CQC Launches Consultation On Its Next Phase Of Regulation

The Care Quality Commission (CQC) is inviting people to give their views on its plans to deliver a more targeted, responsive and collaborative approach to regulation across health and adult social care in England.

Having carried out a comprehensive inspection of every NHS trust in England at least once, CQC has a more detailed understanding of the quality of NHS care than ever before. The quality regulator plans to use that understanding, together with improved systems for gathering intelligence, to move towards smaller and more targeted inspections for NHS trusts, while still being focused on what matters most to patients – whether services are safe, caring, effective, responsive to their needs and well-led. These inspections will be based on inspection findings and ratings, as well as wider intelligence about the quality of care gathered through improved monitoring activity.

The proposals, published today (Tuesday 20 December), describe how CQC intends to develop its ‘next phase’ of regulation for all health and adult social care services, with a particular focus at this stage to the way it will monitor, inspect, rate and report on NHS trusts and adapt its approach in response to emerging new care models. CQC plans to work with changing care models as they develop, and ensure close alignment with other regulators to minimise unnecessary burden for providers.

CQC’s inspections have shown that good leadership is critical in ensuring that people receive safe and high-quality care and in driving improvement. With this in mind, CQC plans to carry out an assessment focused the trust’s leadership.

As well as this, CQC intends to carry out an unannounced inspection of at least one ‘core service’ (such as urgent and emergency or child and adolescent mental health wards) of a NHS trust. The core services inspected will be chosen based on previous inspection findings and ratings, as well as wider intelligence that indicate either risk or improvement. Also, CQC’s consultation outlines proposals to strengthen and simplify the assessment frameworks and ‘key lines of enquiry’ across health and adult social care, which inform its judgements. This will make it easier for providers to know what is expected of them and to allow greater consistency in how quality is measured.

Alongside this consultation, CQC is consulting jointly with NHS Improvement on the approach to leadership and ‘use of resources’, recognising that effective use of resources is fundamental to enable trusts to deliver and sustain high quality services for patients.

The plans in these consultations build on what CQC outlined in its five year strategy for regulation (2016 to 2021), Shaping the future.

David Behan, chief executive of the Care Quality Commission (CQC) said: “People tell us that they want to receive care that is high quality and safe. This consultation is about evolving our existing approach using what we have learnt from our comprehensive inspections to help drive further improvement in the quality and safety of care, while adapting to changes in the way services are being provided.

“Our proposals for NHS trusts are designed to enable us to be more responsive to risk and improvement while at the same time being more efficient and effective. By working more closely with partner organisations, we will reduce duplication and unnecessary burden for providers.

“We want to simplify our assessments, but also strengthen them using what we have learned over the last three years to make sure they continue to highlight best practice, identify concerns and where necessary, to take appropriate action whilst supporting inadequate providers to improve their quality and safety in the interests of people who use their services.”

CQC is seeking views on a number proposals set out in its consultation document, including for all providers it regulates:

• Updates to the frameworks inspectors use to make judgements about the quality of care. This includes reducing the number of assessment from 11 to two – one for health services, and one for adult social care. This will reduce complexity and better align the questions inspectors ask of different sectors. Service-specific material and prompts will still be used to inform inspections of core services.
• A set of principles to guide our approach to regulating in a changing landscape of care provision, including new care models and complex providers.
• Updated guidance for registering learning disability services which makes clear the expectation on providers to ensure their models of support are built on evidence-based care and in line with national policy.

For NHS trusts specifically:

• A shift to focus on the use of information gathered through strengthened ongoing monitoring of trusts and improved relationship management, while carrying out a more targeted and tailored approach and fewer comprehensive inspections.
• A new annual provider information request for all NHS trusts that will be less detailed, requiring them to describe their own quality based against CQC’s five questions. This information will feed into ‘CQC Insight’ and the wider intelligence held about the trust and used to help inform where and when to inspect.
• Greater alignment with NHS Improvement to avoid duplication and support trusts to meet the dual challenges of quality and efficiency.

The consultation is open for eight weeks and will close on 14 February 2017. CQC expects to formally respond to the feedback from the consultation in spring 2017.

A further consultation focusing on how CQC will regulate adult social care and primary medical care will take place next year.