Care Quality Commission New regulatory model webinars, 31 Mar 2022

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From YouTube: Adult social care services | Presentation

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Hear from Kate Terroni, Chief Inspector of Adult Social Care as she updates you on our current regulatory approach, including how we’re monitoring and prioritising inspections. And the next steps in developing our new regulatory model.

Check out the Q&A in part two: https://youtu.be/S6-CDBV224g

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Good morning, all a very warm welcome uh to our webinar this morning on our new regulatory model. We're really pleased to have you join us for the next um hour to talk um all things uh new model uh and cqc.

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um For those of you who don't know me, my name is kate tarone, I'm the chief inspector of adult social care here um at the cqc, um and I will um be uh shortly introducing my colleagues who will be uh joining me to take uh questions, but before we get into the content and what we're going to cover um today.

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I just want to take a moment to recognize that yesterday, as we're all aware, was the national day of reflection uh marking two years since we went into um lockdown at the start of the pandemic and as ever when I have the opportunity to talk to a large number of people like I do uh this morning.

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I just want to pause for a moment and just say again a massive thank you for everything you've done and your teams have done over the last uh two years uh to support people in the most extraordinary uh difficult and challenging um times. So I just wanna before we get into the business bit.

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I just wanted to recognize that yesterday was a really important day for pausing and reflecting on uh what everyone has been through over the last two years, but also uh sat with you today to say a massive thank you for for what you for what you've achieved and how you supported people in these incredibly incredibly difficult times so um on the call today, uh the format is I'm going to talk to you for a little bit for the first uh part of the webinar, um but then I'm really pleased to be joined by two of my uh deputy chief inspectors: rob assel and sue howard.

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um It's fabulous to have dave james who's, our head of policy and join us. So between myself, uh sue, rob and dave. We will respond to your questions uh towards the end of the session and then we've got our team uh making this happen. So we've got latoya david and steph and a big thank you uh to those colleagues who have got us uh here today ready to uh cover what we're going to cover. So that's that that's the team, um the plan uh for the session uh this morning.

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uh As you know, this is a teams live uh chat, so uh we will be talking you from already able to put your questions um into the chat. So please do please react. As I talk, please pose um any questions and there will be time uh to pick them up uh about halfway through the session once I finished uh talking um as you would expect.

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Probably at this webinar webinar is recorded and we will upload it onto our youtube channel later for colleagues who haven't been able to join and who would wish um who and who would wish to hear the content and also we will share with you the slides that we are presenting today, so no need to be scribbling and notes you will get, uh you will get a copy of them um at the end of the session, so we've got an hour together and we will absolutely be finished uh in time, but please be active participants and jump.

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Your questions, your reactions and your chat uh into the chat as we go. So what are we going to cover uh today?

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We did a quick recap of our cqc strategy, which we launched last year, we're going to talk about what we've been focusing on in terms of our regulatory activity uh recently and what our priorities are uh going forward.

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We're then going to focus on our new regulatory model and I'm going to do a bit of a compare and contrast to the current model and our plans for our new regulatory model, uh we're going to get into our single assessment framework, and then we will hopefully have plenty of time for questions and answers, q and a's at the end. So that's the plan for the hour.

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Okay. So if I can move on to uh talking a bit about background setting the scene and uh talking a bit about our strategy, we're still calling it our new strategy, but actually we published it back in um uh may uh 21.

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and we published it after having and really benefiting from a huge amount of engagement in what our strategy uh should look like. So a massive. Thank you to probably many of you who helped shape up our strategy that we published um in in may last year, but it is still relatively. It still still feels relatively uh new. So just so a quick recap of what our our strategy says.

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um Fundamentally, we want to be a regulator who regulates through the eyes of people with lived experience, so we want our our regulation methodology to be based on what matters to people we want to have the ability to not only regulate the quality of individual care delivered by individual providers, but to comment on how people experience care through a pathway, how joined up people experience their care. So we are. The kind of first pillar of our strategy is around people and communities. So how? How do people ensure that they access care in a timely way?

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What happens about inequalities and how we can regulate through the eyes of people with lived experience? The second pillar is about being a smarter regulator. No doubt um many of you on the call will have opinions about how we regulate to date. We are really keen that we continue to be an incredibly helpful resource to the public in terms of giving them up-to-date uh helpful information about the quality of care out there. We also want to help providers improve by showing what best practice looks like, um so to be a smarter regulator.

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We want to present information in a way, that's more timely and we want to have a spectrum of ways, a spectrum of tools that we can use in the way that we regulate, so that we can be proportionate as well, and that we've got real clarity between us and between providers about what we can. uh What we expect when we come out and and look uh look at the quality of care being delivered, so um our second pillar is around being a smarter regulator. That bill is around accelerating improvement.

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We, through our strategy discussions, had lots of conversations about what our role should be around improvement. There was, um there was quite an appetite for us to play uh more of a role in showing what are the ingredients that enables uh providers to deliver um outstanding care. What are the components of improvement and that's a space. We're really excited to be in more and then the final pillar is around our uh our role around uh driving uh safety through learning.

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uh So those are the four pillars of our strategy, underpinned by uh our willingness to uh wanting wanting to look at issues around inequalities and our new roles around assuring systems that we will talk about a bit as we go. Okay, if we can move on to the next slide, uh please steph!

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So little recap. I won't talk much about um everything we've done since the start of the pandemic, but um just want to take this opportunity to remind people uh that we uh we have never stopped regulating through the pandemic. From the from the beginning of the pandemic, we uh talked about pausing, routine inspections, but we have continued to do risk-based inspections.

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um You may remember back in the summer of the of 2020, we developed our new infection prevention control methodology, so we've continued to risk risk-based inspections, and I have a real focus on how providers are effectively delivering ipc.

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So, since the start of the pandemic, we've done 13 000 um inspections. um Since december this december uh just scorn, uh we've done two thousand uh seven hundred and eleven, uh with two thousand a little over two thousand of them being uh around infection prevention control. um It would be worth a little reminder to this group. um We have broadly been assured across all the a ticks of assurance when it comes to ipc.

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The only area that needs continual vigilant focus is around um making sure providers have the most up-to-date policies around how they deliver effective ipc so of the areas of assurance that falls down. uh We've noted uh in recent months. It's the issue around policy, so just a little plug for that, and just the final comment on what we've seen with our ipc inspections. um You'll, probably be aware that a component of ipc inspections is looking at how providers are supporting people to have um visits, I'm talking, particularly at the moment, to um care home providers.

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I think uh all of us are acutely aware of the impact over the last two years where um providers have had the incredibly difficult job of weighing up keeping care home residents physically safe, um while also maintaining their mental well-being through contact with loved ones. It's been a really difficult balance to strike and throughout it we've asked providers to follow government guidelines.

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uh We've said that blanket bans were unacceptable and would probably trigger an inspection, um and we have looked at every concern that has come to us around visiting um uh we've looked at visiting on our inspections uh uh over uh the last few months since december, in particular, and in 97 of those 2000 inspections. We were assured on visiting, so it's been a tough job. uh Broadly providers have been getting that balance right, but we continue to look very closely around visiting because of the significant impact it's had on residents, mental well-being also.

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So that's a little bit about what we've done if we can turn to the next slide, which is our focus going forward from march. So um I haven't seen your questions yet, but I anticipate there will be questions around.

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um When are you going to come back out and rate us? We know that it is incredibly important for particularly adult social care providers to have up-to-date ratings. We know that the public really use our ratings to make decisions about where they want to receive their care from.

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uh We know a a less than good rating impacts on staff, morale and the massive challenges we have in the sector around recruitment and retention, and then there's also, finally, that kind of commercial challenge of having a lesser good rating and what that means for your business and and stability etc.

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So we are really keen to get back out and start re-rating um wherever we can so our priorities from this month going forward, as you would expect, uh absolutely continue to be about responding to risk, and we will always flex that as our priority, so the amount of inspection activity and our areas of focus will always be number one. Responding to risk and ensuring people remain safe.

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However, whatever we can, we want to re-rate. So we know we can re-rate through our focus inspections, and we know our direction of travel, which I'll talk about shortly is about uh producing reports that are succinct and that get to the point. um So we will be doing focus inspections and we will be re-rating uh whatever we possibly can.

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um We will be going back to inadequate and requires improvement uh services. We will be going back to some good and outstanding services. um uh A for all the reasons I've set out, but also our inspectors are desperately keen to uh get some balance back. Where um I know nothing gets my uh inspectors more excited than going out and seeing outstanding practice, so uh they want it.

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You want it, but also we want to make sure we can support the improvement agenda by showing what best practice uh looks like um and then finally, we want to go. We want to get out and rate services that have been registered with us, but have yet uh to be rated. So those are our priorities for march uh going forward and I I really hope in the coming months uh we will be able to talk to you about an increasing volume of services where we have. uh We have re-rated as well.

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Okay, we can move on steph, okay, quick, quick, zip of water right. So we're going to talk now about our changing approach to uh regulation and I'm going to talk through this slide. I'm going to kind of do it column by column, as I think that is it's the easiest way in my mind, to explain how we are changing so currently uh believe it or not. We have four assessment frameworks.

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We have one for health, one for social care and we have two in registration and those assessment frameworks have pages of key lines of inquiry and they run to about 330 uh pages of questions uh that we ask and we look at on providers.

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So a massively complex assessment framework regime, our intention and what we've committed to going forward is to have a single assessment framework, so moving from four assessment frameworks to one and that assessment framework will be the one we use for all health and social care providers, be it a gp practice, a home care provider, a shared live service, an acute hospital, um so a single assessment framework for our providers, but also the single assessment framework will be what we use as we take on our new powers around assuring local authorities and assuring systems, so the same assessment framework for those three layers of um assurance and regulation.

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So that's the first column. Second column, so, prior to the pandemic, a lot of our activity was driven by previous ratings. We always responded to risk, but a lot of our activity was um driven by previous ratings, and providers would tend to have a sense of how frequently we'd come out uh depending on whether they were inadequate or outstanding. To give you, the extremes, um through the pandemic, we've become much much much more responsive, so 52 of our risk-based inspections are triggered by information we received by the public families.

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People who work in in the the social care sector, but our old ways are working were a lot more kind of planned inspections based on uh previous ratings um and then a kind of set piece, so we'd come out and inspect uh we'd rate the service, and we would publish it our ambition going forward.

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So if we think about what the public wants from us and what we want to do around driving improvement as we want to move towards a much more ongoing view of assessment, a much more timely way of sharing with providers and with the public what we know about the quality and risk of services out there.

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So, instead of moving away from these kind of set pieces where there may be an inspection every three years to a much more fluid way of updating uh providers and the public about what we know about quality and risk, so let's talk about the uh inspection changes that we will be making so currently an inspection um before the pandemic would often have been comprehensive.

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We would have gathered a huge amount of evidence across our five key lines of inquiry and that information would have been accurate at that point in time. So at that point in time, on those uh you know hours few days we were with that provider. That was what we found and that was accurate going forward. We don't want our inspection activity to just be a point in time.

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We want to have multiple opportunities to update what we know about the quality of care being delivered uh in in a in a social care in a setting, that's delivering um social care we want to. um We want to use our data and our intelligence better to keep uh keep that updated and when I talk about data, um your mind might just jump to numbers and excel spreadsheets. When we talk about data and intelligence, we talk about the wealth and knowledge held by um inspectors held by local authorities.

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Clinical commissioning groups advocacy agencies, so all of that knowledge and intelligence is what we are talking about when we talk about that, but also we want to going back to that proportionate point, we absolutely will be continuing to inspect and there are services where we want to spend more time in those settings to get a better idea of what it feels like to receive care in those um environments and that might look like more out of hours um assessments depending on uh any concerns we might have.

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um Some of you will be familiar uh with our sophie framework, our short observational framework, where we sit, and we just observe a handover and real time how uh colleagues talk to the people they are supporting.

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So we envision uh in certain circumstances, spending more time on site, more observation, but also having a wealth of other ways of updating what we know and around quality and risk.

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Moving on to the fourth column, um how we develop judgements so um the way we've done things today is we will line up our judgments against the ratings characteristics and that what we that's, what we will publish, um there's a huge amount of um inspector uh insight and uh what they, um what they've perceived to be captured in that we want to, in our new way of um our new methodology, be a lot clearer about what evidence is needed to satisfy, uh which uh which topic we're talking about.

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So we want to be really clear for our inspectors and for providers about what we expect to be enough to satisfy that. We have reached this judgment um and in order to do that, there will be the ability for us to assign schools to what we are, uh what we are judging and the um the thinking behind that is. We have really heard you talk about um consistency, transparency. How have you reached that judgment? What's different between that service? Getting that rating and that service?

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Getting an alternative rating we want to do all we can in our new methodology to really explain our thinking in how we've reached the judgments and that we've reached and then the final column. um As you know, uh prior to the pandemic, we would uh monitor inspect rate and publish, uh often quite lengthy reports. I think for many people, um uh people would look at a rating and they may cast their eyes over the first page or two about our findings.

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um I'm not sure how often people would read through a kind of 30 page pdf uh report, so we want to uh have the ability to update ratings more frequently to publish short statements on our website, as we have been doing um for maybe about six months now, a short statement that says: we've reviewed the information we have on the service and there's no need for us to uh go and inspect at this time um and the ability to produce more succinct reports that tell the public what they need um as a result of what we know about the service.

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Okay. So that's a little bit of a flavor of what's going to feel different, I'm going to move on now to talk about our new assessment framework. um So we are, we are all feeling uh we at cqc and- and people that have been involved with this today- are feeling quite excited by this new framework, and I'd be really keen to hear how this lands with you. As we talk about it today, my personal excitement um and dave james who will be joining us in the q.

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A is um there has been some fantastic work done a long time ago by think local app personal to develop uh something called the making it real. I statements where, after massive con consultation co-production, they came up with a set of statements about what matters to people about the quality of care that they receive.

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As I mentioned at the start of this presentation, our ambition in our strategy is to regulate through the eyes of people. We've lived experience so at the top of our triangle, I'm really pleased to say that we will be keeping our five key questions. It's a it's a way of regulating that you know. We know and the public knows, but we will be aligning those five key questions with the making it real. I statements what matters to people when it comes to caring, safe, effective, etc. So our five key questions remain.

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If we go down a layer of the triangle we are, um we are moving away from our ratings characteristics to having quality statements, and these quality statements are going to be expressed as we statements. So we as a provider of home care will- and these we statements will be set at the level of good.

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So this is about having real clarity about what matters to people and what we expect from providers to hit the good bar when it comes to uh what we are, what we are looking for when we go and and when we inspect and assess uh providers, so there will be, uh there will be uh state quality statements um and they will be expressed as we statements at the uh level of good, underneath that we are going to be a lot clearer about what evidence we will.

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We will collect to satisfy uh the judgments we've reached on those quality statements, and there are six categories of evidence that we are going to look to we're going to look for people's experience. We're going to look to information. We've had back from staff and leaders, we're going to look at feedback from partners critically we're going to do observation, we're going to look at policies, processes, procedures and we're going to look at outcomes for people.

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So we're going to be clear about what evidence we're going to collect and we're also going to be clear about when is enough evidence collected, so you may be a provider on the call who has experienced um uh possibly an inspector coming back for more and more and more information for them to uh feel that they can conclude the judgment they've reached. We want to be really explicitly clear about. When is enough enough?

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When have you got enough evidence to satisfy the judgments you have reached, so those three aligns in the pyramid will be the same principles. We will apply for providers for local authorities and for systems.

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The bottom bit of the pyramid is where we will flex a bit depending on what we are looking at.

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So, for example, we may look at different areas of different quality indicators, different areas of evidence in a local authority uh in comparison uh to a extra care housing scheme care delivered there, for example, so, and the bottom bit of the pyramid gives us some flexibility about the data and information that we will capture, depending on the scope of the assessment that we are looking at and as you'd expect, all of our methodology will be underpinned by best practice, standards and guidance. So that is our our new.

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um That's our new flavor of our new assessment framework. So if we can move on please so I've mentioned a couple of times. I know this isn't the main focus for this call.

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But um if you are a provider of social care, I am confident you will have an interest in what our new role will be around local authorities in particular, but you might also be interested in our new role around um integrated care systems, so the health and care bill which is in its final stages of moving through uh parliament, will uh is looking to see us taking on new powers from april 2003 uh 2023 to um uh to assure the quality of services being delivered by local authorities and by integrated care systems.

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When it comes to integrated care systems. We have already been advised by government about the areas of focus, which is around leadership, integration and safety and quality when it comes to local authority um assurance. um This is a power we we are very enthusiastic to take on and the reason why uh we are uh multiple reasons, but if I think about the many conversations I've had with providers, one of the main things that social care providers say to me and say to my team: it's the way that you are commissioned.

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The way that your um your commission, the the the amount, that's paid for the quality of care that you deliver significantly impacts on on what you can the support you can provide to people receiving care. So it's something, I think, is a sector we've been really keen to um have a role with um our role.

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Around local authority assurance is about assuring ourselves government the public about local authorities, delivery against the care act, part one, and for those of you who know the care act, it is it's a huge, huge, very important bit of legislation, so we've been really benefiting from working with an expert advisory group of people who use services, families and stakeholders, obviously including local government and government, to home down on what they think matters when it comes to local authority assurance and we've got four groups, four areas of focus that will be worked up a lot more over the next 12 months.

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um One is about working with people. How do people get their needs assessed in a timely way? How many people have character, eligibilities that are waiting for a package of care to be sourced to placement, etc? The second one is around how local authorities provide support so how they work with the market. How do they co-produce and design services with providers?

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How do they support people where providers have to leave the market? The third bucket is around um ensuring safety, so local authorities approach to safeguarding um market management, uh contingency planning, etc, and then the final one is leadership. So I won't. uh I won't go into this in depth today. um We've got uh workshops that we're holding on these two topics. So if it's an area you have a particular interest in, we would welcome you to the table um because we're spending the next 12 months designing this.

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So we're ready to go live in april and I'm confident. If we get this right, we can really help uh improve outcomes for people in terms of getting access to care in a timely way and showing what best practice looks like when it comes to the way local authorities work, and I suppose just one final thing.

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The ability we can that we can look at three layers um is that we might go into a place and we might see a number of social care providers who aren't delivering care at the quality we would expect and during those inspections it might become apparent.

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There might be a recurring theme from those, for example, home care providers that the um hourly rate that they're being commissioned at and the way that they are being commissioned um by, for example, a particular local authority, is impacting on uh how they are um able to deliver high quality care. We will be able to look at that information and think, oh, do we want to go in and have a look at how the local authorities are doing uh commissioning and market shaping?

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We could go in and look at the local authority and find whatever we may find, but actually that may uncover that there are challenges in the relationship between the local authority and health leaders and how that collective money is being spent and how um how they are collectively looking at the needs of that population, which will enable us to look at go in and look at the um integrated care systems, and there are many different versions of those of of that escalation.

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I've described, but the fact that we, with our same assessment, framework about what matters to people can look at those different layers is, um is something I hope you will feel uh positive about as well right I'll move on okay, so um things such as our assessment framework are approached around local authorities and integrated care systems. We are benefiting hugely from having such a fabulously engaged sector, who regularly tell us where we could do better uh when we're getting things right and how things need to look different.

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So this slide just gives you a flavor of the numbers of people who have been involved today uh with um with the method with our approach and how that's shaping up and, at the end, I'll remind you um if this has wetted your appetite and you want to get more involved, how you can do so as well.

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So if we can move on so just a couple of other things before I pause at the corner of my my eye, I can see your questions coming in thick and fast, so uh we need to make sure we've got ample time for that. um We've talked about our strategy. We've talked about our priorities and our new assessment framework. I just want to flag you a couple of other things that may um may not be in the forefront of your mind.

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So, prior to the pandemic, we produced two really important um publications that I would love you to uh refresh yourself with. um If, if it's um you know, obviously a huge amount has happened in the last two years.

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The first one is our our report into um or healthy people in care homes uh called smiling matters where um are cut to the chase, where we we didn't, find consistently residents having uh up-to-date or healthcare plans, access to dentists, and sometimes even the basics, such as uh you know, a toothbrush uh to ensure that their teeth are clean and all the uh physical implications associated with poor oral health were drawn out during that.

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So we uh shared that publication and um uh we are looking at focusing in on oral health in our up and coming inspections. So just a little reminder, um maybe dust that off your shelf or click on the link and have a little look at oral health and then the other really important publication we shared prior to the pandemic. Was um we looked at issues around supporting individuals to have uh relationships, their sexuality recognized?

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um And in that report we reflected that uh and what you often find in as you'd expect in in the social care sector is, it reflects what happens in wider society, which is generally uh we as a society, maybe aren't as comfortable as we could do with being about having conversations about sex, sexuality and relationships, and our report found um people working in the social care sector um didn't feel that they had.

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This always have the skills and the training and the confidence to broach what can be sensitive topics around uh sexuality, and the report draws out best practice. But it also shows um how things can go very badly wrong for people when um those need when there is an adequate kind of planning and support around those aspects of people's lives.

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And we all know uh that high quality person-centered care is holistic uh and includes all aspects of uh the lives that you and I lead, and we need to make sure we uh obviously support and focus on that when it comes to people receiving social care as well. So just a little flag on that, and I think I've got a couple of wrapping up slides and then we will get to questions. So.

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um We've got a huge amount of transformation, we're doing as an organization we're changing the way we regulate we're, also changing the way we are organizing ourselves um with our operational teams.

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So in order to deliver our ambition to uh effectively regulate systems and to not just look at providers in isolation, but to look at how people move between providers, we are moving our inspectors into what we're calling multi-disciplinary teams, where you would have an adult social care inspector still inspecting adult social care services, but working closely with a primary medical services inspector who might inspect a gp practice and a hospital inspector who might inspect a hospital and then that team of people can also, as well as using their sector, specialisms to inspect those respective service areas.

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They can look at how people move between services as well um we're going to be doing a lot of testing um through uh april through to march about our new methodology, um and we will continue to learn and uh adapt that based on what we hear as well.

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um If we can move on steph, I think next one so um you'll probably be aware of this. We have our blogs. We have our twitter pages. We have our citizens lab, which is our um digital way of people engaging in uh things that we are consulting on um and we have our podcast series, so lots and lots of ways to get in touch and keep up to date.

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