Transcript Focussing on outcomes: Challenges and Drivers

Focussing on Outcomes:
Challenges and Drivers
Marilyn Hansford
Compliance Manager
East Sussex
Purpose of presentation
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What do we mean by optimum health?
• Outcomes based
• Guiding legislation
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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
CQC will work with
partner organisations
taking into account the
key determinates of
health
David
Seedhouse
2002
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Shape and Form
to Health
Psychological
Every individual has a life long
need for Health and Social
stability
Physical
Psychological
Individuals at times in their lives
may have a health and/or social
need that requires a service
response
Social
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What is the impact of compromises?
Psychological
Cancer
Coronary heart disease
Chronic ill health
Poor quality institutionalised
care
Physical
Social
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What is the impact of outcome
focussed care?
Psychological
Person Centred
Outcome Focussed
Commissioning and Delivery
Physical
Social
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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
Primary legislation
set by Parliament
Regulated Activities
Regulations
Which services are required
to be registered by virtue of
what they do
Secondary legislation
set by Parliament
Compliance Guidance
Tells providers about compliance
with the regulations
Prescribed by primary
legislation
written by CQC and
subject to consultation
Further Advice for
Implementation
Gives providers more detail that
they might find helpful when
implementing the guidance
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
Plain English
Safeguarding and safety
Suitability of staffing
Outcome based
People focussed
Quality and management
Suitability of management
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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
Local intelligence
Declaration
Notifications
Data
Compliant/
non-compliant
Cross-checking
Profile of
each
provider
Validation
What?
Who?
How?
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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
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
May include a site visit
All findings will be published
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.
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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 see
safe 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
Opportunity
is 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
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