Annual provider survey results December 2017 n =25 1
Introduction The provider survey is conducted annually and all registered providers are invited to respond Since March 2012 we have asked a set of core questions in order to track changes in providers knowledge, understanding and opinion of CQC this is the last time we will run the survey in its current form This year s ran between 12 Jan 2 February 2017; we reduced the number of overall questions to 15, focusing on 3 key areas: providers experience of inspection our strategic approach our reports and publications. The results in this report is broken down by the following sectors: adult social care hospitals primary medical services. n =25 2
Next steps We have shared these results of this survey with colleagues across CQC to highlight key themes and issues. The results will continue to be used across the organisation to drive improvement in how we work and engage with providers and our stakeholders. The next annual survey will be sent in January 2018 to a sample of our providers. This follows a review during 2017 looking at how we collect data on providers through surveys. We have now combined the following: post-registration survey post-inspection survey annual provider survey Sending the survey to a sample of providers will reduce workload for providers overall and enable us to report results that are representative. n =25 3
Breakdown of respondents by sub-sector Supported living 10% (330) Hospice 2% (59) Other 3% (106) Other 2% (58) Primary Dental Services 8% (220) NHS Community Healthcare Service 4% (37) NHS Mental Health Service 2% (16) NHS Hospital Other 3% (32) Independent Acute Healthcare 8% (78) Adult social care (ASC) n = 3327 (up 20%) Primary medical services (PMS) n = 2639 (up 67%) NHS Acute Care 5% (45) Hospitals n = 988 (up 140%) Independent Community Healthcare 24% (225) Community 26% (877) Residential 59% (1955) + 19 General Practice 89% (2361) Independent Hospital Other 37% (339) Independent Mental Health Service 23% (216) Due to the ability of respondents to select more than one sub-sector, the total shown here will equal more than the total of individual responses later in the results 4
Breakdown of respondents: rating 1% 1% 17% 9% 3% ASC 1% 9% 10% 5% PMS (only includes the sectors that CQC rates) 14% 9% 7% Hospitals n = 2955 68% n = 2403 72% 14% n = 921 53% Overall sector numbers: Outstanding 1%; Good 71%; Requires improvement 26%; Inadequate 2% n =25 Overall sector numbers: Outstanding 4%; Good 83%; Requires improvement 10%; Inadequate 3% Overall sector numbers: Outstanding 6%; Good 52%; Requires improvement 38%; Inadequate 4% - 18 Overall sector numbers accurate as of May 2017 5
Bar charts - Key The bar charts depict this year s results, and where available the arrows indicate movement compared to the previous survey results. Movement from last year s result. Direction of arrow denotes increased or decreased percentage 12% n = 2902 70% 18% 12% Overall sample size Sector PMS 6% Only variations from the previous year s survey results greater than 5% have been displayed on the charts. 70% 12% Rounding: values have been rounded, 84% - 1 7% n = 1652 therefore in some instances may not total 100% 6
At a glance: all providers Our strategic approach Response scale % Satisfied Variance from previous survey Overall, how well do you think CQC is doing to encourage health and social care services to improve? 13 13 22 29 21 72% 7% Overall, how well do you think CQC works with partners in the health and social care system to coordinate our work? 16 13 14 20 24 14 58% No change To what extent do you believe the way CQC regulates is beneficial to the quality of care received by people 24 19 27 29 75% Don't know Very poor Fairly poor Satisfactory Fairly well Very well 8% 8% Experience of inspection Response scale % Positive Variance from previous survey Gathering information for the CQC provider information request (PIR) before my inspection helped us to identify areas for improvement. 9 12 19 41 17 58% No change The inspection helped us to identify areas of improvement 9 11 16 42 22 64% No change The inspection report provided information that will help us improve our service 13 14 20 34 19 53% No change Strongly disagree Disagree Neither agree nor disagree Agree Strongly agree 7
Our strategic approach How would you rate your overall understanding of the approach CQC takes to regulation and inspection? 100 90 80 70 60 50 40 30 20 10 0 n =25 2013 2014 2015 2016 PMS Hospital ASC Percentage answering very good / fairly good 8
Our strategic approach How would you rate your overall understanding of the approach CQC takes to regulation and inspection? Very low Fairly low Very good / fairly good 3% ASC n = 2954 7% Hospital 89% n = 918 9% 12% n =25 77% PMS n = 2645 9
Our strategic approach Overall, how well do you think CQC is doing to encourage health and social care services to improve? Very poor / fairly poor Don't know Satisfactory Very well / fairly well 10% 20% ASC 70% n = 2949 11% 11% n = 7% 60 19% 21% Hospital 65% n = 918 n =25 50% 25% 19% PMS 15% n = 2640 10
Our strategic approach Overall, how well do you think CQC works with partners in the health and social care system to coordinate our work? (e.g. CCGs, local authorities) Very poor / fairly poor Don't know Satisfactory Very well / fairly well 13% 11% 8% 20% ASC 55% n = 2949 20% 14% 13% 16% 21% Hospitals 50% n = 919 20% n = 2636 n =25 47% 22% 18% 14% PMS 11% 5% 11
Our strategic approach To what extent do you believe the way CQC inspects and regulates is beneficial to the quality of care received by people? Not beneficial Slightly beneficial Fairly beneficial Very beneficial 7% 12% 35% 46% n = 2956 ASC 10% 8% 15% 5% 6% 34% Hospitals 41% n = 919 13% n = 2644 n =25 48% 28% 15% PMS 6% 10% 8% 12
Annual Provider Survey Results Your experience of inspection: Gathering information for the CQC provider information request (PIR) before my inspection helped us identify areas for improvement Strongly disagree / disagree Neither agree nor disagree Strongly agree / agree Don't know 7% 10% n = 2347 n = 2347 19% 70% n = 3005 ASC 11% n = 205 12% n = 205 10% 18% Hospitals 68% n = 902 n = 49 39% n =25 7% 20% 41% PMS 6% n = 2394 13
Experience of inspection Do you think the prospect of enforcement action is an effective deterrent to encourage compliance? Don't know No Yes 5% 10% 16% 74% n = 2946 5% ASC 21% 11% 17% 72% n = 917 9% 12% Hospitals 14% 16% 42% 42% n = 2642 10% PMS 14
Experience of inspection The inspection helped us to identify areas of improvement Strongly disagree / disagree Neither agree nor disagree Strongly agree / agree 8% 7% 13% ASC 80% n = 2901 7% 8% 7% 15% Hospital 76% n = 917 9% n =25 39% 20% 41% 6% PMS n = 2642 15
Experience of inspection The inspection report provided information that will help us improve our service Strongly disagree / disagree Neither agree nor disagree Strongly agree / agree 7% 10% 16% ASC 74% n = 2804 10% 13% 5% 19% Hospital 69% n = 869 15% n =25 50% 25% 24% PMS n = 2585 6% 16
Annual Provider Survey Results Our reports: Were the following CQC reports of interest to your organisation? Aware of the report, and it was of interest to our organisation Not aware of the report, but it would have been of interest Aware of the report, but not relevant to our organisation Not aware of the report, and not relevant to our organisation n = 5974 n = 5908 n = 5864 n = 5888 n = 5758 n = 5822 n = 5799 38% 41% 29% 23% 28% 35% n = 5852 40% 34% 12% 6% 13% 21% 5% 12% 8% 10% 36% 42% 41% 26% 50% 42% 39% 40% 14% 11% A different ending (May n =25 2016) 17% 30% 10% 18% 14% 15% Better care in my hands (May 2016) Building bridges, breaking barriers (July 2016) Not seen, not heard (July 2016) Safe data, safe care My diabetes, my care (July 2016) (September 2016) State of Care 2015/16 (October 2016) Monitoring the Mental Health Act in 2015/16 (November 2016) All sectors have been combined for the purposes of this graph 17
Annual Provider Survey Results Our reports: Did your organisation take any action to make changes as a result of reading the following reports? 37% 34% 42% Don't know No Yes 13% 14% 17% 13% 14% 14% 16% 15% 43% 35% 40% 47% 37% 50% 52% 41% 44% 51% 46% 37% 48% n = 2202 n = 2345 A different n =25 ending (May 2016) n = 1602 n = 1337 n = 1964 n = 1568 n = 2180 n = 1925 Better care in my hands (May 2016) Building bridges, breaking barriers (July 2016) Not seen, not heard (July 2016) Safe data, safe care (July 2016) My diabetes, my care (September 2016) State of Care 2015/16 (October 2016) Monitoring the Mental Health Act in 2015/16 (November 2016) All sectors have been combined for the purposes of this graph 18
Annual Provider Survey Results Our reports: As a result of the changes you made, have there been improvements in care? Don't know No Yes 8% 9% 10% 20% 10% 11% 10% 13% 10% 7% 7% 86% 86% 85% 70% 82% 86% 80% 85% A different n =25 ending (May 2016) n = 1041 n = 1170 n = 619 n = 564 n = 965 n = 673 n = 741 n = 887 Better care in my hands (May 2016) Building bridges, breaking barriers (July 2016) Not seen, not heard (July 2016) Safe data, safe care (July 2016) My diabetes, my care (September 2016) State of Care 2015/16 (October 2016) Monitoring the Mental Health Act in 2015/16 (November 2016) All sectors have been combined for the purposes of this graph 19
Key themes: where we are doing well Some key themes emerged from the feedback respondents gave us: Providers told us our approach helps to assure their performance [CQC] ensures providers are all providing appropriate levels of care and a good service and takes action when this is not the case. (ASC, Good) Providers told us that we help them identify improvements It helps to concentrate on each [of the five key questions] we know what to expect in an inspection and in turn [it] improves the quality of care we deliver. (Hospital, Good) Our work is supported by clear and accessible guidance [inspections] provide clear information about where and why improvements are needed. (ASC, Good) Relationship management is key to fulfilling our regulatory functions We have a good working relationship with CQC and I find the engagement meetings we have with them keep me appraised of strategic changes (Hospital, Requires Improvement) 20
Key themes: where we need to improve We were told by some providers that our approach was disproportionate to risk enforcement action seems harsh and could be disproportionate to original incidents (Hospital, Outstanding/Good) Providers told us we need to be more consistent 3 surgeries in a single location were assessed in different ways would be more accepting of enforcement if I knew all organisations were measured in same way. (GP, Good) Some providers talked about the bureaucracy involved in regulation Inspectors seem more interested in the quality of red tape than that of the care given it s all about the paperwork (ASC) A number of providers said that we should take more account of provider context The process generates unnecessary stress to an already overstretched and underfunded service. (Hospital) 21
How are we taking action in the areas we need to improve? Our approach to risk management and enforcement action o In our Strategy 2016-21, Shaping the Future we made a commitment to become an intelligence-driven organisation. By using intelligence in our inspection planning and targeting we will be able to target our resources more efficiently on the areas where the need is greatest. o Our inspectors will have a number of sources of data available to them (e.g. CQC Insight) with which to make more informed decisions about levels of risk. Improving the consistency of our approach o We are conducting a review into consistency across our inspection methodology and processes. This will include working with providers to understand more about their experiences of inconsistency. Following this we will make a number of recommendations based on our findings to drive improvement in this area. o We are holding additional learning days with staff as we implement our next phase approach to ensure that consistency is maximised. 22
How are we taking action in the areas we need to improve? Reducing the impact that regulation has on providers o We are working closer with partners across regulation and healthcare to reduce the impact of regulation on providers. o In general practice, we have worked with NHS England and the General Medical Council to rationalise the data we ask for through the provider information collection that will be implemented during 2018. This means that we are reducing duplication of requests on providers, asking for information once, and using it many times. Understanding the provider context o All people deserve good quality care. During 2017 we completed our comprehensive inspection programme for all the sectors that we regulate. This gave us an unprecedented view of the quality of care in England. Having this knowledge enables us to understand the provider context in a more holistic way. We are able to use this information in an number of ways, including in our national annual report, State of Care. 23
Building on where we are doing well Using our independent voice o An overwhelming majority of providers said that they saw improvements as a result of changes made following reading our range of reports. We will continue to use our independent voice to help providers. Strong relationship management o Providers told us that strong relationships with inspectors are key to fulfilling our regulatory functions. As part of our next phase of regulation, we will continue to strengthen this process. Closer relationships with providers will enable us to better understand the local context and the level of risk at a provider. Clear and accessible guidance o We recently made a number of improvements to our provider guidance following an extensive programme of user research. This will ensure that providers are able to find the information they need quickly and that it is written with clarity. 24