Published on March 11, 2014
Raising standards in accident and emergency care Chris Day, CQC 26 February 2014
2 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
3 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
4 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 5
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) 6
7 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
8 State of Care (published 21 Nov 2013)
9 State of Care (published 21 Nov 2013)
10 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
11 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
12 State of Care (published 21 Nov 2013)
13 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….
14 Thank you Chris Day Director of Engagement firstname.lastname@example.org
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