PUBLIC BOARD, 19 January 2022

TITLE: Executive Team Report to the Board

Executive Sponsor: Ian Trenholm - Chief Executive

PURPOSE: FOR ASSURANCE

This paper is provided to enable the Board to fulfil their duties in relation to:

Holding the Executive to account for performance and the proper running of the organisation

PROPOSAL OR RECOMMENDATION

This is a paper for the Board to note. Information contained in this report was accurate as of 12 January 2022. Any further developments or amendments since the circulation of this paper, will be brought to the Board’s attention in the meeting.

Chief Executive Officer’s report

1. Annual Report and Accounts

Following pension assurance work by the National Audit Office, we have prepared to certify and lay our Annual Report and Accounts. As Accounting Officer, and with the delegated authority of the Board, I have reviewed and approved the final report prior to its certification with the Comptroller and Audit General. I anticipate that the report will be laid in Parliament later this month. I wish to record my thanks to everyone who participated in the production of the Annual Report and Accounts, including our members of the Audit and Corporate Governance Committee.

2. Executive Recruitment

The selection process for the National Director of Healthwatch England has concluded and I am pleased to announce that Louise Ansari has been appointed and is due to start next month. Louise joins with a strong background in health communications, social policy and local services. For the past five years, she has been Director of Communications and Influencing at the Centre for Ageing Better. Louise will attend an upcoming Board meeting to introduce herself to colleagues.

Chief Inspector of Adult Social Care’s report

3. Operational Priorities

During January ASC will focus our inspection activity in 3 areas:

1.Inspections of emerging risk:

These inspections will be in response to emerging or inherent risk agreed as part of a Management Review Meeting.

2. Infection Prevention Control (IPC) ‘Plus’ (including our workforce tool):

These inspections use targeted methodology and therefore cannot re-rate, using our IPC tool. They also include our workforce tool, questions about visiting arrangements and vaccinations as a condition of deployment (VOCD). They can be scheduled or triggered by concerns about any of the following; IPC practice, visiting, workforce, VOCD.

3. Inspections to create capacity in the system:

These will be inspections of services primarily rated as Requires Improvement where our intelligence tells us the quality of the service has improved and by re-rating we may create additional capacity in the sector; or services that are unrated where awarding a rating will create additional capacity in the system.

4. Workforce

Emergence of the Omicron variant has added to staffing pressures within the Adult Social Care sector, with large numbers of care workers required to self-isolate. Over recent weeks we have seen a significant increase in notifications about staffing shortages which impact on a provider’s ability to deliver a regulated activity. We are monitoring these notifications and inspectors are sharing information with local authorities as appropriate to ensure that people continue to receive safe and effective care.

Appendix A contains an update to the care home vacancy data we first shared in our State of Care report in October 2021, along with a breakdown by region. We will continue to monitor and publish these vacancy figures, and aim to provide more and wider information on workforce issues in adult social care over the coming months.

5. Visiting

The current government guidance on visiting for ASC care homes was published on 30 December 2021. The guidance makes it clear that people should have access to an essential care giver and three other nominated visitors. Where providers are not following this guidance, we are following this up and where necessary undertaking inspections, particularly if there are concerns about blanket bans.

We have communicated in our external ASC provider bulletin about the importance of visiting and have issued a statement on our website on 17 December 2021 emphasising the importance of providers supporting people to have access to their visitors.

When concerns are reported to CQC we ensure we corroborate what we are hearing, we discuss the concerns with the person who has made the referral, with people who use services and relatives as well as with the provider. We are also using our experts by experience to ensure we get feedback from people using services and their relatives/visitors.

Chief Inspector of Hospital’s report

6. Update from Chief Inspector of Hospitals

All services continue to be under considerable pressure, brought about by a combination of recurrent winter pressures with the continuing Covid-19 pandemic. Many services are having to manage severe workforce shortages caused by staff isolating.

We are working closely with NHS England at national and regional level to ensure there are not regulatory barriers to necessary risk-based plans to maintain safe care. This includes support for flexible use of the workforce and the establishment of surge hubs on hospital sites.

We have postponed our on-site regulatory activity in acute hospitals and ambulance services but are continuing to closely monitor the levels of risk. Where there is evidence of risk to life, or the risk of serious harm we will intervene directly.

As a consequence, our inspection activity has been more limited and focused on the independent health sector and Mental Health services. During December we conducted 40 inspections in total and published 10 reports. Whilst we have a schedule of inspections to the end of March that is being kept under regular review to ensure we are able to support the acceleration of the national vaccine booster programme, recognising the increased pressures the NHS finds itself under due to the rapid spread of the Omicron variant.

Chief Inspector of Primary Medical Service’s report

7. Medicines Optimisation

We currently have 40 medicines information pages to support adult social care providers and inspectors to promote a single shared view of quality for medicines optimisation. Over the last two years we have had 891,977 views of these pages and excellent feedback about them. The two most popular pages have been reporting medicines related incidents and covert administration of medicines. We signpost a large number of enquiries to these pages that come via our medicines.enquiries@cqc.org.uk mailbox and encourage all new inspectors, through the induction sessions we present at, to be conversant with them.

8. Give Feedback on Care – GP Practices

The number of Give Feedback on Care enquiries for GP practices has been rising over the last two years (for example there were 367 in January 2020 compared to 1185 in November 2021). The numbers broken down by region and team are being monitored.

Concerns from people using services and stakeholders about access to general practice, continue to be a significant theme in the contact we receive. In order to respond to the information we receive in a timely and proportionate way, we have undertaken some short inspections with a specific focus on how GP practices enable people to access appropriate healthcare.

During December 2021 we undertook 40 of these inspections and are currently reviewing our findings. Although we carried out these inspections in response to potential risk, we also sought to identify and highlight good practice where we found it. Our review of the inspection findings is helping us to broaden our understanding of the approach of the local healthcare system as a whole to support appropriate access to healthcare.

Executive Director of Operation’s report

9. Update from the Executive Director of Operations

Last month I updated the Board on the steps we were taking to increase capacity in the system. As we had decided before Christmas to adjust our operational approach, particularly in relation to GPs and NHS Trusts, to support the Vaccine Booster campaign, we have deployed a number of Primary Medical Services and Hospitals’ colleagues to Adult Social Care to support their priorities. Training has been done and colleagues are now undertaking the additional inspections I promised. I will give the Board an update when we meet.

Otherwise, I have continued to oversee work to lighten the workload of our inspection teams by, for example, equipping the National Customer Service Centre to take on additional enquiries and complaints and making fuller use of our cadre of Bank Inspectors. I have also been working with the central Performance Team as we look to advise the Board on our operational priorities for the new performance year.

Chief Operating Officer’s report

10. Performance Report for November 2021

Our business plan for 2021-24 was published in August 2021 which is a 3-year rolling plan for 2021-24, with a firm set of objectives for the first period to March 2022. Across December 2021 our organisational priorities changed both in support and responding to the risk in the sector. These priorities have resulted in a change in our delivery focus in January. This update summarises the key delivery areas against our business plan and public commitments at the end of November 2021, as well as an update on the CQC financial position as at Month 8. A verbal update can be provided during board on our December and January delivery to date.

Delivering Our Regulatory Business

Manage risk to people – We will analyse data we capture and interpret it to identify risk

We undertake both inspections and provider calls (our monitoring approach) to undertake regulatory activity. 16.5% of registered services had regulatory activity for the year to November 2021 which is an increasing position. As well as our inspection and monitoring activity we make a judgement on services and publish a regulatory response, speak to people receiving care, staff and the public through our National Customer Service Centre. Our Market Oversight and Corporate Provider Team also meet with providers on regular occasions.

Of those inspections that have a recorded risk trigger, due to new intelligence/information triggering our inspection, 53.19% are triggered by information of concern.

Where the information we have does not find evidence that we need to re-assess the rating or quality at a service, we now publish a short statement on the profile page on our website for these services. We are undertaking some sample inspections of these services. As of 31 December 2021, 234 QA sample inspections and 37 QA clinical reviews and monitoring calls have been undertaken which helps to inform our learning and future approach.

Ensure we offer a timely registration service which meets the needs of public and providers

Simple (-13.2%) and Normal (-11.4%) registration applications are progressing well to meet the 15% reduction target by year end. Complex applications are at 8% increase however as there are on average 46 complex applications each month the timeliness is variable. Year to date 22,294 registration applications have been complete and processed.

Respond to risks in a way to keep people safe

YTD we have seen a 63% increase in GFOC from the same period last year, equating to an additional 15,099 enquiries in this period. A driving factor is the increase in PMS, in particular the General Practice sector which has seen a 151% increase.

From April 2021 to 31 December 2021 we have undertaken 3645 inspections in response to risk, 3022 are published of which over 56% were rated requires improvement or inadequate, a 9% increase from reporting at the end of October 2021.

As part of our quarterly engagement survey (with services) we are now asking services if they are confident that we use the experiences of people effectively in our regulatory activities, decisions, and judgements. The most recent survey went live in December 2021; therefore we will have more information available for the next board meeting.

Transform regulation of learning disability and autism

Currently 86% of services for people with learning disabilities and autistic people are rated good or outstanding. We will continue to monitor the variance in ratings across sectors and regionally.

In response to the findings of the ‘out of sight’ report and the Glynis Murphy reviews we are testing out a new approach to the inspection of services for people with learning disabilities and autistic people. This includes a multidisciplinary team approach to the new inspection, new tools and an expectation that site visits are planned to look at key times during the day, including out of hours. To date we have undertaken 28 new approach inspections and 46% included some out of hours inspection activity.

Deliver our independent voice and key publications

Of those services completing the quarterly engagement survey, 42% said our independent voice products supported them to make changes to improve quality of care. The most recent survey went live in December 2021; therefore we will have more information available for the next board meeting.

We are monitoring the number of report views on our independent voice report publications. Since State of Care was published in October 2021 it has received over 20,000 views. ‘Successful community support for people with a learning disability, a mental health need and autistic people’ and ‘Safety, equity and engagement in maternity services’ have both been well received with 5224 and 3879 views respectively since publication.

Transformation to deliver our strategy

Most milestones documented in our business plan, from our change programmes, are currently on track for delivery. There was a delay in the Fees Calculator work which was due to go live in October and has now gone live in December, and the Data and Insight Unit go live expected in January is now scheduled for March 2022. Mitigations and focussed reporting are in place in both areas to minimise any further risks and/or delays.

Managing our people and resources

Deliver our people plan

In our people pulse survey in July 2021 61% of colleagues said they would recommend CQC as a good place to work

Demonstrate a visible commitment to good mental health and equip managers to regularly engage, monitor and respond well.

In our people pulse survey in July 2021, 59% of colleagues said CQC supports the wellbeing of colleagues.

The overall sickness rate is currently 3.7%, across the 12 months. The rate of sickness for stress or mental health is 1.3%.

Develop a diverse CQC workforce with equal opportunities for everyone and a culture of inclusion

14.0% of all employees are minority ethnic groups, whilst 8.7% of colleagues have declared a disability.

100% of recruitment panels for executive and grade A roles have an independent panel member.

Manage our finances and resources effectively

Revenue: at the end of November, the revenue budget is underspent by £9.5m and this is forecast to increase to £11.3m for the 2021-22 financial year. This is across pay and non-pay and reflects a combination of ongoing reduced travel and timing of delivery of our activity.

Capital: at the end of November the capital budget is underspent by £2.9m, however this is forecast to reduce to a £0.1m underspend for the 2021-22 financial year.

11. People Plan update:

Inclusion and Wellbeing

Mental Health and Wellbeing Strategy:The July Pulse survey evidenced a high awareness of Mental Health and Wellbeing resources but lower usage than we would expect and brought out inconsistencies in people feeling supported. We are now reviewing the pathways to managing mental health and wellbeing in the workplace to ensure that these are effective. This looks at what mechanisms would best support and what actions are required to embed effective use.

Key factors:

Maximising available resources to deliver the greatest impact.

Balancing support to stay well and support to aid recovery.

Considering the different needs between general MH and wellbeing and managing a diagnosed mental illness.

The outcome of this review will include decisions on our provision of support mechanisms and what is required to embed their effective use. Any decisions will be agreed for implementation early in the next financial year.

Employee Experience

Talent and Resourcing: We have 32 colleagues enrolled to start their Level 3 or Level 5 Management apprenticeship. Selection is also underway for three candidates to join us in January 2022 as part of our first Digital Graduate programme.

Employee Insights

The biennial People Survey closed on Tuesday 7 December 2021. The survey received 2,211 responses (a 73% participation rate). The questions asked in the survey were selected following consultation with a range of stakeholders including networks, unions and specific topic owners. They are broadly consistent with those asked in 2019, which allows us to track progress. High-level results will be shared with the Board in February 2022.

Chief Digital Officer’s report

12. Information and Cyber Security Risk

There are no significant information or cyber security issues to report this month.

Last month we reported the global Apache log4j cyber vulnerability and our response. I can confirm that we have now completed all necessary patching and remediation activity and can report that there's been no impact on CQC.

Our programme of continuous improvement for Cyber Security is progressing well and recent work includes the review and optimisation of our information security policies and our security operations centre capabilities. We are also progressing well in a review of training and education needs for the organisation as a whole.

Engagement, Policy and Strategy Directorate’s report

13. Parliamentary update

The Health and Care Bill has now completed all stages in the House of Commons and Second Reading in the House of Lords. The Bill is now in Committee Stage in the House of Lords. We continue to engage with Peers, as well as monitoring the progress of amendments through this stage. On 10 January, Ian Trenholm and Chris Day met with Rt Hon Jeremy Hunt MP, Chair of the Health and Social Care Select Committee to discuss our future approach to regulating systems and our response to the ongoing pandemic.

We have submitted written evidence to an inquiry on ‘Workforce: recruitment, training and retention in health and social care’ being held by the Health and Social Care Select Committee. Our evidence looks specifically at our findings from Provider Collaboration Reviews in relation to whether there were enough staff with the right skills in place to support people during the pandemic.

Ian Trenholm and Peter Wyman have written to the new Shadow Secretary of State for Health and Social Care, Wes Streeting MP, to welcome him to the role and to offer an overview of our work.

Peter Wyman and Ted Baker have written to Daisy Cooper MP, the new Liberal Democrat Spokesperson for Health, Wellbeing and Social Care to respond to her recent letter on our regulation of ambulance services and our monitoring of the sector.

14. Engagement update

Ethnicity data recording in mental health: Appendix B cover the quality of ethnicity data recording for mental health services within local health and care systems. This follows on from concerns raised in our State of Care report and the Provider Collaboration Review on children and young people’s mental health services, on how the pandemic has shone a light on inequalities in mental health care. We highlight the poor recording of ethnicity and the importance of improving how this data is captured and used by services and systems.

Public Behaviour Change Campaign Launch: January will see the return of our ‘Because We All Care’ campaign with the national launch of the year-long, multi-channel, behaviour change campaign. ‘Because We All Care’ seeks to drive people to share experiences of care with CQC to increase the support our effective and smarter regulation of services. Feedback is essential to the NHS and social care system – and people’s experiences of care are fundamental to understanding and improving services. Throughout the year we will focus on and target specific audiences: carers, long term conditions, over 55s, people with a learning disability and autistic people – a thread across all these audiences is reaching people from marginalised groups.

Mental Health Act Annual Report: This is our statutory annual report to Parliament on our Mental Health Act (MHA) monitoring activities in 2020/21, due to publish in January 2022. This is a continuation from the annual report last year, looking at monitoring of the Act during the pandemic. As well as reporting on our statutory responsibilities, the report focuses on key issues around person-centred care, ward environments and equalities. In particular, the report highlights examples of good practice in the provision of inpatient mental health care during the pandemic. It also acknowledges the difficulties experienced by patients and staff due to the reduced opportunities in various stages of lockdown. This year’s report also includes a report on the findings from the Independent Care, Education and Treatment (ICETR) reviews.

2021 Maternity Survey: Since 2007, the maternity survey has been carried out as part of our wider NHS patient survey programme (NPSP) and will publish in February 2022. The 2021 survey asked women over the age of 16 who gave birth in an NHS trust run maternity service during February 2021 about their experience - from the first time they saw a clinician or midwife, during labour and birth, through to the care provided at home in the weeks following the arrival of their baby. The survey used a mixed mode method of data collection where respondents were encouraged to respond online in the first instance (with SMS links and reminders) but were still given the option of a postal questionnaire. A summary of the national results and data on the findings at trust level will be published in February 2022.

Author: Eleanor Sharpe, Executive Personal Assistant