The CQC s approach to regulating urgent care. Ruth Rankine Deputy Chief Inspector for Primary Care CQC

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1 The CQC s approach to regulating urgent care Ruth Rankine Deputy Chief Inspector for Primary Care CQC

2 NHS Confederation Urgent and Emergency Care Forum Ruth Rankine Deputy Chief Inspector of General Practice & Integrated Care 25 March

3 Objectives for today To share with you: The role of CQC CQC s new approach to inspecting and regulating urgent care Emerging themes from NHS 111 consultation CQC s developing approach to integrated urgent care To hear your views on: The assumptions and principles underpinning the proposed approach to inspecting and regulating urgent care 3

4 Our purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Our role We 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. We will be a strong, independent, expert inspectorate that is always on the side of people who use services. 4

5 5 Our new approach

6 Our Key Questions Safe? people are protected from abuse and avoidable harm Effective? people s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence Caring? staff involve and treat people with compassion, kindness, dignity and respect Responsive? services are organised so that they meet people s needs Well led? the leadership, management and governance of the organisation assure the delivery of high quality care, supports learning and innovation, and promotes an open and fair culture 6

7 What are we doing differently? Inspection teams of specialist inspectors, supported by specialists and clinicians Introductions of ratings telling people whether services are Outstanding, Good, Require Improvement or are Inadequate Strengthening our intelligent monitoring of providers using nationally held date and local intelligence New ways of gathering patient views both before and during inspection Develop a clear approach to responding to inadequate care and use our enforcement powers (including cancellation of registration & prosecution) where necessary 7

8 Inspecting and regulating urgent care Our approach to regulating and inspecting urgent care will include: Inspections of individual providers of urgent care GP practices, GP Out of Hours, NHS 111 etc either as a standalone inspection or as part of a combined provider inspection Inspections of integrated urgent care 8

9 What we re doing now Service/ provider type Approach to date 9 Acute Trusts Ambulance Trusts Minor Injury Units/ Urgent Care Centres/ Walk in Centres NHS 111 services GP out of hours providers Social care providers Community pharmacies Urgent and emergency care is a core service in inspections. Consultation on the inspection methodology and piloting. Inspect 111 and urgent care services with ambulance services. Provider of these services may be acute, community or primary care. Inspect these services at the same time as we inspect other services they provide. Consulting and piloting new approach. Approach developed and inspecting. Urgent and emergency aspects of these services are included within the inspections of adult social care providers. Inspected and regulated by the General Pharmaceutical Council. Considering how we can work more closely together with them in our approach to inspection across a system

10 Timeline for NHS 111 regulation February 2015: Launched consultation on approach to 111 services March 2015: Pilot inspections of NHS 111 services (3 providers) Evaluation of pilot inspections and feedback from consultation May to June 2015: Launch of final NHS 111 inspection methodology 10

11 Timeline for urgent care regulation February to September 2015: Develop approach to inspecting urgent care pathway/integrated urgent care September 2015: Pilot inspection of urgent care pathway/integrated urgent care 11

12 NHS 111 consultation latest CQC is mid way through a public consultation on methodology for regulating and inspecting NHS 111 services We are seeking feedback on proposed approach including key lines of enquiry and prompts for inspection teams, gathering service user views, and observing quality of care CQC are testing the proposed approach in three pilot inspections of NHS 111 providers The consultation closes on 24 th April we encourage your participation 12

13 Research For CQC s new approach to be credible with the public, it is essential that the features of the service it inspects and rates reflect public expectations CQC commissioned Research Works to help understand what service users think good looks like in urgent care and NHS 111 These include Fast access to care and treatment, follow up care and information. Managing patient expectations was a consistent priority Confidence in staff experience and expertise (with concerns raised when NHS 111 staff appear to be reading from scripts ) Good patient handling, staff demonstrating compassion and respect as well as taking the time to listen 13

14 Integrated care the case for change The Care Quality Commission (CQC) recognises: Health and adult social care should be designed around a person s individual needs and not focused on organisational structures, as these do not represent the reality of experience. As the regulator for health and adult social care, we support this vision for improvement. (David Behan, Chief Executive, Care Quality Commission, 10 th March 2015)

15 Defining integrated care There are multiple ways of defining Integrated Care Population groups Features of care By organisation By outcomes Frail older people Personalised GP Practices Better citizen experience People with LTC Case managed Acute hospitals Lower Costs

16 Defining integrated care the National Voices definition: I can plan my care with people who work together to understand me and my carer(s), allowing me control and bringing together services to achieve the outcomes that are important to me This definition of integration works well for long term conditions. We need to a definition that fits urgent care equally well. Source: National Voices Narrative for Person-centred Coordinated Care

17 Barriers to integrated care It is important that we break down real and perceived barriers to integrated care: Regulatory Financial Cultural Provider regulation Quality regulation Payment Systems Contractual limitations Fragmented Budgets Lack of compelling evidence base

18 Vision for the regulation of integrated care Current situation Future vision

19 Towards a national framework for the regulation of integrated care CQC s vision for the future: A regulatory system which is person centred (as it demands of providers) and assesses quality of patient care in a holistic way (the way patients actually experience their care) A regulatory system which assesses the interfaces and gaps in a patients journey as much as it looks at the individual interactions A regulatory system which actively encourages providers to work together for the benefit of patients and not just their own organisation Spreading and fostering good practice 19

20 Update on CQC themed inspection programme Published Diabetes care pathway Cracks in the Pathway (Dementia) Complaints matter Publish by the end of Q1 2015/16 MH crisis care Safety in hospitals People s involvement in their own care Ongoing through 2015/16 Integrated care for older people Diabetes care in community settings End of life care Neonatal care Urgent care 20

21 Discussion How should CQC examine how people receive integrated urgent care? What do we mean by integrated urgent care? What do we know about the variation in outcomes for people receiving urgent care? How do we measure this? What does good integrated urgent care look like?

22 The CQC s approach to regulating urgent care Ruth Rankine Deputy Chief Inspector for Primary Care CQC

23 NHS Confederation Urgent and Emergency Care Forum Ruth Rankine Deputy Chief Inspector of General Practice & Integrated Care 25 March

24 Objectives for today To share with you: The role of CQC CQC s new approach to inspecting and regulating urgent care Emerging themes from NHS 111 consultation CQC s developing approach to integrated urgent care To hear your views on: The assumptions and principles underpinning the proposed approach to inspecting and regulating urgent care 24

25 Our purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Our role We 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. We will be a strong, independent, expert inspectorate that is always on the side of people who use services. 25

26 Our new approach 26

27 Our Key Questions Safe? people are protected from abuse and avoidable harm Effective? people s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence Caring? staff involve and treat people with compassion, kindness, dignity and respect Responsive? services are organised so that they meet people s needs Well-led? the leadership, management and governance of the organisation assure the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture 27

28 What are we doing differently? Inspection teams of specialist inspectors, supported by specialists and clinicians Introductions of ratings - telling people whether services are Outstanding, Good, Require Improvement or are Inadequate Strengthening our intelligent monitoring of providers using nationally held date and local intelligence New ways of gathering patient views both before and during inspection Develop a clear approach to responding to inadequate care and use our enforcement powers (including cancellation of registration & prosecution) where necessary 28

29 Inspecting and regulating urgent care Our approach to regulating and inspecting urgent care will include: Inspections of individual providers of urgent care GP practices, GP Out-of-Hours, NHS 111 etc - either as a standalone inspection or as part of a combined provider inspection Inspections of integrated urgent care 29

30 What we re doing now Service/ provider type Acute Trusts Ambulance Trusts Minor Injury Units/ Urgent Care Centres/ Walk-in Centres NHS 111 services GP out-of-hours providers Social care providers Community pharmacies Approach to date Urgent and emergency care is a core service in inspections. Consultation on the inspection methodology and piloting. Inspect 111 and urgent care services with ambulance services. Provider of these services may be acute, community or primary care. Inspect these services at the same time as we inspect other services they provide. Consulting and piloting new approach. Approach developed and inspecting. Urgent and emergency aspects of these services are included within the inspections of adult social care providers. Inspected and regulated by the General Pharmaceutical Council. Considering how we can work more closely together with them in our approach to inspection across a system 30

31 Timeline for NHS 111 regulation February 2015: Launched consultation on approach to 111 services March 2015: Pilot inspections of NHS 111 services (3 providers) Evaluation of pilot inspections and feedback from consultation May to June 2015: Launch of final NHS 111 inspection methodology 31

32 Timeline for urgent care regulation February to September 2015: Develop approach to inspecting urgent care pathway/integrated urgent care September 2015: Pilot inspection of urgent care pathway/integrated urgent care 32

33 NHS 111 consultation latest CQC is mid-way through a public consultation on methodology for regulating and inspecting NHS 111 services We are seeking feedback on proposed approach including key lines of enquiry and prompts for inspection teams, gathering service user views, and observing quality of care CQC are testing the proposed approach in three pilot inspections of NHS 111 providers The consultation closes on 24 th April we encourage your participation 33

34 Research For CQC s new approach to be credible with the public, it is essential that the features of the service it inspects and rates reflect public expectations CQC commissioned Research Works to help understand what service users think good looks like in urgent care and NHS 111 These include Fast access to care and treatment, follow up care and information. Managing patient expectations was a consistent priority Confidence in staff experience and expertise (with concerns raised when NHS 111 staff appear to be reading from scripts ) Good patient handling, staff demonstrating compassion and respect as well as taking the time to listen 34

35 Integrated care the case for change The Care Quality Commission (CQC) recognises: Health and adult social care should be designed around a person s individual needs and not focused on organisational structures, as these do not represent the reality of experience. As the regulator for health and adult social care, we support this vision for improvement. (David Behan, Chief Executive, Care Quality Commission, 10 th March 2015)

36 Defining integrated care There are multiple ways of defining Integrated Care Population groups Features of care By organisation By outcomes Frail older people Personalised GP Practices Better citizen experience People with LTC Case managed Acute hospitals Lower Costs

37 Defining integrated care the National Voices definition: I can plan my care with people who work together to understand me and my carer(s), allowing me control and bringing together services to achieve the outcomes that are important to me This definition of integration works well for long term conditions. We need to a definition that fits urgent care equally well. Source: National Voices Narrative for Person-centred Coordinated Care

38 Barriers to integrated care It is important that we break down real and perceived barriers to integrated care: Regulatory Provider regulation Quality regulation Financial Payment Systems Contractual limitations Fragmented Budgets Cultural Lack of compelling evidence base

39 Vision for the regulation of integrated care Current situation Future vision

40 Towards a national framework for the regulation of integrated care CQC s vision for the future: A regulatory system which is person-centred (as it demands of providers) and assesses quality of patient care in a holistic way (the way patients actually experience their care) A regulatory system which assesses the interfaces and gaps in a patients journey as much as it looks at the individual interactions A regulatory system which actively encourages providers to work together for the benefit of patients and not just their own organisation Spreading and fostering good practice 40

41 Update on CQC themed inspection programme Published Diabetes care pathway Cracks in the Pathway (Dementia) Complaints matter Publish by the end of Q1 2015/16 MH crisis care Safety in hospitals People s involvement in their own care Ongoing through 2015/16 Integrated care for older people Diabetes care in community settings End of life care Neonatal care Urgent care 41

42 Discussion How should CQC examine how people receive integrated urgent care? What do we mean by integrated urgent care? What do we know about the variation in outcomes for people receiving urgent care? How do we measure this? What does good integrated urgent care look like?

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