Changing the
way CQC
regulates,
inspects and
monitors care
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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 and expert inspectorate that is
always on the side of people who use services
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Adult social care vision
The Mum Test
Is it
effective?
Is it
well-led?
Is it responsive to
people’s needs?
Is it
safe?
Is it
caring?
Is it good enough for my Mum?
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Our new approach
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Mental Capacity Act and
Deprivation of Liberty Safeguards
Duty to monitor the use of the Deprivation of Liberty
Safeguards
Inspect and report on services’ approach to meeting the
Mental Capacity Act code of practice
In particular, we look at how and when capacity is
assessed and how decisions are recorded in compliance
with the Mental Capacity Act
Included in our prompts and descriptions of ratings for
safety, effectiveness and caring
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Making the Mum Test Real
Communication
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What will be different?
Now
Future
Risk based model
More targeted
Caseloads
More manageable
Making judgements
Enforcement when
needed
Publishing our
findings
Ongoing monitoring
On the 5 key
questions
Commitment to
taking firm action
Clearer reports
Better information
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Timetable
Oct 2013 –
March 2014
April
2014
Co-production and development to
shape consultation proposals
Consultation on regulatory approach,
ratings and guidance
4 June:
Consultation
closes
April –
Wave 1 pilot inspections
May 2014
June
2014
Evaluation; guidance and standards
refined.
July –
Wave 2 pilot inspections and
Sept 2014 initial ratings of some services
Oct
2014
New approach fully implemented
and indicative ratings confirmed
March
2016
Every adult social
care service rated
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Inspection principles
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What will be different?
Intelligent monitoring
Provider information return
Questionnaires – community services
Sharing information with external partners
Inspections
6 months – 2 years
Tailored inspection teams
Increased use of experts
Experts by Experience
Specialist Advisors
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Our key questions and key lines
of enquiry
We will no longer focus solely on whether providers
are compliant or non-compliant with regulations
Our focus is on the five key questions about
services:
Is it safe?
Is it effective?
Is it caring?
Is it responsive?
Is it well-led?
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Principles for our key lines of enquiry
For each of the five key questions there are mandatory key lines
of enquiry
There will be additional key lines of enquiry based on:
An inspector’s knowledge of the service
Information available
The inspectors professional judgement
They support consistency of what we examine under the five
key questions and focus on those areas that matter most
Key lines of enquiry are supported by guidance on the ‘key
things to consider’ as part of the assessment – these are
called prompts
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Safe
By safe, we mean that people are protected from abuse
and avoidable harm.
In adult social care, this means that people are supported to make
choices and take risks and are protected from physical,
psychological or emotional harm; abuse, discrimination and
neglect.
Key line of enquiry example:
How are people protected from bullying, harassment, avoidable harm,
abuse and breaches of their human rights?
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Effective
By effective, we mean that people’s care, treatment and
support achieves good outcomes, promotes a good
quality of life and is based on the best available evidence.
In adult social care, this means that people are supported to live
their lives in the way they choose and experience the best possible
health and quality of life outcomes.
Key line of enquiry example:
How are people’s needs and choices for care, treatment and support
met?
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Caring
By caring, we mean that staff involve and treat people
with compassion, kindness, dignity and respect.
In adult social care, this means that people, their families and
carers experience care that is empowering and provided by staff
who treat people with dignity, respect and compassion.
Key line of enquiry example:
How are positive, caring relationships developed with people using
the service?
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Responsive
By responsive, we mean that services are organised
so that they meet people’s needs.
In adult social care, this means that people get the care they
need, are listened to and have their rights and diverse
circumstances respected.
Key line of enquiry example:
How do people receive personalised care that is responsive to their
needs?
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Well-led
By well-led, we mean that 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.
In adult social care, this means that people get the care they need,
are listened to and have their rights and diverse circumstances
respected.
Key line of enquiry example:
How does the service promote a positive culture that is person
centred, open, inclusive and empowering?
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Ratings
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Four point scale
High level characteristics of each rating level
Innovative, creative, constantly striving to
improve, open and transparent
Consistent level of service people have a right to
expect, robust arrangements in place for when
things do go wrong
May have elements of good practice but
inconsistent, potential or actual risk, inconsistent
responses when things go wrong
Severe harm has or is likely to occur, shortfalls in
practice, ineffective or no action taken to put
things right or improve
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How key lines of enquiry and
evidence build towards ratings
Define the
questions to
answer
Key lines of
enquiry
(mandatory
plus
additional
KLOEs
identified
from
information
held)
Gather and record
evidence from all
sources
Intelligent
monitoring
and local
information
On-site
inspection
Preinspection
information
gathering
Speak to
staff and
people
using the
service
Make
judgements
and build
ratings
Apply
consistent
principles,
build
ratings
from the
recorded
evidence
Write report and
publish alongside
ratings
Outstanding
Good
Requires
improvement
Inadequate
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How do we decide a rating?
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To what do we give ratings?
Services will be rated at two levels:
level one - we will use our rating methodology and
professional judgement to produce separate ratings for
each of the five key questions
level two - we will aggregate these separate ratings up to
an overall location rating using ‘ratings principles’
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Principles
The five key questions contribute equally to the overall location
rating. Overall ratings are produced using the following
principles:
If two or more of the key questions are rated ‘inadequate’,
then the overall rating will normally be ‘inadequate’
If one of the key questions is rated ‘inadequate’, then the
overall rating will normally be ‘requires improvement’
If two or more of the key questions are rated ‘requires
improvement’, then the overall rating will normally be
‘requires improvement’
At least two of the five key questions would normally need to
be rated ‘outstanding’ before an overall rating of ‘outstanding’
can be awarded
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Rating limiters
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Other ways to share your views
Consultation: 9 April to 4 June 2014
Get involved:
Web form at www.cqc.org.uk
Twitter @CareQualityComm
Email CQCchanges.tellus@cqc.org.uk
Provider online community:
join at www.cqc.org.uk
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www.cqc.org.uk
Thank you
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