Focussing on Outcomes: Challenges and Drivers

Marilyn Hansford

Compliance Manager

East Sussex

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Purpose of presentation

• What do we mean by optimum health?

• Outcomes based

• Guiding legislation

• How do we check that requirements are met?

• Quality Risk Profile

• What is a Provider Compliance Assessment?

• Drivers for change

• Quality

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DEFINITION OF HEALTH

W.H.O. IN 1998 famously defined health as a ‘state of complete physical, mental and social well-being, not merely the absence of disease and infirmity’

A holistic view of health takes into account a vast range of interacting factors relating to people and the environment within which they exist.

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THE WHEEL OF HEALTH

David Seedhouse

2002

CQC will work with partner organisations

taking into account the key determinates of

health

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Psychological

Physical Social

Every individual has a life long need for Health and Social

stability

Individuals at times in their lives may have a health and/or social

need that requires a service response

Shape and Form to Health

Psychological

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What is the impact of compromises?

Cancer

Coronary heart disease

Chronic ill health

Poor quality institutionalised care

Psychological

SocialPhysical

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What is the impact of outcome focussed care?

Person Centred

Outcome Focussed

Commissioning and Delivery

Psychological

SocialPhysical

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Outcome focussed because…….

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Status - Hierarchy of Instruments

Health and Social Care Act

Establishes the overall system of regulation

Registration Requirements Regulations

What services have to do to become registered

Regulated Activities Regulations

Which services are required to be registered by virtue of what they do

Compliance Guidance

Tells providers about compliance with the regulations

Further Advice for Implementation

Gives providers more detail that they might find helpful when implementing the guidance

Primary legislation

set by Parliament

Secondary legislation

set by Parliament

Prescribed by primary legislation

written by CQC and subject to consultation

No status in legislation

written by CQC

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Outcomes based

The regulations mapped to six outcome headings:

Involvement and information

Personalised care, treatment and support

Safeguarding and safety

Suitability of staffing

Quality and management

Suitability of management

Plain English

People focussedOutcome based

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Why Outcome Focussed?

•Reviews will be focussed on outcomes rather than systems and processes

•By outcomes we mean – the experiences we expect people to have as a result of the care they receive

•This takes our review of care to the person centred level – to understand the daily experience of people who play out their lives for a period of time in receipt of care services either at a domiciliary or residential level.

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How we check that requirements are met

Declaration

Notifications

Local intelligence

Data

Cross-checking

Validation

What? Who?How?

Compliant/non-compliant

Profile of each

provider

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Quality and Risk Profile (QRP)

•Gathers all we know – from other regulators, people who use services, whistle blowers etc• Not a rating, ranking or league table• Assesses risk of a provider becoming non-compliant• Inspectors make judgements based on information in the QRP• Prompts front line regulatory activity• Constantly updated, builds over time

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QRP – how it will look

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QRP – how it will look

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Compliance Reviews

Responsive

A responsive review of compliance:

Is triggered when information, or a gap in information raises concern about compliance

Is not a full check of all 16 key quality and safety outcomes

Is targeted to the area(s) of concern

May include a site visit

All findings will be published

Planned

A planned review of compliance:

Is a scheduled check of all the 16 key quality and safety outcomes

Will take place at intervals of between 3 months and 2 years

Will be proportionate, with additional activities focused on gaps on information

May include a site visit

All findings will be published

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Planned Review

•Starts with a review of all information we currently hold on a provider against the 16 outcomes

•Assess what we know and identify what we do not know

•Contact the provider to gain further information only against those outcomes where information is limited

•A Provider Compliance Assessment may be asked for to fill in the gaps

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What is a Provider Compliance Assessment?

A PCA is a self assessment tool designed to help providers assess their level of compliance on an ongoing basis

You may collate evidence to demonstrate compliance in a different format but you must submit such evidence within the specified time frame when we ask for it.

The focus is not on systems, processes and policies but what comes directly from people who use services, relating directly to their experience

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Example Evidence: Outcome 2

Consent to care and treatment

The registered person must have suitable arrangements in place for obtaining, and acting in accordance with, the consent of service users in relation to the care and treatment provided for them.

Regulation 18 of the Health and Social Care Act 2008 (Regulated

Activities) Regulations 2010

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Outcome 2: Consent to Care and Treatment

What should people who use services experience?

● Where they are able, give valid consent to the examination, care,

treatment and support they receive.

● Understand and know how to change any decisions about

examination, care, treatment and support that has been previously

agreed.

● Can be confident that their human rights are respected and taken into account.

This is because providers who comply with the regulations will:

● Have systems in place to gain and review consent from people who use services, and act on them.

Outcome➜What should people who use services

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Self assessing outcome 2

What self assessment questions might you ask?

Do you routinely use effective consent procedures?

What are the knowledge and skills of your staff?

How do you know procedures are followed in practice, monitored and reviewed?

What about people who cannot make all or some of the decisions about their care, treatment and aspects of their lives?

What about people who choose to withhold consent?

What about meeting the requirements of the Mental Capacity Act 2005, the Mental Health Act 1983 and Deprivation of Liberty Safeguards

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How do CQC seesafe and effective care

Effective Care

A person using services receives evidence based care that is appropriate

to their need and achieves a positive outcome - delivered by the right

person, with the right skills and expertise, in the right place, at the right

time, taking into account the views and wishes of the person.

Safety

Safety is freedom for people who use and deliver services from

unnecessary harm or potential harm associated with health or social care

services, where harm can be physical, psychological and/or emotional

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Drivers for change

Public services in the future:

1. Demographic driven demand – increased demand for public services because of ageing population.

2. Shifting identities – individuals are geographically more mobile and create new identities and communities across neighbourhood, local and national levels

3. Meeting diverse demands – increasingly diverse demands make it difficult to find consensus on some policy areas, especially where there are fundamental differences in value and priorities between sections of society. A ‘one size fits all’ approach is unlikely to suffice.

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Drivers for change

5. Technology – a driver of change, a solution and as a problem, technology is changing the way we live, work and interact with each other in fundamental ways. This has implications both for the types of public services that will be needed and the ways that they are delivered.

6. Rising citizen expectations – expect more from private sector services, demanding service standards that meet the best equitously across the country.

7. Economic Climate – a testing climate of economic constraints

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Challenges going forward

•Change! Change! Change! Change!

•Change is the only constant.

•BUT…………………..

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Challenges present opportunity

Opportunityis NOWHERE

Opportunity is now Here

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Quality

Quality is never an accident, it is a result of high intention, sincere effort, intelligent direction and skilful execution. William A Foster

Quality is not an act, its is a habit. Aristotle

Quality means doing it right when no-one is looking. Henry Ford

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Final Thoughts

Quality, Safe, Personalised health and social care must be a way of thinking and not a discrete task

whatever the prevailing economic or political climate

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Thank you for your attention

“Here is Edward Bear,coming

downstairs now, bump, bump, bump,

on the back of his head, behind

Christopher Robin. It is, as far as

he knows, the only way of coming

downstairs, but sometimes he feels

that there really is another way, if only

he could stop bumping for a moment

and think of it”

A.A. Milne 1926

Illustration E.H.Shepard 192614