The Care Quality Commission and the Healthwatch network: working together September 2014
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The Care Quality Commission and the
Healthwatch network: working together September 2014
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Introduction This briefing describes how the Care Quality Commission (CQC) will work with local Healthwatch and Healthwatch England in its new approach to inspecting health and care services. It has been produced jointly by CQC and Healthwatch England, with the advice of local Healthwatch. It will be updated when CQC has finalised its new approach to inspections in all sectors. This briefing includes information about: • CQC’s role
• How CQC works
• CQC’s inspection teams
• How CQC works with local Healthwatch
• CQC and Healthwatch England. CQC’s commitment to the Healthwatch network
CQC will work effectively with the Healthwatch network to ensure that the views and experiences of local people gathered by the network:
• Inform the development, design and monitoring of CQC’s new approach to regulating health and care services.
• Inform CQC’s planning and delivery of inspections across all sectors.
• Are coordinated with CQC’s other partnerships with the wider voluntary and community sector.
• Inform Healthwatch England in advising CQC’s Board.
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Fundamentals of the working relationship
Relationship
Every local Healthwatch has an effective two-way relationship with CQC, which is coordinated by the primary and integrated care inspection team manager, and meets at least every three months.
During inspection activity the relevant CQC inspection team (primary, hospital, social care) will engage directly with the local Healthwatch.
Local Healthwatch and CQC will share work plans to avoid duplication and identify opportunities for a coordinated approach.
CQC inspection teams need to take into account the capacity of their local Healthwatch
Evidence
CQC will share information, such as profiles and recent findings from inspections.
Local Healthwatch will share people’s experience data and reports from engagement with their local communities with CQC, such as Enter and View reports.
CQC will actively involve local Healthwatch in thematic reviews of user groups or care pathways.
Healthwatch England and CQC will investigate the use of the Healthwatch CRM to support the sharing of information.
Improved health and care services for the public
Inspection
Local Healthwatch will be invited to contribute evidence and advise on inspections.
Local Healthwatch will be invited to advise and support CQC in how it undertakes community engagement.
CQC inspection teams will keep the local Healthwatch informed of anything that is of interest to the public, such as the suspension of a service.
Local Healthwatch will be involved in the quality summit (or equivalent mechanisms).
Improvements
Local Healthwatch will receive feedback from inspection teams on any next steps.
CQC will provide local Healthwatch with information on improvements made following inspections, as a channel to inform the public.
Local Healthwatch will have an ongoing opportunity to share their insight on provider progress and to flag any continuing public concerns.
Local Healthwatch will inform CQC where improvements have been made to services as a result of their engagement.
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CQC’s purpose and role The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. Its purpose is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care, and to encourage services to improve. CQC’s role is to monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety. This includes publishing reports that show performance ratings to help people choose care and share good practice. How CQC works Health and adult social care services have to be registered with CQC to provide care in your local area. When a service registers with CQC they have to specify what ‘regulated activities’ they offer. CQC is then required to monitor and inspect these services. To find out more about what the regulated activities are and who has to register, click here. Service providers have to inform CQC if they set up a new service or make a change to an existing service to provide different sorts of care. The main types of services CQC regulates are set out in the box below. These may be run by the NHS, private companies or charitable organisations.
Hospitals Including urgent care and ambulances
Community health services Including community hospitals, services for people with long-term conditions and district nursing services
Clinics Which offer services such as IVF, cosmetic surgery and advice or treatment to help with family planning or losing weight
GPs and doctors Including GP practices, out-of-hours services and walk-in centres
Dentists
Care homes Both with and without nursing care, extra care housing services, shared lives and supported living services
Services in your home Home care agencies
Services for people with mental health problems
Including people who need support with drug or alcohol misuse
Services for people with a learning disability
Hospice services
Prison healthcare services
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CQC’s monitoring and inspection programmes CQC’s inspection programmes are led by three chief inspectors, responsible for monitoring and inspecting adult social care, primary and integrated care, and hospital care (which includes mental health, community, acute hospital and ambulance care). The inspection teams carry out inspections of all the registered services. On all inspections, CQC asks five key questions about a service:
• Is it safe?
• Is it effective?
• Is it caring?
• Is it responsive to people’s needs? • Is it well-led? CQC publicly announces inspections of NHS and independent hospital services, community and mental health services in advance. Inspections of adult social care and primary care services are not publicly announced. They take place on a rolling programme across the country on an ongoing basis. All CQC inspection teams gather and use feedback from people using services, their carers and families, and their representatives. This includes nationally available data such as patient surveys, as well as people’s experiences that they send to CQC. Healthwatch are invited to contribute evidence about people’s experiences of care, as are other patient and public representatives and groups, including overview and scrutiny committees and NHS complaints advocacy services. CQC also asks local partners, including local authorities and clinical commissioning groups (CCGs) to share information about the quality of services before inspections. During the inspections, CQC’s inspection teams check on different aspects of care, the environment, the staff and how the service is run. They observe care being delivered, where appropriate, talk to people using the services and their family or carers, and talk to staff, and check policies, records and care plans to decide on the quality of the care.
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CQC is introducing ratings of all services Following an inspection, CQC gives a rating to tell you about the quality of an organisation and its main services, which are rated as: Outstanding
Good
Requires improvement
Inadequate
Inspection reports After every inspection, CQC publishes a report explaining what the inspection team found. This includes examples of good practice as well as areas for improvement. The report includes the rating given to the organisation and its services. Reports are published on the CQC website at www.cqc.org.uk. You can sign up to receive all the inspection reports in your area.
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Taking action against poor care CQC has a number of powers if it they finds services are not meeting the regulations for care set out by the government. These range from warnings and fines, to cancelling a service’s registration so it can no longer provide care, through to prosecuting those responsible for the service. From April 2015, CQC’s enforcement powers will be strengthened to protect people who use regulated services from harm and the risk of harm and to hold providers and individuals to account for failures in how the service is provided. You can read more at www.cqc.org.uk. Special reviews CQC also has powers to run special reviews looking at how care is provided for people with particular health needs or across different services. For example, during 2014/15, CQC is running special reviews about the quality of crisis care, dementia care and end of life care. CQC inspection teams CQC has specialist inspection teams for hospitals, adult social care and primary and integrated care throughout England. In most cases, inspectors work in the area they live in, but in some cases they have specialist roles and may work across larger areas to inspect a particular type of service, such as a range of substance misuse services. The box below shows the local services CQC teams are responsible for inspecting. It shows the areas they cover and the main services they inspect. There are also registration teams who work across all sectors.
CQC local inspection teams
Hospital inspection teams
Primary and integrated care inspection teams
Adult social care inspection teams
Work across regional areas
Work across CCG areas Work across local authority areas
Responsible for inspecting NHS acute, ambulance, mental health and community health trusts and independent hospital services
Responsible for inspecting GP practices, out-of-hours services, dentists, healthcare in the criminal justice system and children’s services
Responsible for inspecting registered care homes, domiciliary agencies and hospices
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How CQC works with local Healthwatch CQC has a duty in law to take account of the views and experiences of local Healthwatch. As part of its new approach to inspections, CQC wants to build on and strengthen the relationships with all local Healthwatch, the Healthwatch network and Healthwatch England. This will involve: Building a strong local relationship • CQC recognises the unique role and functions of Healthwatch. CQC inspection
teams will develop, maintain and coordinate ongoing and consistent local relationships with each Healthwatch organisation, taking into account local Healthwatch capacity.
• The local primary care inspection manager or designated inspector will coordinate the Healthwatch relationship. They will meet with local Healthwatch at least four times a year. Healthwatch can also expect to have contact during the year with the inspection teams for adult social care and NHS acute hospital services as part of their inspections.
Making Healthwatch evidence count • CQC and Healthwatch England will develop the best mechanisms for gathering
and using information from local Healthwatch.
• CQC will continue to keep local Healthwatch updated on where, when and how they can share information with inspection teams when changes are made to the new inspection process.
• CQC inspection teams will coordinate their work to capture, store and use information from local Healthwatch so it is used to inform all CQC inspections in the area.
• Healthwatch will be actively encouraged to provide evidence to the new CQC inspections across all sectors (both announced and unannounced).
• CQC hospital inspection teams will invite a Healthwatch representative to contribute to the ‘quality summits’ to discuss inspection findings for NHS trusts.
• Local Healthwatch will receive feedback about how CQC inspection teams have used the evidence they provide.
Working together when we engage the public • Wherever possible, CQC inspection teams will make use of the networks and
events already organised by local Healthwatch to hear about people’s experiences of care.
• When CQC plans public or community engagement activity as part of an inspection, Healthwatch will be invited to advise CQC of the best approach. CQC will also test ways of working more closely with Healthwatch on public or community engagement activity, including trialling joint events to listen to the views and experiences of people using local services.
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Sharing information about CQC • All local Healthwatch across the country will have access to CQC information
about health and care services and their quality, which can be used to drive service improvement.
• The regional and national communications and engagement teams will continue to provide regular updates to local Healthwatch about inspection reports and about CQC’s national work and inspection programmes, and will coordinate any communication with Healthwatch England.
Developing guidance and briefings • Healthwatch England and CQC will develop guidance and briefings for both
CQC inspection teams and local Healthwatch to help build a common understanding of our respective roles, powers and functions, and to build effective local relationships.
• CQC will not direct local Healthwatch plans or activity. Each local Healthwatch and the Healthwatch network will decide how it responds to CQC’s requests for information and evidence and whether local Healthwatch should be directly involved in CQC’s work.
Exploring new approaches to working with the Healthwatch network • At the regional level, CQC inspection teams will work with Healthwatch
England and clusters of local Healthwatch to test ways of sharing information effectively about corporate providers, regional specialist services or other large providers (such as ambulance trusts).
Involving local Healthwatch in CQC’s national work • CQC will continue to invite all local Healthwatch to contribute information and
to get involved directly in national programmes of work and advisory groups to shape how we work.
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How local Healthwatch can share information with CQC CQC inspection teams use local Healthwatch information to: • Identify good and poor practice in particular services and how well services
work together.
• Inform individual inspections to decide what services to inspect and when to inspect them.
• Understand how services respond to requests for information and handle their complaints and concerns.
Local Healthwatch should send any information it holds about the quality of health and care services directly to CQC and it will be passed to the most appropriate inspection team. This includes: • Comments from members of the public and from local groups or communities
• Surveys and questionnaires.
• Enter and View reports.
• Trends in concerns and complaints and how they are handled.
• Other reports from Healthwatch engagement activities. Please note that CQC welcomes information from Healthwatch at any time.
Tips for sharing information with CQC
• Name the provider(s) your information is about. CQC may not be able to use the information if the location it refers to cannot be identified. Provide, as a minimum, the name and address of the service. The postcode is also useful.
• For information that does not relate to a specific provider, give a short summary of what it covers, for example which type of health and care service, the main topic or subject.
• It would be helpful to outline whether the information raises any serious concerns about the care provided.
• Be clear about whether the information shared is positive or negative about the service or a combination of both.
• For all information, outline the time period it covers.
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Information should be sent to CQC using the channels set out below rather than through the local primary care inspection manager. This helps to get information to the relevant people as quickly as possible. Healthwatch can send CQC information in the following ways: • Information about primary care services such as GP practices, dentists and
out-of-hours services, adult social care services or information about combinations of local services to [email protected].
• Information about acute and ambulance services to [email protected].
• Information about community health services to [email protected]. • Information about mental health services to [email protected]. • Information about all sectors by telephone on 03000 616161. If in doubt, send the information to the mailbox that is most relevant and it will be shared with the appropriate inspection teams, or ring CQC’s customer service centre on 03000 616161. Concerns about safety If you are concerned about someone’s immediate safety, especially if they are in vulnerable circumstances, please contact your local authority safeguarding team, who have the primary responsibility to follow up individual concerns. You can also share your concerns with CQC. Call 03000 616161 and CQC will pass the information as a matter of urgency to the local CQC inspector for that service. CQC does not deal with individual cases of safeguarding, but does work closely with local authority safeguarding staff and can use the information when monitoring services. CQC can follow up a service where concerns have been raised, which may lead to enforcement action if standards have not been met.
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CQC and Healthwatch England At national level, there is a memorandum of understanding between CQC and Healthwatch England. Healthwatch England have the power to escalate serious concerns to to CQC. The memorandum of understanding can be read by following this link www.cqc.org.uk/public/about-us/partnerships-other-organisations/joint-working-agreements. CQC and Healthwatch England have also agreed to: • Produce updates of this briefing together.
• Hold joint advisory meetings with local Healthwatch to make it easier for Healthwatch staff to discuss issues with CQC and Healthwatch England together.
• Work more closely together to keep Healthwatch up to date on the changes to the new fundamental standards of care and how relationships between CQC and Healthwatch are developing so each partner can take steps to solve any problems.
• Review how the relationship between CQC and the Healthwatch network is working
• Promote and circulate good practice in the ways Healthwatch and CQC work together to highlight where sharing information about people’s experiences of care has made a difference.
Comments and questions about this briefing are welcome and should be sent to [email protected].
For further information about how CQC works with local Healthwatch, talk to your local primary care inspection manager or phone CQC on 03000 616161 and ask if the inspection manager can contact you. You can also discuss this briefing with CQC’s national public involvement and engagement team by emailing [email protected].
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