Care Quality Commission New regulatory model webinars, 29 Mar 2022

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From YouTube: Adult Social Care Services | Q&A

Description

Kate Terroni, Chief Inspector of Adult Social Care is joined by Rob Assall, Sue Howard Deputy Chief Inspectors and Dave James, Head of Adult Social Care Policy as they answer the questions on people's mind around our new regulatory model.

Watch the presentation in part one here: https://youtu.be/Fd7nNSCb5Ow

A

Over two questions, so at this point, steph I'll take a long sip of water and I will hand over to you to take a suit of questions. Please.

B

The first question is around: when will this start to feel real uh with the assessment framework, with our oversight of local authority assurance and systems.

A

Thanks latoya rob. Can I come to you first for that. Please.

C

Thank you, kate and good morning, everyone um so for our work with systems. So when we're going to start to um when we're going to start to assess integrated care systems and local authorities that will commence from april 2023 so between now and then we are doing, like you said, kate, we're doing lots of work with a whole range of different colleagues and partners across the the system.

C

So we're working very closely with the local government association, the department of health and social care, the association of directors of adult social services and a whole range of different other stakeholders as well, including providers and the voluntary community sector as well.

C

So um what we will be doing is we're going to be doing some piloting um over the next couple of months as well, to really start to think about our methodology, um for when we regulate the integrated care systems and local authority and working with particular local authorities and integrated care systems, so that we can really test out uh whether that methodology is going to work. So so it will come into place from april 20, 23.

A

Thank you. What we got next latoya thanks.

B

Rob thanks, kate. uh So the next question is around inspections and our prioritization of inspections. So lots of people are asking you know. When will we start getting re-rated from ri to good and what about us outstanding um providers? One more. They start to be uh rated to confirm that that rating is still current, so still applicable.

A

Thanks latoya sue: do you want to have a go at that one.

D

Yes, good morning, so while we are still working with our current methodology, uh we are, as kate has already described, starting to uh really think carefully about how we re-rate services and that's not just services that are requires improvement or indeed inadequate. We also want to look to good and outstanding services as well, so that we've got a real mixture of services and a real balance of services across all of the quality indicators.

D

It's quite difficult to give time scales on that, because, obviously we're having to prioritize all the time, depending on the information that is coming in, depending on the risk that might be in a particular area, but we are committed to making sure that we start to do that immediately um and- and so we are already starting to think about how we can use every opportunity of crossing the threshold to assess and to review and and re-rate the service.

A

Thanks sue, what do we got next.

B

Latoya and just to carry on on the theme of inspections um are the club, other chloe, so the key lines of inquiries are they still valid, and when will we start to transition into the assessment framework.

A

Okay, thanks dave: do you want to go for that? One.

E

Sure so, um as as sue said, we're still using the existing model um through to probably april of next year, so they are still valid, and what we'll do is uh to help you understand the transition we'll set out how those key lines of inquiry have been morphed and developed into the quality statements and into the evidence, categories that that that kate talked about so it'll be clear to you as to how that alignment works, and I think an important point to make is um stepping into this new approach doesn't mean we have to go out and do a whole program of comprehensive assessment to start again we're very much building on on what we've been doing.

E

It's just we're trying to do things in a much clearer, uh more transparent and more consistent way so april of next year is the kind of the date we're working to to um to start to roll out the new model.

A

Thanks dave, what do we got next latoya.

B

And just um so, we've had a few questions about our monitoring, approach and uh kind of wanting to be a bit more clearer about what that consists of and um kind of. What will will the focus always be on kind of the um digital inspections, or will providers start to feel a bit more of that kind of on-site um and being able to show you know the improvements that have been made with the inspectors.

A

Yes, so I I hope, as I convey during um the presentation, on-site inspection observation will remain a really critical tool of ours, but we want to supplement that with much more uh updated information that we receive um from uh people who get in touch with us. I'm casting my eyes through uh some of the comments and things such as someone asked about how do we work with local authority uh quality teams? Well, that is useful intelligence. We need to be using.

A

How do we use information we get from give feedback on care to inform our view of uh quality and risk etc. So there are a huge number of sources that give us information about services and we want to have the ability to provide that updated view to providers and to the public much more rapidly than we do now. But on-site inspection remains a really key part of how we will work going forward.

B

Thanks, kate and then one of the most liked questions is a three-parter, so I'll take it in bits as we go along sorry. um So the first part of the question is what has cqc learned over the last two years of the pandemic, and how will you put into practice going forward.

A

Okay, that's a that's a big one. um I think I think we've all learned a huge, a huge amount. I don't think any anyone who's been through the last two years hasn't learned personally professionally, learn different ways of how we run our respective businesses.

A

um So I I think I think we have learned that there are ways that we can work, that don't need us to um to be on site while uh noting that there will always be a critical role for that. So one of the ways we adapted our way of working uh through the pandemic is we work with the uk. Oh, it was the uk home care association, it's now the home care association to pilot whether we could form a view of quality and risk uh for people receiving home care uh without visiting uh their office.

A

So instead of my inspectors, traveling to a an office that could be, you know somewhere on an industrial state what if they spent that time having uh zoom team uh calls speaking with people who received care of their own homes, speaking with uh staff uh virtually and that um we were all, I think we all went into it. I think our natural starting point is: we want to see things in person. I think particularly for home care.

A

We as a as home care providers and inspectors grew confident that, in in those circumstances, in in a lot of cases, we could seek that assurance without uh spending time in an office. So I think we learned what we could do.

A

What how we could review policies, how we could uh be assured on a whole wealth of things that meant that when we visited a place, we spent that time talking to people talking to staff, observing care rather than visiting, visiting a place to spend you know an hour or two sat in an office flicking through uh files. I think that probably there's many things I can say, but that might be the the main thing I'd say: latoya.

B

Thanks, kate, so the next one- and this one relates to a lot of other questions that have been asked is around staffing. uh Obviously, there's a massive um significant issues around staffing across all health and social care. But how are cpc going to take this into consideration uh when going out to on-site inspections and during our monitoring, calls and other observations.

A

So if I can just briefly talk about what we are doing in terms of uh highlighting the issue of staffing and then either rob or sue, if we could talk about what that means for uh how we make judgments so so we are acutely aware of the I mean it's been an issue for forever, but particularly um uh through the pandemic, the increasing challenge around recruitment and retention, and we have been publishing monthly updates, so um home care, so care home providers have been submitting provider information returns and we've been able to show that back.

A

In april of last year, vacancy rates and care homes were at six percent they're. Now at 11.5, um so we've been able to share that. We've also been able to share uh the information.

A

We have the notifications in which uh staffing issues affect impact on the quality of care delivered and that could be in any setting and we were able to demonstrate, particularly in november and december and january, and it's kind of set up a bit back down now how um how there was a significant increase in in workforce affecting providers ability to provide continuity of care, and then finally, we've been looking at when providers exit um the market, be that any and any social care provider and we've been asking them what has prompted their uh their their leaving the sector uh and uh people might think money would be number one.

A

But actually those conversations today have been showing that workforce has been pipping money as the main reason that providers are no longer able to stay, delivering care and again our interest in that. So we have two areas of interest in particular in workforce, which is one how workforce impacts on quality and to how workforce impacts on the stability as a sector.

A

So rob do you want to talk a bit about workforce and when we go and inspect.

C

Yes, no, I was just going to say that you know it's really important, that we understand the context that providers are working in and the extreme difficulties with workforce, and it is a huge challenge. If you've as you've said kate, we always need to think about what this means for people and the impact upon that care. So that's, ultimately our primary responsibility to think about how people are being supported. So we always need to consider that.

C

However, we always do need to think about the real, difficult circumstances that providers are working in and we do take that into account.

C

um It's just really important that if providers are struggling, that they speak to cqc, so they speak to their inspector, they let us know and that they tell us about what plans they're putting in place to try and resolve issues, how they're seeking support from the the local authority and from other partner agencies that may be able to support as well that's really important and how they can perhaps work with with other providers as well, when there are particular difficulties as well.

C

I think that that's really important, but I think the important thing is that the key points for me is we always focus on what what's in the best interests of people and what the impact is on them. We are very sensitive to what the issues are, but keep us updated. If there's particular issues.

A

Thanks rob: what have we got next latoya.

B

Thanks rob so just uh another bit of a two-parter around local authorities and their ability to kind of understand um and commission care. So the first part of the question is: um what uh what do we envision is going to be kind of our approach to um making sure that local authorities deliver a fair cost of care to to and in that way, like increasing fees?

B

How are we going to um support support with that, so that providers are able to deliver high quality care.

A

Okay, that's either a rob or a dave who would like to go first.

C

I don't mind dave, do you want me to? Would you want to go? First then, tell me.

E

You can guess you like, you've got the conch.

C

Thank you thanks dave, I mean this will be absolutely something that we will look at. So when we start to do our assessments, we will be looking at commissioning and leadership that you know the two go hand in hand, so we'll be looking at and I've seen some other questions that have popped up, so how how providers will be supported.

C

um So we will be looking at what the current commissioning arrangements are in place, but also thinking about how the local authority is working with other partners as well to really think about what the needs of people in their local area are. What the needs are for particular people from from different communities.

C

How are they developing and shaping services at this moment in time, but also? How are they thinking about how perhaps their demographics and their population needs are going to change over a given period of time and what they are thinking about for the future as well, and really how they're evolving people who use services working with providers working with all of the other partner agencies, to really think about?

C

What is the range of support that is being provided to people and what do we need to develop in the future and then in terms of the um charging reform I mean that is certainly something that we will be looking at. uh We will be able to make any decisions or say to the local authorities.

C

You must do this, but what we will be able to do- and this is really important in our independent voice role- uh we will be in the unique position that once we start to do those assessments of the local authorities we'll be able to see what's happening both in regional areas and national areas and we'll be able to report on that back to parliament, so that that feedback from providers and from other partner agencies around those issues are really being reported back and then can hopefully be acted upon.

C

I don't know if there's anything dave, you wanted to add to that.

E

No thanks rob that was really comprehensive. I think thank you.

B

Thanks rob and that's actually covered the second part of the question I was going to ask, but also just to carry on in terms of local authorities.

B

um How are we going to prepare our inspectors to to be able to kind of go into local authority and inspect and assess the right things, and then how are we going to convey that to the public and providers.

C

Thank you that that's a great question and that's actually something that we're working on at this very moment in time. So um so we're starting to think so. As we've said, we're starting this in just over a year's time in april 23 and we're already starting to think about what teams do we need in place who, from cqc, will be involved in this work, and it won't just be inspectors. It will be a range of colleagues as well.

C

So it'll be our policy colleagues, it will be our analysts and we will all they will all need to have specific skills. So we're already starting to think about what training and development needs and our colleagues will have- and we will be certainly working on that as we approach april 2023 we're already working with some sector specialists.

C

So we have a uh a senior advisor, so uh uh a man called paul nazarik and up until very recently he was the chief executive of healing council uh and he's working with us and we're really using his wealth of knowledge around how we can really understand what the contemporary issues are within that local authorities are grappling with and how we can then bring that into our training and development of colleagues and we're also thinking about when we get to the point.

C

When we start the assessments in april 23 how we can use external specialists as well so people who already, for example, work in local authorities and how they can work with us, alongs and be part of our team, so that we've got cqc people involved, but also those external specialists, so that we've got it all fully covered.

B

Thanks rob uh so the next question is going to be around systems.

B

um This person is particularly asked around discharge processes, but I think, from a wider perspective, uh how would the adult social care voice be kind of heard in the integrated care systems um processes that we're going to go the oversight powers that will that we potentially have um and this person? Yes they've, asked around discharge processes and how that will be affected in people's writing choices. So yeah.

C

I'm happy to to answer that one as well again, a really great question. So thank you for that, and I think it's just really important when kate was talking about the system. Work that we're going to be doing um the local authorities will actually be part of the integrated care systems as well. So it's really really. They are very interdependent on each other.

C

So when we look to do our local authority assurance work, we will be very much thinking about well. How are they working with providers? How are they working with nhs colleagues? What are the key issues within that particular area, and we all know that um hospital discharge and throughput through a hospital is a key issue, so that is absolutely something that we will be will be. You know looking at, but we'll also look at it when we're actually doing those assessments, but we're also sitting on a gold mine of information in cqc as well.

C

So we do all of the uh inspections of the hospital trusts of all of the adult social um care locations of all of the the gp practices and within uh as we're developing our methodology and as um kate has talked about really starting to think about how people are receiving support across all of the different services will use the information and intelligence and the care home providers are telling them where there's issues and we'll be able to really focus on that.

C

When we look at those inspections, so really great questions, but will be absolutely something that we'll be looking at.

B

Thanks rob and moving kind of back to our current practices, around um inspections and the processes from start to finish, when you're newly registering, how would the experience be um changing for people that have just newly registered with cqc and but also currently at the moment, what what could be doing to address kind of people that have newly registered as a provider with the service and um kind of them getting inspected uh like for the first time or reinspected?

B

um Maybe one for sue and dave.

A

Yeah sue: do you want to come in yeah.

D

Of course, so we absolutely recognize the importance of um rating um services that have not yet uh had a rating, and we know that's really really important, and it was something that we were not able to do as frequently as we wanted to do during the pandemic.

D

So it is part of our priorities um at this very moment in time, as I say, using the current methodology um again with other types of services, we have to risk, assess and prioritize within an area and, for example, a service that has been um registered but not been rated for longer is going to have an inspection sooner, so we're going to obviously going to give that priority, and we would also give priority to a service. Maybe that has not had a rating, and maybe we've had information of concern.

D

But absolutely we see unrated services as a real priority for us to get out to undertake a comprehensive inspection and that's again using the current methodology to make sure they get a rating as soon as possible.

E

And if I could just add to that um in terms of the future model, we recognize as there's currently a bit of a gap between registration, new registration and and rating an assessment, and we definitely want to close that gap. So what we are doing through the single assessment framework through really clear evidence, requirements that kate set out, we can actually start building that assessment from registration so that if we've looked at policies and procedures on registration, we don't necessarily need to then go and look at them again.

E

In order to start building that rating we've done that work, the teams have been much more closely aligned. So actually we can. We can build on that from that first point of registration right through to the actual confirmation of the rating, so we're actually getting a head start really on that work as part of the future model.

A

Thanks dave, I'm thinking latoya's maybe got time for one or two more uh questions.

B

Yes, definitely, um I think uh so. The next I guess question or two will be around um our current practices and reducing burden on providers. um We've had a lot of questions kind of asking to address uh the the stresses that um providers of andre at the moment um and that and they want to know what efforts cqc are making to to kind of reduce burden on. I guess submitting information data or just generally how we want how we're going to maybe be approaching um and be more and understanding of of their current situation.

A

Okay, who wants to kick off with that? I've seen a few questions about provider, information returns and and and whatnot I mean our whole. Our whole ambition is to make sure we use all the information that's available as effectively as possible and that you're not asked to duplicate information, but I I I see from the comments in the chat there is. There is frustration about that. Does anyone want to talk dave? Do you want to talk a bit about um what it might look like in terms of how we use data?

A

That providers give us in a way.

E

Yes, certainly um I mean, and and first off that's that was the original inspiration really for the single assessment framework.

E

Recognizing that providers are commissioned by different authorities might have different need to share the same information slightly differently for different audiences, so we're really trying to convene the whole health and social care sector into one shared space here, so that actually we can collect once and share many times um and absolutely what we're trying to do through our through the enhancements, we're looking to make through the the way that our processes work, but also the way that rit works is actually.

E

It will feel much more like a a smooth running service for providers uh and service is a word that I I definitely want to emphasize there. That is the approach that we're doing we're. Looking. How can we develop our registration service? How can we develop our regis, our assessment service, so that it is easy, as a byproduct of just you doing what you're doing as providers? Actually we can. We can access the information that we need and in a way that is easy for you to share part of that will be.

E

How can we essentially lift information out of digital care management systems which, around about a third of social care providers, are currently using, and that would lift uh we think quite a lot of uh burden from providers. We can actually just get that insight from from those systems, um but we also want to look at other ways. I'm really keen to get any other ideas um from you as to how we can streamline and really and really kind of, reduce that uh that regulatory burden, wherever we can.

A

Thanks david said, one more latoya and then I'll wrap this up. If that's okay,.

B

Yes, uh so um saved the best to last, hopefully uh ending on a bit of a positive note. How will cqc promote and celebrate innovation.

A

So the fact that we have one of our four pillars around accelerating improvement- I hope, indicates our our ambition to uh really highlight best practice and encourage other providers to adopt that. What's been tough uh for everyone over the last years, many things, but one of the things is it's the focus on on risk and the need to get out to services that we're worried about.

A

We want to move back to a much more um much more variety, where we can also be getting out to our standing homes to homes that are uh confident that we would find outstanding practice if our inspectors went out and spent a bit of time with them, and we want to do that because uh our strategic goal is about driving improvement and looking at innovation, and we can only do that if we're sitting and we're seeing it and publicizing it so that best practice can can also be shared, so um watch his space.

A

I am really hopeful that in the coming months there will be an increasing emphasis on re-rating, but also getting uh getting back out there to look at the you know the wealth of best practice. That is also happening, whilst providers are juggling a huge amount of kind of turmoil and challenges as well.

A

So thank you very much latoya for that really difficult job of juggling 250 questions and I'm sure there will be people on the call who are frustrated that this hasn't haven't been answered, but um you've done a great job at drawing out the ones I think, with most likes and and ones and grouping together themes. So, and thank you so much for your um your questions and your engagement. um As I said at the top of the call, uh we will be sharing this uh webinar on our youtube channel.

A

We will be making the slides available and there are many ways to get involved if uh this is, as I say whether your appetite and you really want to uh help us think about our thinking about local authority assurance or you, uh you know- want to get involved with a pilot for the new single assessment framework for providers or whatnot. So um a massive thank you for your your time and engagement today. I hope you found it um useful.

A

uh Give us uh give us feedback as to how uh this has landed with you, and we look forward to many more conversations over the next 12 months as we uh as we stand up on our new approach to regulation from april 23.. So at this point we will end the webinar and I wish you a good good rest of your day. Thanks all.

A