Email your comments

The BGS interviewed Mr James Rentoul of the Care Quality Commission (CQC), asking how its programme might impact upon the care of older people.

The Care Quality Commission is the independent regulator of all health and adult social care in England. Our aim is to make sure better care is provided for everyone, whether that’s in hospital, in care homes, in people’s own homes, or elsewhere.

Our vision is of high quality health and social care which supports people to live healthy and independent lives; helps people and their carers to make informed choices about care; and responds to individual needs.

By high quality care, we mean care that is safe, has the right outcomes, including clinical outcomes. For example, do people get the right treatment and are they well cared for? Is it a good experience for the people who use it, their carers and their families? Does it help prevent illness does it promote healthy, independent living? Is it available to those who need it when they need it? And does it provide good value for money?

We are currently consulting on our five year strategy (2010 – 2015) and our strategic priorities are:

• Ensuring care is centred on people’s needs and protects their rights
• Championing joined-up care
• Acting swiftly to help eliminate poor quality care
• Promoting high quality care
• Regulating effectively in partnership

The details of the consultation are available on our website.

Our main activities are:

• Registration of health and social care providers to ensure they are meeting essential common quality standards
• Monitoring and inspection of all health and adult social care
• Using our enforcement powers, such as fines and public warnings or closures, if standards are not being met
• Improving health and social care services by undertaking regular reviews of how well those who arrange and provide services locally are performing and special reviews on particular care services, pathways of care or themes where there are particular concerns about quality
• Reporting the outcomes of our work so that people who use services have information about the quality of their local health and adult social care services. It helps those who arrange and provide services to see where improvement is needed and learn from each other about what works best.

Do you have any special reviews coming up over the next twelve months?
Following consultation the CQC Board has agreed seven topics for reviews and studies for 2009/10. These are meeting the healthcare needs of people in care homes; ensuring services for people who have had a stroke and their carers; meeting the physical health needs of those with mental health needs and learning disability; supporting families with disabled children; commissioning, health promotion and health inequalities; ensuring Social Services responds to people’s first contact with them; and managing the impact of financial downturn on the quality of care.

All the above topics include older people issues in varying degrees, depending on the topic. We will be consulting on the list of topics for 2011/12 soon. Some of the future topics include Nutrition and Dementia, which are highly pertinent to the older people agenda.

Is there a role for the CQC to encourage PCTs and local authorities to commission appropriate services for frail older people?
CQC is very keen to ensure high quality outcomes for all, particularly those who may find themselves in vulnerable situations due to their age, disability, ethnicity or other reasons. We have the remit of assessing commissioning arrangements by PCTs and Local Authorities and we will use this remit to ensure that the services are being commissioned in a way that produces high quality outcomes for vulnerable groups while maintaining dignity, safety and human rights for these groups in all care settings. For PCTs our assessment of commissioning will include performance against national priorities for the NHS set by government and World Class Commissioning guidance. Our assessments of councils will be based on the outcomes that have been commissioned for people who use services and will incorporate findings about the quality of care in regulated services commissioned by councils. Findings of our assessments of commissioning will also feed into Comprehensive Area Assessments.

As a joint regulator of health and social care, how do you think the CQC can play a part to encourage greater service integration and more joined up care pathways?
One of our strategic priorities is to champion joined up care which indicates our strong commitment to this important area. We are very keen to use the care pathway approach towards provision and commissioning to ensure that people using the services do not face challenges and disjointed care due to gaps in services. We are already working on looking at the care pathway for people who have had stroke, which is very relevant to older people agenda. Our view of joined up care pathways is one that aims to join up services to achieve the best outcomes for people and meet their needs. We are working with NICE to develop national quality standards for Dementia and Stroke, based on the respective care pathways.

How will you encourage higher standards in care homes and hospital settings?
Promoting high quality care and acting swiftly to eliminate poor quality of care are two of our strategic priorities. The Care Quality Commission has launched guidance for all health and adult social care providers on meeting new essential standards of quality and safety, that will apply across the care sector. Providers must show they are meeting essential standards as part of a new registration system which focuses on people rather than policies, on outcomes rather than systems. The essential standards relate to important aspects of care such as involvement and information for people, personalised care and treatment, safety and safeguarding. Subject to legislation, the new registration system comes into force for NHS trusts on 1 April 2010 and for adult social care and independent healthcare providers on 1 October 2010. CQC will continuously monitor compliance with essential standards as part of a more dynamic, responsive, robust system of regulation accompanied by new enforcement powers. CQC's guidance is focused on outcomes - the experiences people have as a result of the care they receive - rather than on systems and processes. It was widely consulted on earlier this year and places the views and experiences of people at the centre of the regulatory system. We are keen to hear from local groups who can provide us with local intelligence which will help us in targeting the poor performers. We have provided a specific mechanism through which local groups can provide us with this information

How do you determine who is responsible for the provision of care in the care home setting? For example, if care home residents are not receiving appropriate health care will you determine if this is the responsibility of the care home provider, the PCT, individual clinicians or care home staff?
We believe providing care that meets the needs of people in any care setting is everyone’s responsibility. The care home provider and the Registered Manager would be expected to ensure that the service provided by them is fit for purpose. They also have a duty to work with others in ensuring that people in their care have access to high quality services and these services provide high quality outcomes. If CQC finds that the care home is not meeting the requirements of registration to make it fit for purpose, we will use our enforcement powers to bring about improvements. In the extreme case where we feel the safety of the people using the service is at risk, we may consider cancelling the registration and closing it down.

With the ongoing shift towards care closer to home, how will you regulate people receiving health and social care in their own homes?
From April 2010 all services that provide personal care in any care setting will have to register with the CQC to ensure that they are fit for purpose. The essential standards for safety and quality that were referred to earlier will equally apply to services provided to people in their own homes. We are also working with skills councils and other professional bodies to ensure that the staff providing care in people’s homes are appropriately skilled and competent to provide a service that meets people’s needs, including maintaining their dignity. Safeguarding people who use services in all care settings is of paramount importance to us and we will use all our powers to ensure that this applies to people who receive health and social care in their own homes too.

Do you use information collected by other audits, for example those conducted by the National Audit Office or the Royal College of Physicians?
Yes we do.

Iona-Jane Harris
BGS PR and Parliamentary Affairs Officer

BGS Newsletter, February 2010
Issue 25 ISSN 1748-634000 25