The Care Quality Commission (CQC) is to inspect more health services provided in the community. Inspections will be carried out by larger teams who will spend more time visiting services. The starting point will be inspections of large organisations that are commissioned to provide a wide range of NHS services to local people.
The plans are set out in A fresh start for the regulation and inspection of community health care
More and more health services are delivered in community settings, including people’s homes, health centres and community hospitals. Care is getting more complex as some acute services are moved out of hospital settings and, where appropriate, people are being cared for where the feel most comfortable, such as their own home.
Some people may receive a range of community health services, as well as other care and support services, at the same time. This increases the need for services to be co-ordinated within an organisation and for it to work well with other local providers and agencies.
CQC’s inspections of these services will be carried out by larger teams and will include specialists in the different aspects of care provided. Inspections will also involve people who use services. Teams will include:
• Expert CQC inspectors
• Relevant clinicians – for example district nurses, community nurses, health visitors, allied health professionals such as occupational therapists, GPs, paediatricians, directors and managers
• Experts by Experience – our comprehensive inspections will always involve people who have experience of using care services.
People’s experiences of services will be at the heart of CQC’s assessments of these services. This means looking at issues such as access to services beyond office hours, the effectiveness of care and support for people living at home, preventing people from being admitted and re-admitted to hospital, the quality of long-term conditions management, the quality of integrations across health and care services, and the sharing on medical records across the system.
Our inspection approach will be to look at a range of services, locations and local areas and we will look at how well quality and risks are managed across all services. CQC wants to improve its understanding of how well services are governed across widely dispersed locations and teams.
The inspection programme will be led by CQC’s Chief Inspector of Hospitals, Professor Sir Mike Richards, who said: ‘Community health care services have an increasingly important role in people’s lives, particularly in terms of providing care to people close to where they live.
‘We have not given enough specific attention to community health services in the past, so I am determined to strengthen our oversight of the sector and develop a picture of the quality of care that is so important in many people’s lives. I will be giving ratings to community service providers so people can be clear about the quality of services and to help drive improvement.
‘Where we can, we will align our inspections of community health services with other sectors we regulate, such as community mental health or learning disability services, substance misuse services, primary care services and acute hospitals.’
CQC’s new approach will start with inspections of five large, complex organisations that provide a range of services, including NHS trusts and social enterprise providers. Once we have tested the approach for these providers, we will consider how we can adapt it to smaller community health care providers in the independent and voluntary sectors.
The five organisations to be inspected between January and March are:
• Bridgewater Community Healthcare NHS Trust
• Central Essex Community Services
• Derbyshire Community Health Services NHS Trust
• Solent NHS Trust
• St Georges Healthcare NHS Trust (hospital and community health services)
A fresh start for the regulation and inspection of community health care says CQC will identify a set of services that it will always inspect for a community health provider. For the first inspections, these will be:
• Services for children and families
• Adults with long-term conditions (including district nursing, specialist and rehabilitation services)
• Adults requiring community inpatient services (we will visit all community hospitals)
• People receiving end-of-life care.
We will learn from the first group of inspections and work with the sector and with patients and the public to explore whether this is the best approach and also to do more detailed work to describe what good and outstanding care looks like for these services.
Community healthcare organisations provide a range of services for adults and children. These include universal services to specific groups, particularly children and families, as well as more specialist and enhanced healthcare services.
Care and treatment services that fall within the community healthcare sector include the following:
• District nursing
• Health visiting
• School nursing
• Community rehabilitation
• Community therapist
• Specialist nursing services for people with long-term conditions
• Hospital at home services
• End-of-life care delivered at home
• Specialist community dental services.
A fresh start for the regulation and inspection of community health care is available on CQC’s web site