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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