Care Quality Commission


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Mr. Gary Needle, Director of Methods
- Quality control system
- Incentives and sanctions used
- Public and private workin side by side for high standard services.

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Care Quality Commission

  1. 1. The Care Quality Commission Finnish Government Study Group – 21st May 2010 Gary Needle, Director of Methods, Care Quality Commission
  2. 2. Content This presentation will cover: • The role of CQC • The new registration and compliance system • The challenge facing the health and adult social care system 2
  3. 3. Our role The independent regulator of the quality of health and adult social care services in England. We also protect the interests of people detained under the Mental Health Act. We make sure that people get a good standard of care - whether services are provided by the NHS, local authorities or by private or voluntary organisations As the first regulator to work across health and social care we have a unique opportunity to look at how well health and social care work together to bring people integrated care 3
  4. 4. Our objective The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services. The Commission is to perform its functions for the general purpose of encouraging: (a) the improvement of health and social care services, (b) the provision of health and social care services in a way that focuses on the needs and experiences of people who use those services, and (c) the efficient and effective use of resources in the provision of health and social care services. 4
  5. 5. ...on a page Our five priorities 1. Making sure care is centred on people’s needs, 3. Acting swiftly to help eliminate poor quality care and which protects their rights 2. Championing joined-up care 4. Promoting high quality care 5. Regulating effectively, in partnership What we do to achieve our priorities Registration and ongoing Assessments of quality Mental Health Act monitoring and enforcement visits Publishing information to support people making decisions The way we work -Involve users to focus our assessments on what is important to them -Are expert and independent -Promote equality, diversity and human rights -Engage with those providing and commissioning care to inform our work 5
  6. 6. CQC well placed to make strong contribution • Statutory Remit Covering ‘consumer protection’ (registration) and tackling ‘information asymmetry’ (assessments of quality) • Particular powers for inspection, data gathering, enforcement Privileged Assets • ‘Whole system’ statutory remit – covering health, mental health, adult social care; commissioning & provision • Trust and credibility driven by independence from government and commercial relationships • Intelligent data analysis and risk assessment Specific • Gathering in and responding to user voice Competencies • Local intelligence, insight & local relationship from field force • National influence, drawing on comparative view of quality & safety of care • User Groups & Regulated bodies Special • Other regulatory and oversight bodies (incl, Govt. Offices, SHAs, Relationships Monitor, AC, Ofsted, NPSA • Secretary of State & DH 6
  7. 7. Improving the quality of care Enforcement Publish action Assessment of information Registration Quality to reinforce - requires other levers providers to ‘improve or exit’ Below essential Essential Above essential standards standards standards Quality of care 7
  8. 8. How we will go about our work Information and Intelligence about quality of care Judgements Analysis on quality of risk Activities in response To view of risk 8
  9. 9. How we will go about our work New information can come from a variety of sources: People who use services, families Providers and carers Other regulatory bodies and Staff and other Information professionals Centre Other bodies CQC e.g. Ombudsman, Assessors and commissioners Inspectors 9
  10. 10. Other players in the field National Quality Board NHS Litigation Authority PCTs ADASS Monitor SHAs NPSA GMC 3rd Sector Providers GSCC DCLG Audit Commission DH NHS Institute Quality observatories SCIE NHS Information Authority NICE Co-operation & Professional regulation NHS Choices Competition Panel Professional accreditation 10
  11. 11. The aim of registration People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights. Adult social care Single system of 1 registration Single set of standards NHS Registration 2 Strengthened 3 and extended Independent healthcare enforcement powers 11
  12. 12. Registration timeline (subject to legislation) April NHS trusts 2010 Oct Adult social care and independent healthcare 2010 providers (CSA) April Primary dental care (dental practices) 2011 and independent ambulance services April Primary medical services 2012 (GP practices and out of hours) 12
  13. 13. Benefits of registration Outcomes - More outcome-based registration that protects and promotes equality, diversity and human rights and makes providers accountable Information - Improved access to timely, relevant and reliable information enabling consistent comparisons and promotion of joined up care Enforcement - Earlier identification and swifter action to follow up concerns including enforcement action where necessary Burden - Reduced unnecessary regulatory burden and associated costs of demonstrating compliance Compliance - Increased compliance by health and adult social care providers Process - Improved transparency, speed, consistency and reliability of registration 13
  14. 14. Guidance about compliance 14
  15. 15. Registration: the cycle Registration application Information Information capture capture Application made Judgement on risk Information Information Application Judgement analysis analysis assessed published Judgement Regulatory Regulatory made judgement response Ongoing monitoring of compliance 15
  16. 16. A national trend for improved performance Overall performance has steadily improved right across the health and social care sector However, a minority of NHS trusts, adult social care services, independent healthcare providers, and councils have under- performed 16
  17. 17. Real improvements for people using services Hospital waiting times have been driven right down • 89% of hospital trusts achieved the 18-week waiting time target from referral to start of treatment Rates of MRSA and Clostridium difficile have reduced by 34% and 35% respectively More people are living independently at home • 2.1% of people aged 65 and above were living in care homes (council-supported) in 2009, compared to 2.5% in 2005 17
  18. 18. Common concerns There are three areas where we have concerns about performance right across the health and social care sector: • Building a safety culture • Protecting people from harm • Workforce training 18
  19. 19. Keeping people safe Building a safety culture Number of incidents reported to the NPSA improved to 1.06 million incidents last year, compared with 920,000 incidents the year before In some organisations reporting levels are low • Reporting from PCTs with hospital beds varied over 20-fold We are not seeing the full picture in primary care • In 12 months, primary care services across the country reported under 3,500 incidents, compared with 693,700 from hospitals 19
  20. 20. Keeping people safe Protecting people from harm • 9% of NHS organisations did not comply with the minimum standard on child safeguarding • Although the majority of social care providers fully met standards relating to safeguarding procedures, 383 (2%) failed with major shortfalls 20
  21. 21. Workforce training Good services rely on good, well-trained people 12 % of NHS trusts did not meet the core standard on mandatory training – the lowest compliance rate of all standards 21
  22. 22. Workforce training 86% or less of adult social care services (such as care homes and home care agencies) meet minimum standards on training Staff training and qualifications were a strength in only 16% of councils 22
  23. 23. An increasing challenge for health and social care By 2026, the Government expects there to be 1.7 million more adults needing care and support There will be greater pressure on public finances Rightly, people are expecting more choice and control over their care 23
  24. 24. Services must accelerate efforts to • Work better together to join up services • Ensure people have clear information and understand their options • Support people in maintaining their independence 24
  25. 25. Major steps forward More people are supported to live independently at home In five years, the number of people with access to council-funded services helping them avoid emergency hospital admission has risen from 80,000 to 148,000 In five years, the number of people with access to services helping them return home quickly from hospital has risen from 112,000 to 157,000 25
  26. 26. But, people face high levels of local variation 3-fold variation in the extent to which councils place older people in long-term residential care 4-fold variation in the rate of occupied bed-days associated with repeated emergency admissions of older people in hospital Over 30-fold variation in the proportion of people whose discharge from hospital is delayed 26
  27. 27. Our estimates suggest If all areas in the country were able to reduce the number of people admitted repeatedly as emergencies and the length of their hospital stay to the low levels seen in the best performing five areas of the country, this would: Result in 8 million fewer days in hospital Free up 2 billion from hospital budgets 27
  28. 28. Sharing of information between organisations must improve Only 53% of GPs reported that discharge summaries sent by acute trusts arrived in time to be useful In our review of actions taken by health bodies in relation to Peter Connelly (Baby P), it was clear that communication between organisations was poor 28
  29. 29. Access to healthcare: a mixed picture The NHS has greatly improved waiting times for acute care The percentage of people who can get an appointment with a GP within 48 hours varied by PCT (between 76% and 92%) Only half of trusts provided adequate access to out-of-hours mental health support 29
  30. 30. Not all people receive useful information on their care • Some people do not receive enough information about their care, e.g. 21% of people discharged from hospital said they were not given sufficient information about their condition or treatment • Information is sometimes given in a way that people cannot understand, e.g. 29% people with disabilities using social care services felt communication did not help them to understand things properly 30
  31. 31. Choice and control has improved, but progress is mixed • Nearly half of people (47%) recall being offered a choice of hospital at their first outpatient appointment, a big improvement compared with 30% in 2006 • Yet 1 in 4 people using acute mental health care were not as involved in their care as they wanted • And councils are not doing enough to give people full control of their care with direct payments 31
  32. 32. Summary 32
  33. 33. What does the analysis tell us? • Overall steady improvement in performance in all parts of the sector • We see some real improvements that matter to people • Some organisations lag behind the pack • Common issues where improvement is needed, including keeping people safe and training • Some people are supported in having choice, control and independence, but variation is high 33
  34. 34. Leadership challenges • Right across the system, an approach that focuses on the individual, carers, and families is needed • How can services best strategically commission in order to deliver the benefits of joined-up care? • Against the backdrop of future pressures, how can services continue to work in partnership to deliver person-centred care? 34
  35. 35. We will play our part A new regulatory system − centred on registration − keeping the spotlight on outcomes the public wants to see We will… • Focus on the people who use services and their carers • Set clear expectations of providers through registration • Identify serious issues by responsive and vigilant assessment • Act swiftly, using our enforcement powers where needed • Drive improvements through performance assessment and our special reviews and studies 35
  36. 36. Where to find out more Read our full report or summary booklet Visit our website: • Watch videos of people telling their stories • Browse key findings • Get accessible versions 36