People need health and social care services that are more joined-up and person-centred, says CQC

Services have steadily improved overall but rising demand and pressure on finances make reform essential, says new regulator

The Care Quality Commission today (Wednesday) applauded overall improvements over recent years, as it published its first annual report to parliament on the state of health care and adult social care in England.

But it cautioned that some services were lagging behind the pack and that there were areas of common concern across health and social care, notably keeping people safe and staff training.
CQC pointed out that services would be operating in a different environment in future, with pressure on finances adding to continuing increases in demand and rising expectations. It said that the next big challenge for health and social care is to accelerate efforts to make services more joined up and centred around people's needs.

Its report argues that joining up health and social care can deliver both better care and greater efficiency.

It calls for investment in services that maintain people's independence, by reducing the need for expensive hospital and residential care. For example, up to £2 billion could be saved annually from hospital budgets if each area were able to reduce the number of older people admitted repeatedly to hospital in an emergency, and the number of days these people spend in hospital, to the levels seen in the best performing areas of the country.

Drawing on the richest sources of information available, this is the first time that an independent regulator has looked simultaneously across both the health and social care sectors.

CQC also published a five-year strategic plan today, which sets out what it wants to achieve for people using health and social care services, and how it will go about it.

CQC's interim chair, Dame Jo Williams, said: "Overall, there have been steady improvements and it is really important to celebrate that. Successes have come in areas that really matter to people such as reducing hospital infection rates and helping people live independently at home. But we are mindful of the fact that pockets of poor practice remain. This must be addressed.

Turning to the future, Williams said: "We all know that the context is changing. Trends such as increasing demand and rising expectations will be exacerbated by pressure on finances. That means we cannot go on as we are. To cope, we need some radical changes in the way that we organise and deliver services.

"This means shifting the culture away from a one-size-fits-all approach to care that puts the needs of individuals and carers at the centre of everything. A key part of this will involve helping people maintain their independence and health."

She added: "We hope providers and commissioners of services will seize on the information we are making available and use it to improve care for the people using their services."

The report's main conclusions are:

Overall there has been major improvement, including in areas that really matter to people. Sixty-three percent of NHS trusts, 77% of adult social care providers and 95% of councils were rated ‘good' or ‘excellent' last year. Hospital waiting times in A&E and waits for non-emergency care have been driven down, rates of MRSA and C.difficile have reduced by 34% and 35% respectively compared with the previous year, and reporting of serious incidents to the National Patient Safety Agency has improved greatly from 922,552 incidents in 2007/08 to 1,061,934 in 2008/09. These figures show that organisations have made progress in routinely reporting serious incidents in order to learn and put things right. From 1 April it will be mandatory for all organisations to do so.
More people had access to services that: help prevent unnecessary emergency admissions to hospital (148,000 in 2009, up from 80,000 in 2004); and services that help them return home quickly from hospital (157,000 in 2009 up from 112,000 in 2004). More people are supported to live independently at home, with 2.1% of people aged 65 and over living in care homes in 2009, compared to 2.5% in 2005.

But some organisations lag behind the pack and there are areas in which services frequently struggle to meet standards. The three key areas of concern highlighted by CQC are:

Safety - It is crucial that organisations report their mistakes or near misses (called ‘incidents') so that they can learn and put things right. Despite national progress, the reporting rate of incidents varies significantly across organisations. Although 90% of patient contact takes place at GP practices, only 3,417 incidents were reported in the year to July 2009, compared to 693,700 from hospitals.

Safeguarding (protecting people from harm) - Nine percent of NHS trusts did not comply with the minimum standard on child safeguarding (up from 4%). The vast majority of social care providers fully met standards relating to safeguarding procedures. There were major lapses in only 2% of services but this equates to 383 services.

Workforce training - All types of organisations find minimum training standards hardest to meet, which includes things like basic training on safeguarding, life support and fire safety. In 2009, the standard requiring NHS staff to participate in mandatory training programmes had the lowest overall compliance rate of all standards, varying from 73% in ambulance trusts to 90% in mental health trusts. Eighty-six percent or less of adult social care services (such as care homes and home care agencies), meet minimum standards on training.

Rising demand and pressure on finances make reform essential. A predicted 1.7 million more adults will need care and support in 20 years' time. This comes at a time where public finances will be stretched further. CQC says services must speed up progress in providing joined up care centred around people's individual needs to tackle these pressures. It says this will improve people's experiences, maintain their independence and make care more cost-effective.

It is even more crucial to accelerate efforts to join up care and give people more choice and control by making care person-centred.

Joined-up care - Access to intermediate services that prevent emergency admissions and delayed discharges has improved. But there is an over 30-fold variation in the proportion of people whose discharge from hospital is delayed. Some older people are admitted to hospital as emergencies twice or more each year, which could be prevented if they were cared for better in the community. If each area were able to reduce the number of repeated admissions and length of time these people spend in hospital to that seen in the best performing areas, it would result in an annual saving of up to £2 billion to hospital budgets.

Person-centred care - Person-centred care is more effective because the focus is on the individual's needs and maintaining their independence and health. The government has calculated that up to £2.7 billion per year could be saved by enabling people with long-term conditions, such as diabetes, to manage their conditions better, treating them closer to home and avoiding unnecessary hospital visits. There is some cross-over between this figure of £2.7 billion and the £2 billion saving from reducing hospital admissions highlighted above. This is because the £2.7 billion figure here also incorporates potential savings from avoiding unnecessary hospital visits, and instead helping people with long-term conditions to keep healthy. Therefore the two figures cannot not be added together.

An important part of centring care on people's individual needs and protecting their rights is giving people choice and control to make decisions. To do this people need adequate access to information about their conditions and treatment options. Nearly 99% of NHS trusts and over 80% of social care providers meet minimum standards on making information available. But, 21% of hospital inpatients said they were not given enough information about their condition or treatment, and 29% of people with disabilities using social care services said they were not communicated with in a way that helped them understand everything properly.

In 2008/09, 86,000 adults used Direct Payments from councils, allowing them full control to choose and purchase their own social care. But this accounts for only 4% of the overall gross expenditure on care. In 53 councils fewer than 5% of people receiving care use Direct Payments.
CQC will play its part in driving improvements to make care joined-up and person-centred, but providers should use these findings to drive change. CQC says from 1 April the new set of standards will help to form the foundations for the shift towards joined-up, person-centred care. The new standards are focused on outcomes and put people at the core of how services are regulated.

CQC says it will identify serious issues by responsive and vigilant assessment and where it finds shortfalls in performance, it will act swiftly, using its enforcement powers where needed. This is alongside driving improvements through performance assessment and through special reviews and studies.

The next public meeting of the CQC will be held on 11 February 13.30 - 16.45 at Finsbury Tower 103 - 105 Bunhill Row. London EC1Y 8TG

Board meetings

We hold regular meetings to discuss our work. We welcome people to come along to the meetings to watch and listen. Each meeting's agenda and the papers being discussed will be available to download from our website a few days before the meeting.

Next board meeting

· 11 February 2010 - see papers here:

http://www.cqc.org.uk/aboutcqc/howwedoit/boardmeetings/boardmeetingfebruary2010.cfm

Future board meetings

We are currently working to agree regionally appropriate locations for all these meetings.

2010

· 18 March
· 19 May
· 16 June
· 15 July
· 15 September
· 17 November
· 8 December

2011

· 12 January
· 16 March

CQC Equality and human rights scheme

This consultation sets out how we propose to integrate equalities and human rights in everything we do. We have incorporated what we think are the key equalities and human rights priorities with the early involvement and engagement of people who use services and the staff we employ. We would like you to help us shape the action plans, so please give us your views.

We ask for feedback specifically on:

• our overall approach to embedding equalities and human rights
• our human rights-based approach
• our priorities for action
• our action plans
  

We invite all stakeholders and any other interested parties to feed any comments back to us.
Once finalised, we will ensure that relevant measures, timescales and responsible leads are aligned before we publish the final scheme. We will consult more widely, particularly to engage people who are seldom heard, and we will continue our engagement activity throughout the consultation process, and on an ongoing basis, to ensure that the Scheme is "live" and developed in response to what people tell us.

We will collate and analyse all responses and provide feedback on how the consultation informed the development of the Equality and Human Rights Scheme and its action plans.

Consultation Document

Equalities and human rights scheme consultation document: (PDF, 301KB, opens in new window)
http://www.cqc.org.uk/_db/_documents/EHRS_FINAL__web_2.12.09.pdf

Download a summary of the consultation in alternative formats and community languages:
http://www.cqc.org.uk/getinvolved/consultations/equalityandhumanrightsscheme/alternativeformats.cfm
Supporting Document

Appendix 1: Legislation requirements (PDF, 48KB, opens in new window) http://www.cqc.org.uk/_db/_documents/Appendix_equaity_legislation.pdf
Send us your responses Please send us your responses by 25 February 2010. Respond online

Fill in the online response form (opens in new window)
http://www.cqc.org.uk/_db/_documents/EHRS_FINAL__web_2.12.09.pdf

Send us your responses Please send us your responses by 25 February 2010.

Respond Online

Fill in the online response form (opens in new window)
http://www.cqc.org.uk/_db/_documents/EHRS_FINAL__web_2.12.09.pdf

Respond by email or post

Download the response form (DOC, 708KB, opens in new window)http://www.cqc.org.uk/_db/_documents/Consultation_Questionnaire_EMAIL_02.12.09.doc

Download the response form (DOC, 708KB, opens in new window)
http://www.cqc.org.uk/getinvolved/consultations/equalityandhumanrightsscheme/alternativeformats.cfm

Find out how to order printed copies of the consultation documents
http://www.cqc.org.uk/publications/orderaprintcopy.cfm

Email your completed questionnaire to diversity@cqc.org.uk

Post your response to:
Sue Buker EHRS Consultation
Care Quality Commission
Finsbury Tower
103-105 Bunhill Row
FREEPOST Lon 15399
London
EC1B 1QW

CQC response to the Department of Health review of GP out-of-hours services, published today (Thursday).

The Care Quality Commission’s chief executive, Cynthia Bower, said: “It is absolutely critical that NHS trusts put monitoring of the safety of out-of-hours services higher up their agenda.

“Our work has suggested that the quality of monitoring has been variable.

“The wide-ranging recommendations in this report will help address these concerns. Commissioners and providers of out-of-hours services across the country must implement them swiftly for the benefit of local people.

“CQC’s enquiries into out-of-hours provider Take Care Now are nearing completion. We will be reporting our full findings in due course and we will make further comments on this issue at that time.”

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About CQC’s review of TCN

CQC’s review of out-of-hours care provided by TCN was triggered by the death of Mr David Gray, a patient treated by an out-of-hours locum doctor from Germany who died following the administration of 100mg of diamorphine.

NHS East of England, the strategic health authority, alerted CQC to concerns about GP out-of-hours services provided by TCN.

The CQC announced the scope of its enquiries in June 2009, outlining that it would look at Take Care Now's out-of-hours service. It is focusing on current systems, including contractual and monitoring arrangements between PCTs and Take Care Now, as well as changes made after recent incidents. The terms of reference can be found here:

http://www.cqc.org.uk/newsandevents/newsstories.cfm?widCall1=customWidgets.content_view_1&cit_id=34923

CQC published its early observations in October 2009, following the initial phase of its enquiries:

http://www.cqc.org.uk/newsandevents/newsstories.cfm?widCall1=customWidgets.content_view_1&cit_id=35381

for further information please contact the CQC press office on 0207 448 9401 or out of hours on 07817 232 143.

CQC responds to the coroner’s inquest on the death of David Gray

Responding to the coroner’s inquest on the death of David Gray, Christine Braithwaite, head of investigation and enforcement at the CQC said:

“The death of David Gray was a tragedy. It should not have happened and such an incident must not happen again. The coroner has clearly highlighted what went wrong. Take Care Now, and the PCTs that commission its services, must learn the lessons.

“We are already looking at Take Care Now’s current procedures as part of our review, as well as contractual and monitoring arrangements at the NHS trusts that buy its services. Any relevant information arising from the inquest will feed into our work, and we will of course take the coroner’s views and final verdict into account. Our enquiries are nearing completion, and we will be reporting in full on the findings in due course.”

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About CQC’s review of TCN

CQC’s review of out-of-hours care provided by TCN was triggered by the death of Mr David Gray, a patient treated by an out-of-hours locum doctor from Germany who died following the administration of 100mg of diamorphine.

NHS East of England, the strategic health authority, alerted CQC to concerns about GP out-of-hours services provided by TCN.

The CQC announced the scope of its enquiries in June 2009, outlining that it would look at Take Care Now's out-of-hours service. It is focusing on current systems, including contractual and monitoring arrangements between PCTs and Take Care Now, as well as changes made after recent incidents. The terms of reference can be found here:

http://www.cqc.org.uk/newsandevents/newsstories.cfm?widCall1=customWidgets.content_view_1&cit_id=34923

CQC published its early observations in October 2009, following the initial phase of its enquiries:

http://www.cqc.org.uk/newsandevents/newsstories.cfm?widCall1=customWidgets.content_view_1&cit_id=35381

for further information please contact the CQC press office on 0207 448 9401 or out of hours on 07817 232 143.

CQC Looking for a National Advisor – Child Safeguarding & Wellbeing

Are you a senior professional working in child safeguarding and social care? Put your experience to optimum use. This is a chance to influence best practice in child social care and ensure the public has confidence in the system and processes we have in place to deal with key, high-profile issues.

The Care Quality Commission (CQC) takes a joined-up view of health and social care services. Our job is to protect the interests of all who use these services, particularly people in more vulnerable circumstances. Your knowledge will be vital to shaping our regulatory and realising our vision.

Your wide remit will involve providing high-quality advice on best practice to the CQC Chairman and the Executive Team, as well as influencing decisions on policy and practice at an operational level across the Commission. The role will involve developing partnerships with Ofsted and other national bodies in the field of social care practice regulation and, providing advice at operational level when serious concerns are raised with us. Appointments are initially for one year and we would expect you to work at least one day a week.

You will need considerable professional credibility and a wide network of contacts within child social care. An understanding of the role of regulatory systems and knowledge of the role of healthcare organisations and a track record of influencing improvement will all be essential. Above all, you should able to hold your own in a fast-moving environment that is the subject of national attention.

To apply, please visit www.cqc.org.uk/aboutcqc/jobsatcqc.cfm to download an application form and
job role profile.

The closing date for receipt of applications is 24 February 2010.

We welcome applications from all sections of the Community and are particularly anxious to ensure proper representation in terms of gender, ethnicity, age, religion, sexual orientation and disability.

CQC announces the closure of applications for NHS registration

CQC director of registration Linda Hutchinson said:

'CQC received all the registration applications it had expected by the deadline, except two.

'One has since submitted its application and we are in dialogue with the other and we’re confident their application will arrive soon.

'This represents an impressive achievement on behalf of the NHS, which has worked hard to understand the new legal requirements, get internal assurance including board sign off and make their submissions to a very challenging timetable.'
'Of the 382 trusts that should have submitted an application for registration, at the close of play on Friday, we had received 376.

'Of the six remaining, two were late and one has since submitted (so we now have 377 applications). We're expecting the other this week.

'A further four did not submit applications, with the prior agreement of CQC. This is because they are in the process of transferring registered services (losing services or gaining new registerable services)

'Three are not expected to provide registerable services from 1 April and one trust is expected to apply in February once its new services are in place.'