4 CM/03/15/04 Chief Executive s report to the Board

Transcription

1 MEETING PUBLIC BOARD MEETING Date 25 March 2015 Agenda item Paper Number Item title Author Sponsor 4 CM/03/15/04 Chief Executive s report to the Board Naomi Paterson Chief Executive PURPOSE OF PAPER: This is a paper for the Board to note. Introduction The report this month provides an update on the following matters: 1. Update on recruitment 2. Update on staff development and the Academy 3. Responding to information of concern: safeguarding 4. Update from the Adult Social Care Directorate 5. Update from the Primary Medical Services and Integration Directorate 6. Update from the Hospitals Directorate 7. GP Intelligent Monitoring 8. Freedom to speak up review 9. Savile: Kate Lampard s Lessons learned report 10. Bill Kirkup s report of the Independent Morecambe Bay Investigation 11. Memoranda of Understanding with Monitor and with TDA 12. CQC progress feedback discussions 13. Scheme of delegation 1. Update on recruitment The new approach of tailored recruitment activity continues to prove successful. As at Friday 13 March we had made 256 offers against the target of 300 inspectors by 30 April, and 29 offers to new Inspection Managers. There is a pipeline of approximately 300 applicants going through the recruitment process. Page 1 of 11

2 A new online recruitment service is in place. The new service will improve our ability to analyse recruitment conversion rates and assess the effectiveness of campaigns in order to continuously improve the process. We have worked with new suppliers to review our candidate recruitment assessment exercises. Assessment material has been refreshed and tailored for Inspection Managers (for all sectors) and for Pharmacist Specialists and further roles will follow. We are working with our new attraction partner, TMP, to develop campaigns for Intelligence and Hospitals directorates. We will then undertake a six-week pilot to test a more targeted and creative approach in these areas. Work is also underway to review the end to end recruitment, welcome and induction process. This will ensure the process is seamless, efficient and effective. It will also ensure there is an aligned set of candidate information to measure progress and focus efforts in the right sectors and geographic areas. 2. Update on Staff Development and the Academy The online Education and Development ( ED ) system continues to develop. So far 83% (2646) of registered users have accessed the system. Currently 18 inspectors are in the process of completing dental methodology training in line with the fresh start work within the Primary Medical Services Directorate, with a further 82 to be trained. A total of 112 new inspectors have completed the new six week role specific induction programme designed to equip inspection staff with the skills to effectively undertake inspections for the Commission, and a further 43 are currently undertaking the programme. The Academy are currently providing the following programmes: Mental Capacity Act Level 2 Core Competency Training; Enforcement Level 1 e-learning (available for all staff via the ED system); Enforcement Level 2 (face to face training for regulatory staff); Fit and Proper Person Requirement e-learning; and Duty of Candour e-learning (both of which have so far been targeted at staff in the Hospitals Directorate and some colleagues in Registration) 3. Responding to information of concern: Safeguarding We have previously discussed the data quality concerns around the performance data against the Key Performance Indicators (KPIs) for responding to safeguarding information. At the last Board meeting I confirmed I was holding a meeting to agree an appropriate way forward. That meeting has now taken place and the following actions either arise or are confirmed. The current KPI The safeguarding record in CRM (CQC s Customer Relationship Management system) was designed to be an accurate audit trail of the actions we took in response to safeguarding information. It is therefore a record of actions taken, once the action has been completed. It was designed before CQC had a timeliness KPI and it is now apparent that using the safeguarding record to capture real time Page 2 of 11

3 timeliness of response (which is not what is was designed for) is causing significant data quality issues. In the CRM record, inspectors can record one or more of several actions: No CQC action required; No action taken; Discussed with the (Local Authority) safeguarding team; Contacted the provider; Noted for the next inspection; Strategy meeting held; Management Review Meeting held; Inspection brought forward; Responsive Inspection; Enforcement action. Some of these actions can be completed within 24 or 48 hours - especially the first few listed. But several cannot be competed in 24 hours, so even if action is underway, the Inspector rightly would not tick that the action has been completed. From a KPI perspective, this will be recorded as no action specified and could imply that the inspector hasn t considered the information, when the reality is that the inspector is in the process of taking appropriate action, but the action is not yet complete. This helps explain why there have been some many cases with no action specified but audits had suggested inspectors were acting on the information received. In general, the more concerning the information, the more time it will take to complete the action in full, if for example it involved a focussed inspection or enforcement action. We could amend the record so inspectors record what action they were intending to take, but this would undermine the accuracy of the audit trail of the safeguarding record and be at odds with recommendations in some internal root cause analyses, such as that in relation to Orchid View. Given the actions that inspections can take in response to safeguarding can in many places rightly take more than 24 hours, the current KPI, and how it is measured, is not appropriate and the KPI will be replaced with immediate effect by new measures, set out below. The way ahead New Responding to Concerns Programme A review of our current processes and systems for CQC's handling of people's concerns about poor care was undertaken as part of the Complaints, Concerns and Whistleblowing Programme during 2014/15. This review included safeguarding. As a result a new programme focused on improving the experience of people bringing us their concerns, and how we handle that information more effectively, is launching in April The Complaints, Concerns and Whistleblowing project is leading a piece of work to fundamentally change how CQC receives and processes any piece of information of concern, primarily focussing on the initial triage of information for onward action. Later this summer, we will pilot a new decision making tool to support triage of all information received by our National Customer Service Centre (NCSC), allowing Inspectors to respond in different timeframes to different levels of risk that the information presents. Once a new system is tested and ready for delivery, a new KPI should be develop that can be show the timeliness of response and action taken as a result of information of concern including safeguarding. This would be available at the earliest for April Better performance information now Page 3 of 11

4 We cannot wait until April 2016 until we have effective performance data for safeguarding. With immediate effect, we will change how we report activity on safeguarding to show: NCSC performance against its Service Level Agreement (SLA), to show the percentage of safeguarding alerts and concerns that were sent to the inspector within one or two days respectively. This will allow the Board to hold the Executive Team to account for ensuring inspectors receive the information as quickly as possible. Timeliness of inspector action against all of the possible actions that can be taken and recorded. So instead of reporting against a single performance threshold of 95% to be actioned within one day, without reference to the type of action taken, we will show the following: No CQC Action Required No Action Taken (the inspector has specified that no action needs is to be taken) Referred to Safeguarding Authority Noted for Next Inspection Discussed with Safeguarding Team Contacted Provider Strategy Meeting Management Review Meeting Held Inspection Brought Forward Responsive [Focussed] Inspection Enforcement Action No Action Specified (the inspector has not specified whether any action has been taken) 0-1 Days Days Days Days 31+ Days Date Disparity TOTAL For the April to July 2015 period, we will report to the Board using the above table. We will use this three month period to analyse the collected performance data to understand what the appropriate performance expectation should be for timeliness for different types of action, and from July we will report against those agreed performance expectations. This information can be presented at CQC, sector, regional, hub, team and individual level to support effective management action throughout the organisation. Page 4 of 11

5 In parallel to changing the performance information, we are also taken forward other action to improve the quality of that data we report with: Referred to safeguarding authority : this action is recorded on different page of the safeguarding record, and up until now it has not been captured within the KPI data. Referring the information to the safeguarding authority (the Local Authority) is an appropriate first action, especially with safeguarding alerts where we are the first statutory body to be made aware of the potential harm. We are amending the performance reporting to include this action, and this will be complete by the end of March. CRM safeguarding training for all inspectors: Sector Support colleagues will be holding training for all inspectors on how to record safeguarding properly and the requirements of the new performance measures. This will include making it clear to inspectors that they should record individual actions as they are completed and not wait until the overall record can be closed before completing actions on the record. For example, if an inspector plans to hold Management Review Meeting (MRM), it is very likely that they will speak to the local safeguarding authority and/or the provider before any MRM (so the MRM attendees have accurate and full information). Inspectors should record that they have spoken to the provider and the safeguarding authority in advance of the MRM, and then later record that a MRM was held when that is complete. These seminars started in week commencing 16 March 2015 and the whole programme of training will be complete by end of April. We will also ensure by the start of April 2015 that the role specific training for new inspectors reflects this intended practice too. Date disparity: although a smaller number of the overall cases, we are making technical changes to the system to address date disparity, where the disparity arises from how two different parts of the system capture dates and time. This will be completed by the end of April I have written to the three Chief Inspectors to reinforce that leaders and managers within the Inspection directorates need to ensure that their teams are responding to information of concern in a timely way, and with appropriate actions and next steps identified and taken. 4. Update from the Adult Social Care (ASC) Directorate Adult Social Care Ratings Since 1 October 2014, the Adult Social Care (ASC) Directorate has carried out over 3,700 comprehensive ratings inspections across community based adult social care services, hospice services and residential social care services and has published ratings for over half of these. As of 16 March 2015, ASC has rated 18 locations as Outstanding, 1,108 as Good, 547 as Requires Improvement and 149 as Inadequate. These ratings follow on from the launch of our new style inspections and ratings system in October 2014 assessing whether people using the services are receiving services that are safe, caring, effective, responsive and well-led. Registration Improvement Page 5 of 11

6 The Board will be aware that the Registration Improvement Project will continue as part of our transformation programme into building upon the work we have done to date to implement the new regulations from 1 April Progress and plans for registration are set out below. Registration is the first step to protect people who use services from poor care if a provider cannot satisfy us that they will meet the fundamental standards of care, we will propose to refuse their application. We are introducing a more thorough test for individuals, partnerships and organisations applying to provide care services. This includes making sure that named directors of a service commit to meeting the requirements and standards set out in the legislation as stipulated in the new regulation including the Fit and Proper Persons Requirement (Directors). We are also updating our tools, forms and guidance to ensure we are effectively introducing the changes to the Health and Social Care Act for 1 April We are laying the groundwork so that we can make the application process more streamlined through the use of online accounts. Our focus will be on the robustness and effectiveness of the registration system, in a way that is responsive to innovation and encourages provision of good care services. Also for 1 April, the structure and content of our external website is changing to ensure providers have clear guidance and a better understanding of the standards they need to meet. We will develop this further so that it provides good signposts to sector specific good practice guidance as well as videos from providers and users of service to give a clear steer on the standards we expect from those applying for registration. As well as improving the user experience we are hoping this will improve the quality of applications we receive and deter opportunistic applicants. On 18 March we are introducing new registration application and registration variation forms for providers with the new forms taking into account the changes to regulations, including the introduction of the fundamental standards, to go live from 1 April. The forms are available to give providers time to start to apply for variations to their registration or to register a new service in advance of 1 April and arrangements are in place to ensure the smooth transfer from the existing forms currently used. We are also focussing on the development of a structure that supports expertise development more closely aligned to provider type and inspectorates. All staff are undertaking fundamental skills training which will be closely followed by specialist specific training over the next year. We continue to provide greater scrutiny to applications from providers of learning disability services and need to make sure that we respond to the agreements we made in the Sir Stephen Bubb s report in respect of deterring market entry from providers where the model of care does not support smaller, community based services. We will be working with policy colleagues to further develop this work. Within CQQ we are strengthening the links between registration and inspection teams and have identified lead managers to be the link with the three directorates. 5. Update from the Primary Medical Services and Integration Directorate (PMS) Page 6 of 11

7 The Primary Medical Services (PMS) Directorate continues with its inspection programme. Since 1 October to the time of writing PMS has completed over 1000 comprehensive ratings inspections of which we have published 356 inspection reports. These include general practices, out of hours services and urgent medical providers. We have rated 11 practices as Outstanding and 10 Inadequate of which 6 have been placed into special measures. We have also rated 297 practices as Good and 38 as Requires Improvement. Our Dentistry wave inspections are nearing completion and PMS will go live with new methodology inspections from 1 April We continue to develop our new methodology inspections for health and justice, urgent medical care including 111 and independent care. We are continuing with our recruitment campaigns supported by HR and to date we have offered positons to 25 inspectors candidates and six children s inspectors candidates; we are continuing with interviews for inspection managers and shortlisting applications for more inspectors and pharmacy specialists. 6. Update from the Hospitals Directorate The Hospitals Directorate inspection programme continues as planned. We have now inspected well over half of all acute hospital trusts and foundation trusts and over a third of all mental health and community trusts. Pilot inspections of independent health hospitals continue, although these are not being rated as yet. As Board members will be aware we recently published the report of a comprehensive inspection at Whipps Cross Hospital undertaken in November We had previously inspected Barts Health NHS Trust (including Whipps Cross Hospital) in November 2013 as one of our wave 1 inspections. The Trust had not been rated at that time, but significant concerns regarding quality and safety were reported. At the November 2014 inspection serious failings in quality, safety and leadership at Whipps Cross were identified and the Trust and NHS Trust Development Authority (TDA) had been notified immediately. Our final report rated the Whipps Cross location as Inadequate overall, with ratings of Inadequate for urgent and emergency services, medical care, surgery, children and young people s services, end of life care and outpatients and diagnostic imaging. As a result, Mike Richards wrote to the TDA asking them to consider urgently whether the trust should be put into special measures. TDA have now taken this action. Reports on the Royal London and Newham Hospital locations and a provider report on Barts Health are scheduled for publication in April Aside from the inspections, engagement with a wide range of stakeholders has been a feature of the past month. Mike Richards has met with or given presentations to colleagues at NHS Clinical Commissioners, NHS Providers, NHS Confederation and the Royal College of Physicians. He has also co-chaired the reestablished National Quality Board with Sir Bruce Keogh and contributed to the Cancer Taskforce and the Cosmetics Interventions Advisory Board, as well as giving evidence to the Public Administration Select Committee. Reports published since last Board meeting: 25 February Southern Health NHS FT Requires Improvement 10 March Ashfield and St Peters NHS FT Good 17 March Whipps Cross Hospital Inadequate 19 March Sussex Community NHS Trust Good Page 7 of 11

8 7. GP Intelligent Monitoring The internal audit of our external facing analyses and lessons learned exercise for GP Intelligent Monitoring have been completed and were presented to the February meeting of the Regulatory Governance Committee (RGC). We will be discussing some key next steps for the GP Intelligent Monitoring tool with the new GP Intelligence Expert Advisory Group on 26 March, and will be in a position to provide a full report on progress and stakeholder views to the April Board meeting. 8. Freedom to speak up review Over the next three months, the Department of Health is seeking views from the public on how it proposes to take forward the recommendations set out in Sir Robert Francis QC s Freedom to Speak Up review, which was published last month. The independent review set out ways for organisations and individuals to create a more open and honest reporting culture across the NHS. While we know that some services report on people s concerns as a matter of routine, sadly this is not happening all of the time, which means that vital information about patient safety is being missed. The review set out a clear need for change, which CQC supports. Within the review, there is a recommendation for a new role of National Independent Officer to be created, who amongst other duties, would be responsible for reviewing the handling of concerns raised by NHS workers against best practice, and support freedom to speak up guardians who would be based within every NHS trust in England. Part of the Department of Health s consultation now considers whether this national role should be based within CQC. If it is, we would create the role within CQC in the same way that the review recommends every NHS trust to appoint its guardians, so that we can model what services are expected to do. We would also discuss how to take this forward with our partners, including Monitor, the NHS Trust Development Authority and NHS England. Full details about the Department of Health s consultation are available on its website. 9. Kate Lampard s Lessons learned report Kate Lampard s report on the lessons learnt from the investigations carried out in response to the abuse carried out by Jimmy Savile in various NHS acute settings, was published on 26 February The report has recommendations for NHS Trusts. The Report identifies the following themes: Security and access arrangements The role and management of volunteers Safeguarding Page 8 of 11

9 Raising complaints and concerns by staff and patients Fundraising and charity governance Observance of due process and good governance In her report Kate Lampard concludes that that it would be wrong to consider the Savile case as exceptional, a unique result of a perfect storm of circumstances, as the evidence gathered indicates that there are many elements of the Savile story that could be repeated in the future. Kate also comments that there is now much good practice in areas that were a concern but that practice is still very varied. The report makes a total of 14 recommendations for NHS Trusts. The Government has asked Monitor and the TDA to ensure that all NHS Trusts review their current practice in three months against these recommendations, and to report back on their plans and progress against each recommendation. CQC are asked to assure compliance against eight of these recommendations. As part of the inspections undertaken by the Hospitals Directorate we already ask about safeguarding in each of the core services we inspect, and report this under a separate subheading within safety for each core service. In practice the focus tends to be on understanding of safeguarding and on uptake of safeguarding training, which varies widely. Kate Lampard s report has led us to consider wider issues related to safeguarding. Our plan is to interview whoever is the executive lead for safeguarding (usually the Director of Nursing) to ask about the overall governance in this area. This would include questions about oversight of volunteers, celebrities and other groups identified by Kate Lampard. We will almost certainly also ask a generic question about action taken in the light of the Lampard report on Jimmy Savile. This will then be reported under the Are services safe? section of the provider report. The Government has accepted all the recommendations in principle, except the recommendation for enhanced DBS checks for all volunteers. 10. Dr Kirkup s Report of the Morecambe Bay Investigation Dr Kirkup s report into the management, delivery and outcomes of care provider by maternity and neonatal services at the University Hospitals of Morecambe Bay NHS Foundation Trust (UHMB) from January 2004 to June 2013 was published on 3 March In CQC s statement I reiterated the apology made to the families for CQC s regulation of the Trust not being as robust as it should have been and for missing opportunities to intervene to prevent poor care. We welcome the positive comments made about CQC now, including the significant progress in the way we regulate hospitals. What happened at UHMB has contributed to the changes and improvements we have made and continue to make. CQC will check on those relevant recommendations aimed at the Trust at the next inspection. Work is underway to take forward those recommendations relevant to CQC. Dr Kirkup s report is available here. Page 9 of 11

10 11. Memoranda of Understanding We have updated our Memoranda of Understanding with both Monitor and the NHS Trust Development Authority (TDA). The agreements will be available on CQC s website. 12. CQC progress feedback discussions Since January, I have had a number of telephone conversations and meetings with key health and social care leaders to discuss their views about CQC. The purpose of these discussions is to seek feedback on: what has CQC done well; what has is done less well; what does it need to continue doing; what should we stop doing; and what should we improve? To date I have had 12 conversations with a range of colleagues including Presidents of some of the Royal Colleges; the Chief Executives of social care Trade Associations; a think tank; professional associations such as ADASS and NHS Confederation; Ambulance Service Chief Officers. I have also asked similar questions in the routine meeting I hold with the senior leadership of key partner organisations. More calls / meetings are booked over the next few weeks. Feedback has been positive about the progress that has been made in changing the approach to regulation; the new methodology is well received, and as more services experience the new methodology this feedback is increasingly positive. The five questions are seen as relevant. There is acknowledgement that there is a strong, focussed leadership team. The organisation is seen as open and transparent. The adult social care sector wants to see an effective, competent regulator. They have longer experience of regulation and are pragmatic in their approach. The regulation of acute, community and mental health is less developed in England, with the regulation of primary medical and dental services having a much more recent history. One President of a Royal College said that It is increasingly recognized how necessary you (CQC) are. There was universal praise from the adult social care sector for the approach that has been taken to co-production, with Andrea Sutcliffe being mentioned by everyone I have spoken to in the adult social care sector for her leadership and engagement. We feel listened to and engaged for the first time was a quote for the Chief Executive of a Trade Association. Another said they felt they felt they had an open line to Andrea. The sense of progress was mentioned across the range of health and care providers. Area for development flagged in these conversations included: the gap between the vision for regulation and the experience of being regulated on the ground, whilst Page 10 of 11

11 getting smaller, nevertheless still exists; the production of reports following inspections takes too long; consistency is improving, but the trade associations in particular pick up concerns. There is great interest in where regulation is going the think tank was interested in both the impact and effectiveness of regulation and what the next phase of CQC s development will bring. There is still a question for some as to whether the benefits of regulations have been evidenced and articulated. There is a question as to how special measures will work in practice in social care. These have been rich conversations which can help inform the progress we are making as well as lead to improvements in our approach. These conversations continue. 13. Scheme of delegation The Scheme of Delegation has been reviewed by the Executive Team on 17 March 2015 and an updated version will apply from 1 April. There are two main changes which have been made. Firstly, we have included the key decisions that relate to our new market oversight responsibilities which take effect from 6 April. Most of these decisions will be taken by the Director of Market Oversight when appointed there is a separate item on the agenda regarding market oversight work. Secondly, the Scheme now reflects delegation of the majority of financial decisions from the Executive Director of Customer and Corporate Services to the Director of Financial, Commercial and Infrastructure and other new roles in the Finance structure. We have also taken the opportunity to make a number of minor amendments which were necessary to reflect current roles and their responsibilities within the organisation. The Board is asked to note these items. Name: David Behan Title: Chief Executive Date: 17 March 2015 Page 11 of 11