Partnership Agreement between NHS Trust Development Authority and Care Quality Commission June 2013 Joint Statement Through this partnership agreement we commit the Care Quality Commission (CQC) and the NHS Trust Development Authority (TDA) to working in partnership and to supporting each other in carrying out our respective roles and responsibilities for the benefit of patients, users of services, their carers, and the public. There will be complete openness, transparency and honesty between CQC and the TDA. Any risks or concerns about the quality of care or leadership of a Hospital will be shared with each other quickly. The interests of patients will always be paramount. 1. Context and Shared Purpose Purpose 1.1 This agreement sets out the nature of the partnership between the NHS Trust Development Authority (TDA) and the Care Quality Commission (CQC). It summarises how the two organisations intend to work together to carry out their respective functions for the benefit of patients, users of services, their carers, and the public. 1.2 The agreement identifies a number of priorities which will be the focus of joint working in the first year of this partnership. It sets out the intention of the partners to establish management arrangements to support and oversee this partnership working, and to enable it to develop and mature as the new health and social care landscape takes shape. 1.3 This agreement will sit alongside others, which both CQC and TDA have in place with other partners in the wider health and social care system. It will be reviewed regularly to ensure that it Partnership Agreement between NHS TDA and CQC 1
continues to reflect our collective ambitions and priorities, in particular as the recommendations of the Mid Staffordshire NHS Foundation Trust Public Inquiry are implemented. Roles and Responsibilities CQC 1.4 The Care Quality Commission is the independent regulator of health and social care providers in England. CQC s role is to 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. This is for the purpose of making sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. 1.5 CQC also protects the interests of people whose rights are restricted under the Mental Health Act. CQC does this by: regulating and monitoring services; listening to people and putting them at the centre of our work; acting quickly when standards are not being met, drawing on our intelligence and unique insight to provide an authoritative voice on the state of care; and working with strategic partners across the system. TDA 1.6 The Government s vision is for a NHS with fully autonomous and accountable healthcare service providers (hospitals, ambulance services, mental health services and community services). The NHS TDA is a Special Health Authority that will oversee, hold to account and support improvement by NHS trusts, helping them to improve the quality and sustainability of services and thereby achieve Foundation Trust status or another more appropriate organisational form. Key Responsibilities 1.7 The National Quality Board s (NQB) report on the quality architecture in the new system 1 sets out more detail on the particular roles of the organisations with regard to the quality of care. 1.8 Both the CQC and TDA will have interactions with NHS Trusts. Clarity of roles is therefore particularly important in this area. 1.9 CQC is developing new fundamental standards to ensure that inspection and regulation of care services will ask the following questions about services Are they safe? Are they effective? Are they caring Are they well led? Are they responsive to people s needs? 1.10 In NHS hospitals CQC will introduce national teams with specialist expertise to carry out indepth reviews of hospitals, particularly those with significant or long-standing problems and trusts applying to be foundation trusts. The CQC will work with TDA to develop a clear 1 http://www.dh.gov.uk/health/2012/08/quality-new/ Partnership Agreement between NHS TDA and CQC 2
programme to tackle the failure of an NHS trust to meet fundamental standards and to review our regulatory and enforcement powers to make sure we, or others, have the power to act where necessary. 1.11 The CQC will also provide TDA with bespoke advice on the quality of care provided by NHS Trusts, for example for those NHS Trusts applying to become NHS Foundation Trusts. 1.12 We will improve how care is overseen, make the most efficient use of our joint resources, and reduce duplication. We will build effective systems for improving how we share information and evidence, strengthening our ability to listen better to people s views and experiences, identify new problems more quickly, and co-ordinate our inspections and other activities better. 1.13 The TDA will oversee all aspects of NHS Trust delivery, ensuring that NHS Trusts provide sustainable, high quality services and proceed to Foundation Trust status or another organisational form. The TDA is responsible for oversight of clinical quality, operational performance and finance, and for developing capacity and capability in NHS Trusts. It will approve FT applications to proceed to Monitor and can intervene to address poor performance. The TDA will make non-executive appointments to NHS Trusts and support transactions and other provider-led organisational changes. 1.14 Fig 1, below summarises the respective roles of the CQC, TDA and other key organisations with respect to NHS Trusts: Fig 1: Responsibilities relating to NHS Trusts NHS Trust Development Authority: oversees and accounts for all aspects of NHS Trusts delivery. As well as providing support and development. NHS Trusts Monitor: authorises Trusts as FTs. Enforces NHS provider licence, which has conditions that are equally applicable to NHS Trusts. Commissioners (CCGs/CB): agree services for Trusts to provide through service design and contracts, monitor delivery of contractual requirements, and fund services (including through use of penalties/incentives). Care Quality Commission: monitors compliance with statutory registration standards for quality. Has enforcement powers where standards are not being met. Partnership Agreement between NHS TDA and CQC 3
2. Joint Priorities 2.1 The partnership between the organisations will operate on a number of levels, including: Strategic where the organisations will seek to align overall goals and support each other s strategic objectives; Operational where the organisations will develop clear approaches to dealing coherently and effectively with a range of operational matters, particularly those relating to the quality of services provided for patients; and Cultural where the organisations will seek to promote common values, based on those in the NHS Constitution, and constructive behaviours. Shared Strategic Goals 2.2 The TDA and CQC commit to the following shared strategic goals: Putting patients first Improving outcomes for patients; Fostering an environment where patient safety is paramount; Developing sustainable, high quality services across England; Improving the quality of the provider sector; Improving value for money; and Ensuring effective, proportionate regulation of services that minimises the burden of oversight for NHS providers. 2.3 The two organisations will work jointly on the development of strategic goals and national policy and legislative changes (for example the 2013 Care Bill). We will work together in putting strategies into action, such as the development of the role of the new Chief Inspector of Hospitals, and implementation of the single failure regime and provider ratings. Operational commitments 2.4 The CQC and TDA will work closely together in a number of operational areas, nationally, subnationally, and locally. Monitoring the quality of care in NHS Trusts 2.5 The TDA and CQC will both receive information, through formal and informal routes, about the quality of care in NHS Trusts. In discharging these responsibilities, the organisations commit to: Early sharing of information, including soft intelligence, to support the respective roles of CQC and TDA; Ensure mutual understanding of the information received about NHS Trusts by each organisation; Partnership Agreement between NHS TDA and CQC 4
Work together where appropriate on the development of information systems, including the national quality dashboard, and to improve the quality of information from NHS Trusts; Ensuring that each organisation makes an effective contribution to Quality Surveillance Groups and Risk Summits; Sharing pertinent information about the wider health and social care system which might be relevant to a particular trust(s). Assessing the quality of care in NHS Trusts 2.6 The TDA and CQC will be required to make assessment about the quality of care provided by NHS Trusts, the TDA as part of its role in overseeing and improving quality, and the CQC in its capacity as the quality regulator. In undertaking these roles the organisations commit to: Agree consistent and complementary approaches to assessing quality, for example by aligning statistical techniques used to analyse data and by agreeing the approach to direct assessment of the services provided by NHS Trusts; Share and align assessments on quality to ensure NHS Trusts receive clear and consistent messages about the quality of care; Work closely on the assessment of Foundation Trust applications by NHS Trusts to ensure there is a shared view about the quality of care between the CQC and TDA prior to a decision by the TDA Board on whether to support particular applications; Work through the Quality Surveillance Group system to ensure there is transparency about respective organisations assessments of the quality of care in NHS Trusts; Respond in a timely manner in sharing information to support a risk summit; Joint consideration of new and emerging techniques for assessing quality, for example for assessing aspects of governance, organisational culture and quality indicators. Addressing concerns about the quality of care in NHS Trusts 2.7 Both TDA and the CQC have responsibilities for supporting and where necessary intervening in NHS Trusts to support improvement and safeguard standards of care. The CQC s responsibilities in this area derive from its role as a statutory regulator, while the TDA s derive from its broader role in oversight of NHS Trusts. The organisations commit to: Early and consistent communication in the event of the potential for intervention by either party in an NHS Trust, where the potential intervention relates to concerns about quality; Engaging at an early stage when the CQC is considering specific regulatory action which affects an NHS Trust; and Considering joint interventions where appropriate (whilst acknowledging the specific statutory role of the CQC) to ensure an aligned approach and sharing expertise on clinical quality to make best use of resources. Partnership Agreement between NHS TDA and CQC 5
Considered and aligned public/media announcements Style and Behaviour 2.8 The over-arching approach to operational working will be characterised by: Openness and honesty no surprises ; Understanding of respective statutory roles, duties and powers; Engagement on issues of mutual interest and importance including joint learning and development; and Early and pro-active information-sharing. 3. Governance for Delivering Joint Priorities Formal Governance 3.1 The executive teams of the two organisations will meet together each year to discuss the overall partnership and common priorities. The executive-to-executive meeting will be the overall governance forum for this partnership agreement, which will be refreshed annually to reflect changes and developments agreed in the meeting. Practical working arrangements 3.2 To maintain an effective working relationship, the CQC and TDA will ensure there is regular contact and close working at both national and sub-national levels of the organisations, including between professional leads and leaders covering common geographical areas. 3.3 Engagement at sub-national level will be led by the four Deputy Directors of Operations in the CQC, and by the four Clinical Quality Directors of the TDA. 3.4 At national level, monthly meetings will be held at Director-level, to co-ordinate on-going work and priorities. The lead director responsible for the partnership in the TDA will be the Medical Director. The lead director for the CQC will be the Director of Regulatory Development. 3.5 Quarterly meetings will be held at chief executive level. It is expected that any issues relating to policy or operational issues between the two organisations will be resolved at this level. David Prior Chair, Care Quality Commission Sir Peter Carr Chair, NHS Trust Development Authority David Behan Chief Executive, Care Quality Commission David Flory CBE Chief Executive, NHS Trust Development Authority Partnership Agreement between NHS TDA and CQC 6
Annex A: Working practices between Care Quality Commission (CQC) and NHS Trust Development Authority (TDA) This annex to the Partnership Agreement between CQC and TDA sets out the detailed working arrangements that will underpin the relationship between the two organisations. This will primarily, but not exclusively, be transacted through the following regular meetings: 1. Chief Executive 2. Policy and Strategy 3. Operational 4. Quality challenge for FT applicants. These meetings are in addition to the Quality Surveillance Group and Risk Summit meetings that will be convened locally and will involve CQC and the TDA where there are NHS Trusts. Meeting Frequency Attendees Aim Output 1. Chief Executive Quarterly David Flory, CE, Discussion of issues of strategic Actions for Strategy and TDA David Behan, CE, CQC importance to both organisations, such as major policy changes and interventions. policy teams, and/or operational teams 2. Policy and Strategy Quarterly Ralph Coulbeck, Director of Strategy, TDA Kathy McLean, Medical Director or Peter Blythin, Director of Nursing, TDA Gina Naguib- Roberts, Head of Discussion of issues of strategic importance to both organisations, and of changes to regulatory/ oversight models. For example: o Development of criteria for CQC registration o Development of CQC reviews, including ratings o Development of TDA s Accountability Framework o Discussion of FT pipeline o Implementation of Agenda and note of meeting to be circulated by hosting organisation Chair to alternate between TDA and CQC and disseminated as required Partnership Agreement between NHS TDA and CQC 7
Meeting Frequency Attendees Aim Output Partnerships, TDA Paul Bate, recommendations from Francis Inquiry Director of Strategy & o Responses to relevant consultations Intelligence, CQC Alex Baylis, Head o Consideration of major operational or comms/public affairs issues of Better Regulation, CQC o Looking forward to policy developments or future issues Amanda o Assessment of partnership Hutchinson, Head working of Partnerships, o Discussion of data flows, technical CQC solutions and maintenance Louise Dineley, Head of Regulatory Risk and Quality, CQC 3. Operational Weekly conference call Kathy McLean, Medical Director, TDA, or Peter Blythin, Director of Nursing, TDA Clinical Quality Director, TDA Professor Sir Mike Richards, Chief Inspector of Hospitals, CQC Sharing of current information and intelligence concerning NHS Trusts. For example: o o o Discussion of regulatory concerns and issues relating to registration Intervention by TDA under Oversight section of Accountability Framework Consideration of joint intervention Note of actions from call to be taken alternately by TDA and CQC, and disseminated as required 4. Quality challenge for FT applicants As required Kathy McLean, Medical Director, TDA Discussion of FT applicants before they are considered by the TDA s Board, as part of TDA s formal approvals process. For example: Note of actions to be taken by TDA and disseminated as required Partnership Agreement between NHS TDA and CQC 8
Meeting Frequency Attendees Aim Output Peter Blythin, Director of o Testing of assumptions and judgements in FT application Nursing, TDA Clinical Quality o Discussion of Quality and Risk Profiles Director, TDA o Discussion of clinical quality and Portfolio Director, governance issues TDA o Discussion of required support Professor Sir Mike and development Richards Chief Inspector of Hospitals, CQC, CQC Louise Dineley, Head of Regulatory Risk and Quality, CQC Deputy Director of Operations of the relevant region(s) Partnership Agreement between NHS TDA and CQC 9
TDA and CQC contact details CQC Key Contacts by type of issue (All CQC e-mails are firstname.lastname@cqc.org.uk ) Issue type CQC lead Contact details Policy and strategic Paul Bate 020 7448 1696 PA: Christina Costa Director of Strategy & Intelligence Alex Baylis 020 7448 9264 Business Coordinator: Susan Choi Head of Better Regulation Amanda Hutchinson 020 7448 9089 Business Coordinator: (tbc) Head of Partnerships Strategic operational Professor Sir Mike Richards, Chief Inspector of tbc tbc Hospitals, CQC Quality challenge for FT applicants Louise Dineley Head of Regulatory Risk and Quality 020 7448 0862 Business Coordinator: Wilson Franque Regional operational Matthew Trainer 020 7448 1662 PA: Jane Lindo Deputy Director of Operations London Ian Biggs 020 7448 9032 PA: Jo Blint Deputy Director of Operations South Andrea Gordon 0121 6005 381 PA: Angela Cullen Deputy Director of Operations Central Malcolm Bower-Brown Deputy Director of Operations North 07901 856 883 PA: Lesley Matholous Partnership Agreement between NHS TDA and CQC 10
TDA Key Contacts by type of issue Issue type NHS TDA lead Contact details Policy and strategic Ralph Coulbeck Director of Strategy 020 7932 1943 PA: Caryl Roudette Caryl.Roudette@nhs.net 0207 932 1968 Gina Naguib-Roberts Head of Partnerships 020 7932 1960 Business Co-ordinator: Caryl Roudette: 0207 932 1968 Strategic operational, including quality challenge for FT applicants Regional operational Kathy McLean Medical Director Peter Blythin Director of Nursing Alwen Williams Director of Delivery and Development London Deborah Stubberfield Clinical Quality Director London Stephen Dunn Director of Delivery and Development South Julie Blumgart Clinical Quality Director South 0207 932 3702 PA (temporary): Nick Genis - 07920 458 484 Nicholas.Genis@nhs.net 01616257266 PA: Rita Roberts 07827 776 070 Rita.Roberts@nhs.net.uk 02079321969 PA: Hayley Tucker 07500 033409 HayleyTucker@nhs.net 02079321949 Business Coordinator: Erica Fearon: 0207 932 1963 02079321947 PA: Sian Fox SianFox@nhs.net 0182 336 1276 Business support: Judy Jackson-Jones Judy.Jackson-Jones@nhs.net Dale Bywater Director of Delivery and Development Midlands and East 01332 888160 PA: Lorett Hough (Lotty) Lorret.Hough1@nhs.net Partnership Agreement between NHS TDA and CQC 11
Issue type NHS TDA lead Contact details Maggie Boyd Clinical Quality Director Midlands and East 0116 295 7536 Business support: Poonam Mistry Poonam.Mistry@leicestercity.nhs.uk Yasmin Chaudhry Director of Delivery and Development North Maureen Choong Clinical Quality Director North 0161 625 7605 PA: Angela Bestwick Angela.Bestwick@nhs.net 0161 625 7605 Partnership Agreement between NHS TDA and CQC 12