Paper Number:
MINUTES OF THE STAKEHOLDER COMMITTEE
WEDNESDAY 2 FEBRUARY 2012
Auditoriums1 and 2, FinsburyTower,
103-105 Bunhill Row, London EC1Y 8TG
Present:
John Harwood (Chair) / CQC Board Member
John Adams OBE / General Secretary - Voluntary Organisations Disability Group
Frances Blunden / Senior Policy Manager - NHS Confederation
Dr John Canning / Representing Dr Laurence Buckman – Chairman – General Practitioners Committee, British Medical Association
Rebecca Cotton / Representing Steve Shrubb - Director – Mental Health Network
Andrew Cozens CBE / Strategic Adviser – Local Government Group
Emily Holzhausen / Director of Public Affairs - Carers UK
Paul Jenkins / Chief Executive – Rethink Mental Illness
Dr James Kingsland OBE / President - National Association of Primary Care
Ruthe Isden / Representing Michelle Mitchell - Charity Director - Age UK
Sarah Norman / Chair of Standards and Performance - ADASS
Professor Janice Sigsworth / Director of Nursing - Imperial Healthcare NHS Trust
Sue Slipman / Chief Executive - Foundation Trust Network
Sally Taber / Director - Independent Healthcare Advisory Services
Jeremy Taylor / Chief Executive - National Voices
Guest Speaker:
Toby Lambert / Policy Director, Monitor
Gillian Leng / Deputy Chief Executive, NICE
In Attendance:
Jill Finney / Deputy Chief Executive/Director of Strategic Marketing and Communications
Rosanna Campbell / Head of Public Affairs
Sandra Eismann / Public Affairs Manager
Amanda Hutchinson / Head of Regulatory Development
Sarah Martyn / Interim Deputy Corporate Secretary (minute taker)
Item 1 – Apologies
1.1 / John Harwood welcomed everyone to the second meeting of the Committee and noted apologies from: Professor Sir Roger Boyle; David Congdon; Arlene Wilkie and Martin Green. He extended a welcome to Toby Lambert, Monitor and Gillian Leng, NICE.
Item 2 – Integrating Regulation in 2012/14 – CQC, Monitor and NICE
2.1 / Jill Finney introduced the presentation stating that the purpose was to:
- Engage the group in an early discussion on integrating regulation in 2012-14;
- An overview of the role of Monitor, NICE and CQC and how they could work better together;
- Moving forward in the new world and getting things right.
2.2 / The Committee noted that the National Quality Board was developing a description of how quality of services could be maintained and improved within the ‘system architecture’ and looking at respective roles and responsibilities along the quality curve. Andrew Cozens asked if there was social care representation on the National Quality Board. Amanda Hutchinson confirmed that it was predominantly health related, but added that social care stakeholders should be engaged moving forward. Sally Taber advised that there was an awayday in March to talk about added representation. It was agreed that the membership of the National Quality Board would be circulated.
ACTION: Secretariat to circulate the membership of the National Quality Board to members of the Stakeholder Committee.
2.3 / The Committee noted that under the Health and Social Care Bill 2011 the future role of CQC remained unchanged and it would continue to register, inspect, enforce and publish.
2.4 / Toby Lambert advised that under the Health and Social Care Bill 2011, Monitor would become the “sector regulator” for the NHS, with a provision for it to move to adult social care at a later stage. There would also be a shift for Monitor in looking at securing the way in which patients, and other members of the public, were involved in their own care. Monitor would also look at licensing, in conjunction with CQC; and price setting for NHS services. Finally, Monitor would be providing a continuity of service for financially troubled providers. A number of additional duties had been published the previous night regarding multi-professional clinical advice on the regulatory framework.
2.5 / It was noted that Monitor would have a comparable rolewith the Office of Fair Trading with regard to anti-competitive behaviour within the independent healthcare sector. Monitor and the NHS Commissioning Board will have a joint role in setting the NHS tariff from 2014. Monitor will set NHS prices; the NHS Commissioning Board will define what constitutes a unit (of services being purchased). In addition, Monitor will be responsible for preventing market failure, and will have duty to take action should designated (i.e. essential) services no longer be available locally. This is to ensure that people still have access to essential local services.
2.6 / Sue Slipman asked how public and patient involvement would fit in with HealthWatch. Jill Finney advised that it was clear that the public and patients needs to be involved; and CQC needs to ensure it has the methods of collecting and utilising soft intelligence. Jeremy Taylor advised there was some on-going work around patient involvement in their own care at entrance level of provision within health and social care. There would also be a piece of work to ensure organisations gather and use feedback to evaluate their performance. Organisations are then able to demonstrate to the regulators that they had a public and patient involvement approach. Paul Jenkins said that this would be an exciting opportunity for services to be seen from a patient voice perspective rather than just a tick box exercise.
2.7 / Frances Blunden advised that this highlighted the need for a strategic function and getting a consumer focus through the whole of organisations. Sue Slipman was pleased to hear that the NHS Commissioning Board would be consulting on the whole system and providers responding to regulatory information requests. Jill Finney felt that these were helpful observations and asked whether the NHS Commissioning Board/Care Quality Commission/Monitor route would be recognised as an effective channel and what should be officially endorsed as a representation of the patient voice.
2.8 / Emily Holzhausen was concerned that from a family point of view, they often could not see the journey and when issues were raised they then dealt with three or four bodies. There was also a common lack of understanding about where social care fits in the map as it does not sit comfortably with healthcare.
2.9 / Ruthe Isden advised that collecting information was hugely time consuming and the NHS Commissioning Board were using the third sector in developing channels of communication. It was noted that cross learning had been completed and continued to be ongoing.
2.10 / Jeremy Taylor thought it would be useful if HealthWatch could be the equivalent of Ofcom, as a strategic body that all national organisations could refer to for information. This would be preferable to information being requested multiple times. Frances Blunden agreed about sharing information and the role for HealthWatch. A simple solution would be required, but it was not always going be easy. Jill Finney asked about the burden on the provider and the clarity around the information.
2.11 / John Adams advised that there had been a lot of voluntary sector engagement and activity through the joint strategic needs assessment (JSNA) process at a local level. He reported that providers did not understand why social care quality improvement and regulation presented such a confused picture.
Andrew Cozens added that it was good to see the shift for Monitor in the future promoting the patient experience which was currently missed in care. Gill Leng advised that NICE was fairly specific around patient involvement and said that listening to the discussion it was apparent that there was a requirement for information to be collated nationally, and asked if there was enough advice available on how patients should be involved at a local level. Jeremy Taylor advised that there was good evidence at local level of better patient care and more involvement. Intelligence gathering was usually around (a) how good a system in place was and (b) interventions of care going wrong. It was noted that Monitor – would be looking at the journey rather than the episodes of care, so there would be an understanding of how well care is being integrated.Toby Lambert also explained that Monitor would have the responsibility of intervening if a provider failed in a sector for which it was responsible.
2.12 / James Kingsland advised that the previous night’s HSC amendments had been about the difference between public and patient involvement and individual patient experience. He reported that the Clinical Commissioning Groups would be looking at behavioural changes and how the patient experience was perceived with local HealthWatches reporting in individual areas. Paul Jenkins advised that he had done a lot of work around public and patient involvement and could help the three regulators to bring the voice and strategic level together. Jill Finney suggested a joint national workshop to ensure patient and public involvement in development of Monitor, NICE, the National Commissioning Board and CQC; and give opportunities for stakeholders to speak to the Department of Health and National Commissioning Board. Paul Jenkins and Jeremy Taylor offered to provide input into this piece of work.
ACTION: Jill Finney to set up a joint workshop around Patient and Public Involvement, with Monitor, NICE and the National Commissioning Board
2.13 / Gill Leng advised that the role of NICE was based on evidence to ensure standard setting; advice and guidance; cost effective pricing and links to the regulators. The impact of the HSC would be around, value based pricing; disinvestment and innovation; and evidence on unlicensed drugs. The NHS Commissioning Board outcomes framework would give indicators about secondary care and performance improvements.
2.14 / Gill Leng said that standards in healthcare were generally around clinical decisions, but some were cross cutting with public health and social care. There were a number of questions that remained unanswered, including how the information would be used by commissioners.
2.15 / John Adams advised that the public found it difficult to understand the varying standards of homes. The previous star ratings system, had had faults, but at least it had been understood, and this was now missing in the social care field. It was noted, however, that many local authorities were already undertaking their own inspections. The problem with the HSC was the focus for the fundamental process could be potentially lost. Frances Blunden advised that care home places appeared to well competed for, with a big number of players that could drive accreditation and assurance. She asked how NICE would be linking to what was a long debated issue, and to what extent it was being taken as part of the evidence and standards. Was there some on-going work to try to rationalise the system so there were not lots of different bodies trying to develop or compete for the same space. It was noted that NICE and the NHS Commissioning Board had a role in this although there remained a gap regarding the quality of care. One solution would be for agencies and regulators to encourage the patient voice to speak out in the media. Sarah Norman felt there was a role for social media and noted that the Social Care Institute for Excellence (SCIE) was developing a website to rate social care services. She advised that it would be a mistake to think that the patient voice would assess the quality of services.
2.16 / Sue Slipman thought it appropriate that the regulators dealt with regulation and drivers for greater quality came from elsewhere.
2.17 / Emily Holzhausen felt that the main challenge remained in social care which was not directly commissioned by the local authority. She was concerned that the consumer voice was very weak and concerns were not listened to.
2.18 / Ruthe Isden advised that it was important to get the user perspective. There was a whole raft of people, many of whom were older, that were being missed. She felt it was important that the regulator saw there was a role for support to be facilitated as there were gaps in social care where people who use services did not come through the commissioning route.
2.19 / John Adams advised that the challenge was to “square the circle”, make best use of investment; assure quality and drive it up. He felt that Boards had a paramount responsibility to know what was going on in their service.
2.20 / Jeremy Taylor advised that quality information needed to be provided to enable organisations to drive up quality and understand how well they were doing. It would not be productive to over-engineer the regulatory structure.
2.21 / A question was asked about whether CQC took into account any accreditation a provider might have. Amanda Hutchinson responded that when registering organisations, CQC would take account of accreditations, and take assurance from that. If there were a compliance issue, then that would be dealt with separately. CQC would be discussing standards around dementia with NICE, and then think about how the information should be publicised.
2.22 / Sarah Norman advised that most social care providers did not have the same structure as health organisations and asked if the system had really got to grips with good purchasing decisions around social care provision. Sue Slipman agreed and stated that regulation was a small part, alongside trade bodies and associations about how the sector could receive commercial help.
2.23 / John Canning stated that in primary care if an organisation was the only provider, then it is not the service that fails if an individual organisation failed. Toby Lambert advised that the focus from the original bill had changed and if there were issues with individual services then Monitor would send in a team to look at essential services. John Harwood said that in other sectors the state would not allow lots of services to close down – institutions would be released from their current provider and interim managers sent in.
2.24 / Paul Jenkins advised that there was a need for a simple narrative, because if the group were struggling with the issue, it would be even more unclear for the person on the street. He said it needed to be clear about what it will do, and what it will not.
2.25 / Andrew Cozens said another dynamic in the puzzle was the issue of personal budgets and people exercising personal choice.
2.26 / John Adams asked if Monitor had any planned working groups set up with the social care sector with regard to economic regulation. Toby Lambert advised that Monitor had not been told that it would be regulating social care in the economic sense.
2.27 / John Harwood summed up the discussion by identifying three themes coming out of the meeting so far:
- the need to develop a narrative describing the future regulatory system and how it will work, specifically NICE, Monitor, and CQC;
- to ensure patient and public involvement in developing proposals for the future regulatory system. Paul Jenkins’ and Jeremy Taylor’s offer of help was noted and would be taken up;
- the need to align information. How does a consumer make sense of all the information available, including essential standards and other improvement information?
2.28 / John Harwood thanked Toby Lambert and Gillian Leng for their time and presentation to the Committee.
Item 3 – Feedback on the Consultation of CQC’s Compliance Model
3.1 / Jill Finney briefed the Committee on the results of the consultation. 174 responses had been received between 19 September and 9 December 2011. In addition to the consultation, CQC had engaged directly with a number of key stakeholders. The Committee noted the views of what people had said and the proposed CQC response, including changes CQC will make as a result of the findings.
3.2 / Jeremy Taylor felt that people would need a break down on what the provider was, and was not, compliant on. John Harwood stated that providers needed to be compliant on all essential (i.e. required) standards, and there remained a serious consistency problem across the sector.
3.3 / Sue Slipman thought that in terms of explaining things differently the proposals sounded good and asked how people would be informed about the compliance model. Amanda Hutchinson agreed to come back about the communications on this.
ACTION: Amanda Hutchinson to provide the communication plan for the new compliance model to the Committee.
3.4 / The Committee noted that the recommendations about changes to the compliance model were subject to Board discussion on 15 February. Changes would go live in April 2012.
Item 4 – Feedback from the CQC Board
4.1 / John Harwood advised that the Board had welcomed the Committee report and the minutes of the meetings and has committed to continued involvement with the group. He noted that there had been minor amendments to the membership and terms of reference, which had been circulated with the agenda. He would be providing a report of this latest meeting to the February Board.
Item 5 – CQC’s Strategic Review
5.1 / Jill Finney advised that the CQC Board would be holding the first session of the Strategic Review on 14 February. Timelines and methods of external consultation would also be discussed. Once the time line of the strategic review was known, the next Stakeholder Committee meeting would be set up to allow timely input into CQC’s review.
ACTION: Secretariat to contact Committee members with a proposed date of the next meeting.
5.2 / John Harwood advised that the Board felt there were two fundamental reasons to relook at the strategy. The first was the changing environment with responsibilities removed, the creation of HealthWatch and involvement of Monitor. There was a series of compliance with required essential legal standards that providers needed to meet, and it was noted that the level of non-compliance was higher than envisaged and there were implications for resources and two underlying drivers. The second was to review the strategy involving all sorts of stakeholders; including committee, thought the timeline was not clear. The next meeting of the Stakeholder Committee would be scheduled as to allow members of the Committee to feed into CQC’s strategic review.
5.3 / Jeremy Taylor asked whether the DH Capability Review and Francis Inquiry would be taken into account. John Harwood advised that the Board had a further meeting the following week with the Department of Health about the capability review but the broad shape of its conclusions and recommendations were clear, and taking into account the Strategic Review and the new NAO report. It was more difficult to predict the outcome of the Francis Inquiry or whether its recommendations would be accepted.
Item 6 – Minutes and Actions from last meeting
6.1 / John Harwood advised that all actions had been completed and they would now be closed on the action log.
6.2 / Sally Taber asked about the draft report of the NHS Future Forum as a link to the final report had been sent to members. Jeremy Taylor apologised that the Committee had not received the draft report to comment on.
Item 7 - Any Other Business and Closing Remarks
7.1 / John Harwood advised that he proposed a meeting in June and would circulate a number of dates. In addition he welcomes the proposal that there should be a meeting before then to consider the emerging CQC strategic plan. When the time table for the strategic review has been developed, dates for an exceptional Stakeholder Committee meeting will be circulate by e-mail. Future meetings would start at 10:30am to allow people to travel into London.
ACTION: Secretariat to circulate dates for an exceptional meeting/ a meeting in June 2012.
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