Regulating the dental sectorTracy NortonCompliance Manager (Central Region)

4 October 2012

People can expect services to meet essential standards of quality, protect their safety and respect their dignity and rights, wherever care is provided and wherever they live, despite changes in the system

Role of a regulator

CQC – what CQC does and does not do

What CQC does not do

We do not make assessments of commissioning – although we can comment on

shortcomings via themed reviews and investigations

We do not assess quality above essential standards

We only promote improvement by focusing on non-

compliance

Inspectors are encouraged to describe what they see,

comment on good practice and reference it

CQC’s role

Register – inspect – enforce – publish

CQC registers care providers then checks whether they are meeting essential standards

If not, we take action – they must put problems right or face enforcement action

We publish what we find as quickly as possible

We share what we know with our partners

We put a premium on users/ whistleblowers

We monitor the care of those detained under the MHA

Scale of CQC regulated care

Primary medical services

9,000 locations

NHS Trusts

2,500 locations

Independent healthcare

2,500 locations

Adult social care

24,500 locations

Independent ambulances

300 locations

Primary dental care

10,000 locations

Combined outpatients and inpatients

77.4 million

People using adult social care services

1.75 million

Dental appointments

36.4 million

Principles ofinspection

Our approach to inspections

Timely

At least once a year or once every two years depending on the provider

Focused

Inspections will focus on outcomes that are important

to people using services

Flexible

We can use different types of inspection to respond to concerns

Unannounced

We do not notify providers before we carry out inspections

What can you expect at a dental inspection?

• A scheduled inspection will check compliance against five regulations (from across the five domains).

• Inspectors will use information we already hold to plan which regulations will be inspected – and also extend the range of inspection on the day if it becomes apparent there may be non-compliance in other regulations.

• We have to inspect the 16 essential standards across a period of five years.

• We will always inspect Regulation 9 (Outcome 4 – Care and welfare of people who use services) at every inspection.

• At first inspections we will usually inspect regulation 12 (Outcome 8 – cleanliness and infection control) using the HTM01-05 Essential Quality Requirements to look for expected practices.

What can you expect at a dental inspection?

• We will want to speak with patients using the service where possible• We will want to speak with the registered manager• We will look at a surgery• We are unlikely to observe treatment but may wish to observe the

initial dialogue (relating to medical history etc)• When inspecting Regulation 12 we will want to speak with the dental

nurses and ask them to show us the procedures for cleaning and decontamination

• We will ask for documentary evidence where necessary ( if records are computerised we will look at those)

• We will not be giving you advice about how to comply – we are an arms length regulator and therefore that is not our role

Compliant or non-compliant?

• If we find that you are compliant with each of the regulations we inspect against then you will usually not receive an inspection for two years (unless we receive information which requires us to bring forward our next scheduled inspection or carry out a responsive inspection).

• If we find you are non-compliant we will use our judgement framework (published) to judge the impact on people using the service (minor, moderate or major).

• We will take compliance or enforcement action according to the criteria within the judgement framework (minor impact = compliance action; moderate = compliance action or warning notices; major = warning notices).

• If we find non-compliance across a number of regulations we will use our regulatory escalator model to help determine our regulatory response.

Following up non-compliance

• If we have set compliance actions we will ask you to submit a report describing how and when you will return to compliance.

• We will re-inspect within three months of the date at which you tell us you will be compliant.

• If we have issued warning notices we will give you a date by which we expect you to be compliant. We will re-inspect shortly after that date.

• If we find further evidence of non-compliance in the same part of the same regulations we will consider and use our enforcement powers.

Reporting our findings

• You should receive a draft report within 10 working days of the site visit (or the last day we gather evidence). The report will have been through our quality monitoring procedures. Reports are sent to the Nominated Individual and the Registered Manager.

• You will have an opportunity to comment on the factual accuracy of the report.

• The final report will be published on our website.

• If you have received warning notices you may make representations against the publication, but not the issuing of the warning notices. Guidance and the appropriate form are on the CQC website.

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What have we learned?

NHS trusts – April 2010, 400 providers

Private healthcare – October 2010, 1,500 providers

Adult social care – October 2010, 12,500 providers

Dental care – April 2011, 8,200 providers

• Early engagement is vital• No two sectors are the same• Tailored approach to registration for each sector• Partnership approach to guidance

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What have we learned?

• Different risk in different sectors

• Tailor our approach to compliance

• Journey of improvement, continue to work with each sector

• Sectors are dynamic, important we are dynamic and responsive

• Open dialogue

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The future

Inspection of each dental provider every two years at least

Cover a wide range of regulations

Inspectors to access dental specialists

Improved registration process

CQC strategic review – What should successful regulation by CQC look like?

Consultation on fees

Share your views on the fees that registered health and social careservices should pay.

We have launched a consultation on the fees that we propose to charge health and social care services that are registered with us.

The changes for the fees in 2013/14 include:redefining fees categories. a change to the banding of fees for primary dental services.

Send us your responsesSend us your feedback online.Email us at octoberfeesconsultation2012@cqc.org.uk.

The consultation closes on Friday 21 December 2012.

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Closing comments

The public puts its faith in those who run and work in care services

There must be a culture that won’t tolerate poor quality care, neglect or abuse – and encourages people to report it

The regulator cannot be everywhere, so we need to regulate with others

We remain cost blind in checking standards

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Questions

CQC – Helping make care better for people

www.cqc.org.uk

Questions?