Grose Head of Healthcare 01202 786163 petergroselalawcom CQCs New Regulatory Approach The Turn of the Screw Is the sector one horror after another Over these last 30 years it feels to me that we have stumbled from crisis to crisis from one Panorama programme to the next fro ID: 443750
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Slide1
Peter GroseHead of Healthcare01202 786163peter.grose@la-law.com
CQC’s New Regulatory Approach: The Turn of the ScrewSlide2
Is the sector one horror after another?
“Over these last 30 years, it feels to me that we have stumbled from crisis to crisis, from one Panorama programme to the next, from inquiry report to inquiry report.”
JRF – John Kennedy’s Care Home Inquiry October 2014Slide3
October 2014: CQC Begins to Turn the Screw
“There is much excellent care but the variation in the quality and safety of care in England is too wide and is unacceptableSafe services occur where effective leadership builds a culture of safety
By looking at CQC’s reports on outstanding and good care, other services can learn and improveCQC’s ratings provide transparent information that allow people to make choices”
CQC Fifth Annual Report October 2014Slide4
The Turn of the SCREWSafe?
Caring?Responsive?EffectiveWell led?
The ‘Five Questions’ now form the basis of CQC’s new operating modelSlide5
CQC’s New Operating ModelProvider Handbook: ‘
How CQC regulates Residential Adult Social Care Services’ March 2015Registration – more rigorousIntelligent Monitoring
Provider Information ReturnFeedback from service users and the publicInspection by experts
Ratings
Holding poor care providers to account,
eg
direct focus on directors; “Special Measures”Slide6
Inspections and KLOESProvider Handbook Appendix A
16 mandatory KLOES, each with “prompts” spread across the five questionsWill inspections be more professional?Slide7
RatingsOutstanding; Good; Requires Improvement; InadequateLegal requirement to display rating prominently: CQC Template
Characteristics: set out in Appendix B of Provider Handbook“We need to be as consistent as we possibly can so that our ratings are reliable and provide accurate information. This will also help reduce the number of requests for review.” CQC Provider HandbookSlide8
Ratings PrinciplesLevel 1 – rating for each key question; Level 2 – aggregate overall location rating
Outstanding – two Os and three GsGood – only one RIRequires Improvement – two RIs
Inadequate – two IsSlide9
Limiters on RatingsThere will always be a rating of “Requires Improvement” if:
No registered manager and no satisfactory steps to recruit within a reasonable timescaleOther conditions of registration not met “without good reason”Not returning PIRSlide10
Inspection Frequencies“Subject to available resources within the following periods”:
Outstanding – two yearsGood – 18 monthsRequires Improvement – 12 monthsInadequate – 6 monthsSlide11
Challenging Ratings
Factual accuracy check (and completeness of evidence)Warning Notice – representations that are upheld may improve ratingRequest for rating review:only ground is that inspector did not follow published process for making ratings decisionc
an only be made when report is publishedsingle opportunity for review
r
eview conducted by inspectors not involved in original inspection with access to independent reviewer
noted on CQC website entry
Parliamentary and Health Service Ombudsman
Judicial reviewSlide12
New Regulations and Fundamental StandardsCQC ‘
Guidance for providers on meeting the regulations’ March 2015HSCA 08 (Regulated Activities) Regulations 2014In force for private healthcare and social care providers from April 2015Contains 11
Fundamental Standards plus:Fit and Proper Requirement for Directors
Duty of
CandourSlide13
Criminal Offences – Part 1Prosecution
without warning notices for certain offences:Reg
11 - Consent to care and treatmentReg
16(3) - Receiving and Acting on Complaints
-
Summary to
CQC within 28
days
Reg
17(3) - Good governance - Report to CQC within 28
days
Reg
20(2)(a) - Duty of Candour - Duty to inform re notifiable safety
incidents
Reg
20(3) - Duty of Candour - Notifications must meet specific
requirements
R
eg
20(A) - Requirement to display Performance AssessmentSlide14
Criminal Offences – Part 2CQC
can prosecute for the following offences, but only if the breach of the regulation results in people who use services being exposed to avoidable harm, a significant risk of such harm occurring or suffering a loss of money or property as a result of theft, misuse or misappropriation:Regulation 12 Safe care and treatment
Regulation 13 (1) to (4) Safeguarding
service users from abuse and
improper
treatment
Regulation
14
Meeting
nutritional and hydration needs
For
breaches of the remaining regulations not listed on these slides, CQC can take regulatory action other than prosecution
.Slide15
Criminal Justice & Courts Act 2015
S.20….ill treatment or wilful neglect: care worker offenceS.21….ill treatment or wilful neglect: care provider offenceS.21 Ill-treatment or wilful neglect: care provider offence
(1) A care provider commits an offence if-
(
a) an individual who has the care of another individual by virtue of being part of the care provider’s arrangements ill-treats or wilfully neglects that
individual
(
b) the care provider’s activities are managed or organised in a way which amounts to a gross breach of a relevant duty of care owed by the care provider to the individual who is ill-treated or neglected, and
(
c) in the absence of the breach, the ill-treatment or wilful neglect would not have occurred or would have been less likely to
occur
Penalties:
Fine
Remedial order
Publicity orderSlide16
Good GovernanceRegulation 17
Systems and processes to assess, monitor and improve quality and safety of services provided inc assessing and reducing riskEvaluate and improve practice re processing information relating to the above
Produce a report to CQC on demand within 28 daysSlide17
Duty of CandourRegulation 20
CQC states “significant room for improvement in under-reporting incidents and failing to learn from things that go wrong” Breach
will be used “to encourage good practice through ratings” rather than prosecutionNotifiable Safety Incidents: death; physical or mental impairment 28 days; prolonged pain or psychological harm; shortening of life expectancy
Providers must:
Inform the person and provide reasonable support as soon as reasonably practicable
Provide a true account of the incident on the facts provider aware of
Advise on further enquiries
Offer an apology
Written notification including details of enquiries to be undertaken and an apology
Keep a secure written
record - produce to CQC on demand within 28 daysSlide18
Fit and Proper Requirement for Directors Regulation 5
Currently corporate “fitness” assessed by testing the fitness of the “nominated individual”From April 2015 all directors (inc non-execs and trustees) will be held accountable if care standards failCQC will be able to exclude from office those responsible for “
serious misconduct or mismanagement (whether unlawful or not) in discharging any office or employment with a registered provider”CQC will require Chairman to confirm fitness of all directors as above and sign a declaration
Enforcement through imposing conditionsSlide19
And finally…..The Five Questions demand greater professionalism from Providers and Inspectors
Cost: higher inspection feesRatings: commercial consequences of a lower rating; purchase a re-inspection?Time is limited for inadequate providersSurveillance?Slide20
Thank youPeter
Grose01202 786163peter.grose@LA-law.comwww.lester-aldridge.co.uk
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