforcement CQC and foundation trust councils of governors guide 13
CQC s public bulletin for news of our national reports about the quality of care, consultations we are running and opportunities to get involved in CQC s work at www.cqc.org.uk/newsletter CQC s provider bulletin is available from your trust or directly from CQC along with other guidance for providers at: www.cqc.org.uk/providerguidance Fundamental standards of care The new fundamental standards of care came into force on 1 April 2015. They describe the standards of care all patients and people using services have a right to expect in law. They cover the following areas, and details of these and the other regulations that foundation trusts are expected to meet can be found at www.cqc.org.uk/ regulations Person-centred care: You must have care or treatment that is tailored to you and meets your needs and preferences. Dignity and respect: You must be treated with dignity and respect at all times while you're receiving care and treatment. This includes making sure: You have privacy when you need and want it. Everybody is treated as equals. You're given any support you need to help you remain independent and involved in your local community. Consent: You (or anybody legally acting on your behalf) must give your consent before any care or treatment is given to you. Safety: You must not be given unsafe care or treatment or be put at risk of harm that could be avoided. Providers must assess the risks to your health and safety during any care or treatment and make sure their staff have the qualifications, competence, skills and experience to keep you safe. Safeguarding from abuse: You must not suffer any form of abuse or improper treatment while receiving care. This includes neglect, degrading treatment, unnecessary or disproportionate restraint and inappropriate limits on your freedom. CQC and foundation trust councils of governors guide 14
Food and drink: You must have enough to eat and drink to keep you in good health while you receive care and treatment. Premises and equipment: The places where you receive care and treatment and the equipment used in it must be clean, suitable and looked after properly. The equipment used in your care and treatment must also be secure and used properly. Complaints: You must be able to complain about your care and treatment. The provider of your care must have a system in place so they can handle and respond to your complaint. They must investigate it thoroughly and take action if problems are identified. Good governance: The provider of your care must have plans that ensure they can meet these standards. They must have effective governance and systems to check on the quality and safety of care. These must help the service improve and reduce any risks to your health, safety and welfare. Staffing: The provider of your care must have enough suitably qualified, competent and experienced staff to make sure they can meet these standards. Their staff must be given the support, training and supervision they need to help them do their job. Fit and proper staff: The provider of your care must only employ people who can provide care and treatment appropriate to their role. They must have strong recruitment procedures in place and carry out relevant checks such as on applicants' criminal records and work history. Duty of candour: The provider of your care must be open and transparent with you about your care and treatment. Should something go wrong, they must tell you what has happened, provide support and apologise. Display of ratings: The provider of your care must display their CQC rating in a place where you can see it. They must also include this information on their website and make our latest report on their service available to you. CQC and foundation trust councils of governors guide 15