Agenda Item: 5

Ref: CM/06/11/04

MEETING: / PUBLIC BOARD MEETING
DATE: / 16 November 2011
TITLE OF PAPER: / Chair’s report on CQC Stakeholder Committee, 17 October 2011
SUMMARY:
This report sets out what was discussed at the first meeting of CQC’s statutory Stakeholder Committee, and asks the Board to consider what matters they would like this advisory body to consider at its next meeting on 2 February 2012.
RECOMMENDED ACTION:
The Board is asked to AGREE that the Commission should explore what role the shape and structure of the care market could play in encouraging improved standards of care.
Executive Decision/
Board for information / Executive and Board decision / Executive and Board shared decision / Executive and Board discussion/Board decision
The Executive Team has made a decision and the Board has been informed / The Board has been consulted in order for the Executive Team to make a decision / This is a shared decision between the Executive Team and Board / This is for when it is clear that it is a specific Board decision (under statutory and legal requirements) ie. signing off the annual accounts
* Check box as required
LEAD DIRECTOR:
AUTHOR: / John Harwood
DIRECTORATE
DATE: / 7 November 2011
SUPPORTING
PAPERS: / Annex A –Minutes of the Stakeholder Committee

GOVERNANCE

AUDIT TRAIL: / There has been no previous discussion of this paper.
LINK TO STRATEGIC OBJECTIVES AND BUSINESS PLAN / The role of the Stakeholder Committee is to offer strategic and policy advice to the Board.
FINANCIAL IMPACT: / There is no measurable financial impact.
RISK IMPACT: / A risk assessment will be carried out depending on the Board’s decision.
REPUTATION IMPACT: / CQC’s role in relation to the shaping of the external market is of interest to policy bodies and key stakeholders.
HEALTHWATCH IMPACT: / Limited; potentially some.
EQUALITY IMPACT
ASSESSMENT: / No.

1. Background

1.1CQC’s Stakeholder Committee held its first meeting on 17 October 2011. The agenda for this first meeting was designed to engage the new membership in discussions of interest with some direct relevance to CQC’s work. In future, the Committee’s agenda will largely be set by the Board (who will propose issues on which they want to seek the Committee’s advice) and in part by the Committee (who may nominate matters for discussion at the discretion of the Chair).

  1. Executive Summary

2.1The minutes of the Committee are attached. Imelda Redmond of Carers UK gave a presentation which led to an interesting discussion about the care market and how it is shaped by commissioning, much of which is felt to be short-term rather than strategic.

2.2It is recommended that the Board should give consideration to the whether CQC can (or should) work with Monitor and other interested parties to explorehow the shape and structureof the care market can be developed to encourage consistently improved quality of care, noting the work already underway through the Future of Care programme.

2.3This exploration would need to balance the role of CQC against those of other players in the sector – including considering the potential role of Monitor as the economic regulator, sector- led improvement in social care (through Think Local, Act Personal) and the responsibilities of local authorities in the new health and social care landscape.

3.Conclusion

3.1This matter deserves consideration by the Board to help clarify CQC’s role in relation to the ways in which the care market is shaped by regulation.

4.Next Steps

4.1If the Board agrees, this matter will be tabled for the Stakeholder Committee on 2 February 2012. The Committee’s views will be reported back to the Board at its meeting of 15 February 2012.

Name: / John Harwood
Title: / Commissioner
Date / 7 November 2011

(ANNEX A)

MINUTES OF THE STAKEHOLDER COMMITTEE MEETING

AUDITORIUM ONE, FINSBURYTOWER,

103-105 BUNHILL ROW, LONDON EC1Y 8TG

MONDAY 17 OCTOBER 2011

11.00 – 13.30

Present
John Harwood / Chair – Commissioner - CQC
John Adams / General Secretary - Voluntary Organisations Disability Group (VODG)
Frances Blunden / Senior Policy Manager - NHS Confederation
Jerina Brown / Corporate Secretary - CQC
David Congdon / Head of Campaigns and Policy - MENCAP
Andrew Cozens CBE / Strategic Adviser - Local Government Group
Sandra Eismann / Public Affairs Manager - CQC
Jill Finney / Director of Marketing Strategy & Communications - CQC
David Haslam CBE / National Professional Advisor - CQC
Paul Jenkins / Chief Executive - Rethink Mental Illness
Richard Jones / Immediate Past President - Association of Directors of Adult Social Services (ADASS)
Claire Murdoch / Chief Executive - Central and North WestLondon NHS Foundation Trust
Imelda Redmond CBE / Chief Executive - Carers UK
Susie Sanderson / Chair of the Executive Board - British Dental Association
Sue Slipman / Chief Executive - Foundation Trust Network
Sally Taber / Director - Independent Healthcare
Jeremy Taylor / Chief Executive - National Voices
Matthew Trainer / Head of Public Affairs - CQC
Patrick Vernon / Chief Executive - Afiya Trust
Arlene Wilkie / Chief Executive - Neurological Alliance
Miranda Wixon / Managing Director and Founder – Homecare Partnership
Care Providers Alliance

Item 1 – Apologies

  1. The Chair welcomed members to the inaugural meeting of the Stakeholder Committee.
  2. Apologies received from the following members, Professor Sir Roger Boyle, Dr Laurence Buckman, Dr James Kingsland and Professor Janice Sigsworth.
  3. The Chair thanked members for agreeing to be part of the new Stakeholder Committee. He explained how CQC was implementing a new stakeholder management structure to give a wider range of stakeholders the opportunity to influence CQC’s work. The expanded professional membership of the Committee would consider and provide advice to CQC’s Board on key strategic issues. The structure of the Committee would be reviewed after a year.

Item 2 – New Stakeholder Management Structure (Ref: SAC/11/01/01)

  1. The Director of Strategic Marketing and Communications (SMC) explained that as well as the Stakeholder Committee, external advisory groups will be set up to inform work on a task and finish basis with CQC on individual pieces of work to help improve the way CQC carries our its regulatory functions.
  2. In addition Stakeholder Forums would be set up to engage with particular sectors, to address ongoing matters of interest or concern to either CQC or to stakeholders.
  3. The Director of SMC explained that CQC will set up a core stakeholder register of CQCnational stakeholders. Advisory Groups will draw their membership from this register. Members of the register are selected on the basis of their organisations’ relevance to CQC’s work, including their level of interest and potential level of impact.
  4. It was agreed members of the Committee would be sent the template for the register.
  5. It was noted that membership of the Stakeholder Committee and the minutes would be published on the CQC website.

ACTION: Template for the register to be circulated to members - Secretariat

Item 3 – NHS Future Forum (Ref: SAC/11/02/01)

  1. David Haslam, National Clinical Advisor and co-chair of the Future Forum workstream on Information provided members with the background to this work.
  2. The NHS Future Forum had been asked by Government to provide independent advice on how information could be used to improve health, care and wellbeing. A key element of the forum’s work was to engage with a wide range of people and organisations to gather views and test thinking.
  3. David Haslam explained that a great deal of work had already been done on the collection, use and sharing of information and it was now important to remove the blocks preventing good ideas from being taken forward.
  4. Jeremy Taylor, National Voices and co-chair of the Future Forum workstream on Information explained that the workstream on information was about providing patients and service users with information about health and social care in a format that would enable them to take more control and have a voice about the service they received in order to make the right decisions and choices to improve their quality of care. Information was an integral part of care and should not be seen as an add on. He explained in detail the eight draft principles of the information workstream. These included access rights of patients of their own data and information governance on protecting confidentiality of electronic health records.
  5. He explained the importance of collating as much information as possible about a service user’s experience. One way of capturing this could be to ask patients and service users to fill in a mini-questionnaire after every exchange asking them about their experience.
  6. In discussion members welcomed the principles but made the following observations:
  7. It was important to ensure that families were partners in care along with clinicians.
  8. Patient feedback should include patient to patient views to highlight their experiences.
  9. Long-term conditions should include alongside, information and choice, advice and psychological details to enable people to come to terms with elements such as mental health problems.
  10. From a service user’s perspective it was accepted that it was logical tocorrect factual inaccuracies from their records, which could affect their end of life care.However, removing information which they might not want included (but which was accurate), raised more difficult questions and tension. An example of this was if they had received a criminal conviction in their 20s. Or where evidence of previous sex offending needed to stay on as a matter of public safety.
  11. It was also important to take into account the human rights of individuals to enable them to challenge information contained in their records
  12. It was important to establish what shifts were needed to embed principles in order to put people in control over their choices.
  13. Information on Health and Social Care could be used to illustrate the good and bad areas of patient care in order to avoid scandals such as Winterbourne View.
  14. It would be essential to ensure there were sufficient funding/resources in any system to deliver quality information.
  15. It was essential to have continuity of peoples’ service plans
  16. Consideration should be given to the regulatory burden on organisations in terms of the collection of data
  17. It was acknowledged that all this would require cultural changes in behaviour alongside empowerment of service users. It was also be important to establish who held the improvement role on the quality of services. Where does regulation begin and end and the role of clinical groups in the health and social care sector?
  18. David Haslam thanked members for their helpful points. He commented that the improvement role should be the responsibility of trusts. Their Boards should know the quality of care being delivered and what service users felt about the service they receive.
  19. The Director of SMC stated that CQC had already invested a lot into the collection of soft intelligence via QRP and Qinetiq. In the future, the role of HealthWatch would be important as they would comment on trends across the sector. Another issue would be the handling of complaints data at a local level.
  20. In discussion it was felt it would be essential not to lose sight of the purpose of the principles which was to improve patient care and also for the person caring for people. It would be important to establish who would be responsible for the collation of data and how this would be funded.
  21. David Haslam reported that next steps would be to share the report with Government before Christmas. He agreed to circulate a reiteration of the document to members for comment.

ACTION: Next iteration of the report to be circulated to Committee members – David Haslam/Secretariat

Item 4 – Review of Quality in Adult Social Care

  1. Imelda Redmond provided a brief introduction to members of the work she is undertaking on behalf of the Department of Health on the quality of care.
  2. The quality of care people receive is a major concern for users, their families and the public more widely. The approach to quality in social care needs to guarantee essential standards of safety and quality and make quality the guiding principle for adult social care.
  3. On the 15 September 2011 the Government launched Caring for our future: shared ambitions for care and support. From this date until early December 2011, the Department will be seeking the views of people who use care and support services, carers, local councils, care providers and the voluntary sector, about the priorities for improving care and support.
  4. The aim is not a full scale consultation but to build on what has previously been done and link this work into the Government’s Green and White Papers on social care.
  5. There were 6 workstreams in place each with an independent chair and co-chaired by a senior civil servant. These were:
  6. Quality Workforce
  7. Integration
  8. Prevention
  9. Shaping local care market
  10. Personalisation
  11. Role of financial services
  12. The first phase of the consultation will end on the 11 November with phase two taking place from 14 November which will pull all the workstreams together. Consideration would then be given as to what good care looked like and the levers for change in order to reach a position where there was a consistency on the quality of care people received. It was also important to establish whose responsibility it was for ensuring care staffwere highly motivated.
  13. The engagement process so far had come up with the following core themes:
  14. What constitutes quality information – it should not just be a report that states that information is important it should contain who is responsible and what need to happen locally and the barriers in the system to enable information to flow.
  15. Consideration should also be given on how commissioning impacts on the quality and morale of staff when they are transferred to a different employer via TUPE.
  16. How can the regulatory framework work to help the improvement agenda – what are the levers/funding mechanisms to ensure that money in the system is used effectively to drive up quality.
  17. In discussion the following points were made:
  18. The care sector market is shaped by commissioning, much of which is short term rather than strategic.The market is worth a huge amount of money. However, the main issue with the care market was the sustainability of business models which had been driven by property values and quick returns. Innovative ideas were critical to the improvement of quality with commissioning playing a key role in the relationships between commissioners and providers. If the quality of provision is really to change then the market structure has to encourage and enable this.
  19. It was important to establish who was working with service providers in shaping the developing market and ensuring the right balance between a national and local approach to improving quality and supporting the workforce
  20. The public needed an easy comparison tool to understand the merits of different providers. It was essential not to wait until the White Paper was completed to have a system in place as people will be using their incomes to buy care and they should beempowered to make choices about the care they buy and the kind of support they want from the social care workforce.
  21. The work streams should also contain the role of the regulators in respect of Equality and Diversity.
  22. It was agreed that user feedback was an important element in determining what represented good or poor quality.
  23. Imelda Redmond thanked members for their comments and said she would contact individuals if she required further clarification of any points.
  24. The Chair acknowledged that this had been an interesting briefing session. However, it was also important to bear in mind CQC’s role as the regulator in driving out poor quality.

Item 5 – Future Meetings

  1. In discussion members felt that in order for the Committee to be as effective as possible it was essential that it met more frequently than twice a year. It was agreed that dates would be canvassed for the next meeting to take place for late January or early February 2012. In between meetings members would be consulted on urgent issues via email. Members were also asked to indicate their preference on the timings for meetings.

ACTION: Dates to be canvassed for January/February - Secretariat

Item 6 – Future Agenda items

  1. In discussion members felt there should be a discussion of the following items:
  2. Local HealthWatch & HealthWatch England
  3. CQC’s revised Strategy – this would done via email
  4. Improvement agenda – Role of the economic regulation alongsidequality regulation - Monitor and NICE to be invited to attend.
  5. Strategic discussion of the implications of the Frances review for the role of the regulator
  6. Whistle blowing
  7. The voice of service users and carers
  8. Medical Validation – and the mechanisms for sharing information.
  9. CQC/Monitor study of the nature of the market
  10. CLOSE
  11. The meeting closed at 13.32pm

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