Improving outcomes for older
people:
Monitoring and regulating
standards
Ann Close 8th June 2011
Overview
• An outcomes focused approach to improvement
• Learning from the DANI programme
• Involving patients in inspecting service – experts
by experience
• Safeguarding vulnerable older people
2
Role of CQC
• Health
and Social Care Act 2008
• Regulation of health and adult social care
• Registration of providers
• Monitoring compliance with essential standards
• Improvement through enforcement action
3
Strategic Priorities
Focus on quality and act swiftly to
eliminate poor quality care
Make sure is centred on people’s needs
and protect their rights
4
The scale of regulated care
Primary medical
services
Independent
healthcare
Independent
ambulances
9,000 providers
1,500 providers
200 providers
NHS hospitals
Adult social
care
Primary dental
care
409 providers
12,500 providers
8,000 providers
Combined outpatients
and inpatients
People using adult
social care services
Dental appointments
77.4 million
1.75 million
36.4 million
Plus additional c700 providers (bodies currently licensed HFEA and HTA)
5
Essential Standards
• Regulations
• Outcomes - 28
• Prompts
- for all providers
- for specific services types
6
CQC’s guidance about compliance:
example of an OUTCOME
Care and welfare of people who use services
OUTCOME 4
What should people who use services experience?
People using the service:
Experience effective, safe and appropriate care, treatment and support that meets their
needs and protects their rights
That is because providers who are compliant with the law will:
Take appropriate steps to ensure people are protected against risks of receiving care or
treatment that is inappropriate or unsafe
Carry out assessment of all needs, including assessments of risk
Plan and deliver care and treatment which meets those needs, ensures safety and
welfare
Delivers care and treatment that reflects published evidence/guidance of good practice
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Outcome 5 Meeting nutritional
needs
Regulation 14 of the Health and Social Care Act
• People who use services are supported to have
adequate nutrition and hydration
Providers who comply will
• encourage and support people to receive
adequate nutrition and hydration
• provide choices of food and drink to meet diverse
needs and make sure food and drink is nutritionally
balanced and supports their health
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Outcome 1 – Respecting and
involving people who use services
Informatio
n
Involved in decisions
Privacy dignity
Independence
respected
Involvement of carers
Diversity, human rights
Values -recognised
Promotion of
independence
Views taken
account of
Support for people and carers
Service users
at centre of care
Encourage being an
active part of community
Involvement on
how services run
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Dignity and nutrition inspection
programme
Significant reports considered
• Still Hungry to be Heard
(Age Concern & Age UK, 2010)
• Listen to the Patient, Speak up for Change
(Patient Association Report, 2010)
• Care and compassion?
(Health Service Ombudsman Report, 2011)
10
Brief
• Request initiated by the Secretary of State for Health –
the request being made under section 48 of the Social
Care Act
• Purpose of the programme is to review the quality of
care in relation to dignity, nutrition and hydration needs
of older people in NHS hospitals
• A 3 month inspection programme to include 100 NHS
acute hospitals nationally
11
Dignity and Nutrition Inspection
review
The inspection team will consist of

a expert by experience

a senior nurse

CQC compliance inspectors
•The results of the inspections will be collated into a national report.
• Reviews follow CQC normal process of compliance review and a
judgement about compliance using the judgement framework will be
made
•Each organisation will receive a compliance report
12
Learning from the DANI programme
- the negative
Nutrition
•People not being given assistance to eat
•Nutritional needs not being assessed and monitored
•People not being given enough to eat and drink
Dignity
•People not involved in own care
•Staff not treating people in a respectful way
•Staff speaking to people in a condescending and dismissive way
13
Learning from the DANI review
- the positives
Dignity
• Polite, sensitive staff – treated patients with respect and kindness
• staff encourage independence but available when needed
• Privacy protected
• Staff explained and gave information
Nutrition
• good choice of food and in sufficient quantities
• Hand wipes prior to meals
• Food hot when served
• Patients encouraged to eat “ see if you can eat a little” “do you like
this?”
14
Involving experts by experience
Patients and nurses
•Added value of different perspective
•Complements generic inspection
•Focus on patients perspective
•Clarity re clinical decisions
•Learning about regulation
15
What do we mean by safeguarding
adults ?
The systems, processes and practices in place to enable
people to live a life that is free from abuse and neglect
through :
• ensuring adequate awareness of issues about the abuse of
adults
• ensuring priority is given to safeguarding people from
abuse
• helping prevent people experiencing abuse in the first place
•recognizing and acting appropriately when there are
allegations of abuse and supporting the person who has
experienced abuse
16
Key concerns about safeguarding
• Confusion about when safeguarding alerts should be made
• What incidents should go through SUI process
• Confusion about notifications
• Lack of preparation re Deprivation of Liberty Safeguards
• Lack of clarity about definitions and concepts
• Insufficient training
• Lack of leadership
• Sporadic engagement across services and sectors
17
Responsibilities for providers for
improving care for older people
Effective leadership at all levels
• Creating right sort of culture
• Ensuring all health care professionals take
responsibility
• Ensuring good practice, high standards of clinical
care, competent staff and effective partnership
working.
• Effective communication and feedback
• Measuring and monitoring performance
• Action and sustained change
•
18
Summary
Most older people receiving care are vulnerable
• Providers are responsible for quality, safe and
effective care.
• Health care professionals have a key role in
protecting older people from unsafe and
inappropriate care
• Essential standards and outcomes are key
measures
• Registration is a basic standard
• Learning lessons from failings is essential
•
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