Current and future developments at CQC Amanda Stride Head of - - PowerPoint PPT Presentation

Amanda Stride – Head of Inspection Sally Newell – Inspection Manager 6 February 2020

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Current and future developments at CQC

Our role and purpose

The Care Quality Commission is the independent regulator of health and adult social care in England We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve

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Overall ratings for adult social care

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Source: CQC ratings data 10/01/2020 Figures are percentages

288 (1%) 3,462 (15%) 18,596 (80%) 994 (4%)

Inadequate Requires improvement Good Outstanding

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Ratings by key question

Source: CQC ratings data 10/01/2020.

1 <0.5 <0.5 <0.5 2 17 11 4 9 20

81 88 91 85 74

<0.5 1 5 5 4

Safe Effective Caring Responsive Well-led

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#StateofCare

Download the report by holding your phone camera to this QR code!

State of Care 2018/19

State of Care 2018/19

• People’s experience of care is

determined by whether they can access good care when needed

• Risk of being pushed into

inappropriate care settings

• Increased demand and challenges

around access and workforce risk creating a perfect storm

#StateOfCare

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#StateOfCare

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8%

fewer learning disability nurses than in 2015

10%

• f wards for people with learning

disabilities and/or autism rated inadequate, up from 1% in 2018

8%

• f acute wards for

adults and psychiatric intensive care units rated inadequate, up from 2% in 2018

State of Care 2018/19: A perfect storm

Access and workforce issues Specialist nurse shortage

• Action from parliament, government,

commissioners, providers and communities for:

• more and better services in the

community

• innovation in technology, workforce

and models of care

• system-wide action on workforce

planning

• Long-term sustainable funding for adult

social care

#StateOfCare

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State of Care recommendations 2018/19

Adult social care specific findings

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80% rated good 4% outstanding 15% requires

improvement

1% inadequate

Overall #StateOfCare

• Concerns about capacity

set against growing unmet need

• Staffing is under pressure

with high turnover, high vacancy rates and a lack of people with the right skills

• Continued uncertainty

about long-term funding

CQC Continues to Change

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• CQC is transforming to support innovation, cross-sector working and

improvement in front line services and the wider system

• CQC will have a more targeted, responsive and collaborative approach to

regulation so more people get high-quality care: Easier for providers to work with us to do their job and innovate Easier for the public to use what we know to make choices about care Easier for inspectors to do their jobs

Improvements: shorter reports and new FAC

Reports

• More focused, more accessible, better

quality

• Only one style for all inspection types
• Feedback at end of site visit
• Providers who tested them find them

‘easier’, ‘great to read and informative’, ‘much clearer’ Factual accuracy

• Clarity, efficiency and effectiveness
• Separate clear guidance
• New form on CQC website

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Improvements: returning to Good and Outstanding services

• New approach
• Inspectors spend more

time on quality

• Shift to 80% of

inspectors’ time on

• bserving and speaking

with people

• Inspectors can flex these

guidelines and be curious

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Leadership and culture

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• Involving people who use services and

their families

• Shaping the culture of the organisation
• Staff feeling valued, given a voice and

empowered to ‘steer the ship’

• Constant focus on improvement

“There’s a saying that to be a good leader you’ve got to have good

• followers. No. To be a leader you’ve got to breed more leaders.”

Jamie Stubbs, Senior General Manager Ottley House Nursing Home

Driving improvement across health and social care: themes

• Report series features

providers that have increased their quality rating considerably

• Similar themes for all reports
• What themes stand out?
• Leadership
• Culture
• Person centred care
• Staffing & support
• Outward looking
• Happy staff means better care

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• New website resource
• Case studies where health and social care

providers make effective use of their staff

• Different methods, not just numbers and ratios:
• How to make best use of skills and disciplines,
• r work across the system – improving quality,

safety, efficiency, teamwork, development

• Taking flexible approaches to staffing can have

a positive impact for people using services

www.cqc.org.uk/effective-staffing-case-studies

Effective staffing

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Oral health in care homes

• Less than half (47%) of care homes

providing specific staff training to support people’s daily mouth care

• 73% of care plans only partly covered or

did not cover oral health at all – homes looking after people with dementia being most likely to have no plan

• 52% of care homes visited had no policy to

promote and protect people’s oral health

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• 1. Pharmacy professionals are vital
• 2. Improve transfer arrangements
• 3. Policies must be correct and part of practice
• 4. Report incidents and learn from them
• 5. Parity between physical and mental health

conditions

• 6. Leadership from local authorities and

commissioners

• 7. Use electronic systems well

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Medicines in health and adult social care

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• 1. Committed leaders
• 2. Principles into action
• 3. Culture of staff equality
• 4. Apply equality & human rights thinking into

quality improvement

• 5. Staff as improvement partners
• 6. People who use services at centre
• 7. Use external help
• 8. Courage
• 9. Continuous learning and curiosity

Equally outstanding: Common success factors

New guidance on relationships and sexuality

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• Supporting people to form and maintain

relationships while helping them to understand risks

• Also diversity, protecting people from harm,

physical disabilities and the importance of

• ffering an environment welcoming to LGBT+

people

• Published February 2019

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Long term segregation

• People who are in long-term segregation can experience:
• more restrictions than necessary
• delays in receiving independent reviews.
• This is particularly true for people with a learning

disability and autistic people.

• Our review into Restraint, Seclusion and Segregation

found:

• missed opportunities
• Poor environment
• Lack of staff skills
• Staff not trying to integrate people onto the main ward

Points 1 – 3, The detention of young people with learning disabilities and/or autism, Second Report of Session 2019, Joint Committee on Human Rights

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Points 1 – 3, The detention of young people with learning disabilities and/or autism, Second Report of Session 2019, Joint Committee on Human Rights

Joint Committee on Human Rights

• In July 2019, 2,270 people remained in

institutions.

• Of this number 57% had a total length of

stay of over 2 years

• The number of children in these settings

has more than doubled from 110 in March 2015 to 255 in July 2019 12% of inpatient services are now rated inadequate (31 October 2019), up from 1% at 31 July 2018

Transforming care for people with a learning disability and / or autism?

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Next steps

Registering the right support – changing the market for LD / Autism Following domestic and international summit we will be submitting proposals to Secretary of State in January for those at risk

• f

segregation From July 2019 we’ve been visiting adult social care services, some mental health rehabilitatio n/ low secure hospitals We are working with Ofsted to consider the use of restrictive intervention in children’s residential services and secure children’s homes Final report March 2020 with reccomendat ions to Secretary of State for Health and Care

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“The 39 people we have visited who are cared for in segregation are in a very vulnerable situation. Their world is narrowed to a highly restricted existence in a single room, or small suite of rooms. They have little or no say over decisions about their lives or their future. Many are also a long way from home - which can make it difficult for families to maintain contact”

Interim report: a system not fit for purpose for the most vulnerable people

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What have we found so far?

• There have been missed opportunities early on - many people we visited

had been communicating their distress and needs in a way that people may find challenging since childhood

• A high proportion of people in segregation had autism
• Some of the wards did not have a built environment that was suitable for

people with autism

• Many staff lacked the necessary training and skills
• In the case of 26 of the 39 people, staff had stopped attempting to

reintegrate them back onto the main ward

• Some people were experiencing delayed discharge from hospital, and so

prolonged time in segregation, due to there being no suitable package of care available in a non-hospital setting

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• In 2017 CQC was commissioned

by government to carry out a programme of 20 local system reviews.

• CQC has now been asked to

continue the programme

• 3 new reviews and 3 follow up

reviews published spring 2019

Overview of our local system reviews

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Regional outlook

These profiles give a picture of the health and social care system by area.

• Contain data for each of the 7

NHS England and NHS Improvement regional footprints.

• Published to encourage

improvement by supporting local areas to explore some of the themes in State of Care.

* Data from Midlands regional profile

Published and forthcoming

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Soon:

• Supporting

people’s sexuality and sexual safety in adult social care

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www.cqc.org.uk enquiries@cqc.org.uk @CareQualityComm