Raising standards

in accident and

emergency care Chris Day, CQC

26 February 2014

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Our purpose and role

Our purpose We make sure health and social care services

provide people with safe, effective, compassionate,

high-quality care and we encourage care services

to improve

Our role We monitor, inspect and regulate services to make

sure they meet fundamental standards of quality

and safety and we publish what we find, including

performance ratings to help people choose care

We will be strong, independent, expert inspectorate that is always on

the side of people who use services

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Independent of politics and the system

Regulate across all sectors

Clinically driven with expert teams

Evidence-based judgement, not regulatory compliance

Highlight excellence and expose poor care with transparent ratings

Always on the side of people who use services

Our direction

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Asking the right questions about quality and safety: the 5 domains

Are services safe?

Are services effective?

Are services caring?

Are services responsive to people’s needs?

Are services well led?

The new CQC hospital inspection programme

• Previous CQC approach was flawed – although it had strengths around evidence gathering and growing use of clinical and patient expertise and insight

• Building on the Keogh Review process for 14 acute hospitals with high mortality

• Our new approach aims to be the best of both approaches

• We aim to be robust, fair, transparent and to help trusts improve

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The Chief Inspector of Hospitals’ task

• To inspect all acute NHS hospital Trusts/FTs by December 2015

• To assess whether a Trust is safe, effective, caring, responsive to patients’ needs and well-led and provide a rating for each trust

• To re-inspect when necessary and to undertake

focused reviews in response to specific concerns

• To extend the programme to include mental health,

community service and ambulance trusts (and

independent sector equivalents)

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What does the new inspection process look like?

Report Quality

Summit and

written

report 6

weeks after

inspection

First four inspection reports published on 21 November

First three ratings publishing March 2014

All trusts inspected and rated by December 2015

Monitor Key lines of

inquiry

Complaints

and raising

concerns

Rate Trust,

hospital and

core service

level rating

Prepare Public

listening

events,

data packs

Inspect 2-4 days,

mixed

teams,

8 core

services

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State of Care (published 21 Nov 2013)

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State of Care (published 21 Nov 2013)

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During 2012/13 9.4% of those 75+ experience at

least one emergency hospital admission for an

avoidable condition

Despite efforts to move this care into the

community, in 2007/08 it was 7.1% of this group

Of all emergency admissions among those aged

75+, 24.6% were avoidable.

A&E staff are devoting an increasing proportion of

their time to older people

These increased admissions could be prevented

by better community care and service integration

Older people and A&E

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In > 50% of PCT areas, people with dementia

in a care home were admitted to hospital with

avoidable conditions 30% more often

In almost a third of hospital admissions of

people with dementia, there was no record of

their condition

People with dementia have longer stays in

hospital, more readmissions and higher

mortality rates

Outcomes for younger patients with dementia

and those with elective admissions were

poorer

Dementia findings

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State of Care (published 21 Nov 2013)

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There are many examples of good practice

The King’s Fund reports that the Royal Free

has:

Appointed a Director of Integrated Care

Introduced ‘hot clinics’ where older people

can be seen urgently without going to A&E

Reduced lengths of stay through

supported early discharge

Focused on admission avoidance and the

development of community hubs to

provide multidisciplinary clinics and case

management outside hospital

It doesn’t have to be this way….

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Thank you

Chris Day Director of Engagement chris.day@cqc.org.uk