By Shannett Thompson, healthcare regulatory partner at Kingsley Napley (www.kingsleynapley.co.uk)
On 27 May 2021, the Care Quality Commission (the “CQC”) launched its new strategy for 2021 and beyond which ‘champions regulation driven by people’s experiences of care’.
The strategy describes a number of key shifts the CQC will adopt, both in terms of its regulatory role and its approach in perform- ing its regulatory function, which care home owners and care home professionals should be aware of.
As well as an ‘unremitting focus on safety”, there is a new emphasis on the culture that operates in care homes and listening to those who work in the sector and the families it serves.
THE CQC SETS OUT ITS AMBITIONS UNDER 4 THEMES:
1. A focus on what matters to people and communities when they access, use and move between services.
Notable here is the intention to prioritise listening to feedback and to implement better tools to enable the CQC to identify and engage with the public including a commitment to the most vulnerable and disadvantaged in our society. Doing more to reach different groups of people and raise public awareness of the CQC and its role as a regulator also features prominently, with an aim of empowering people and providing greater transparency on how the CQC views what is good and outstanding care.
2. Ensuring smarter regulation that is more dynamic and flexible in approach to enable the CQC to better target its resources to manage risk and, when care is poor, to respond effectively and proportionately.
Traditionally, the CQC’s method of quality assessment has predominantly involved carrying out routine on-site inspections to observe and rate the care people receive. Its new strategy suggests a move away from reliance on such, towards an approach that is more flexible and targeted.
This marks quite a considerable change for the CQC and could be more favourable for providers in the health and social care sector. The present inspection model has a significant margin for error since it can only realistically provide a snapshot based on what the inspectors see and hear during the process. The new approach should mean greater emphasis on the CQC conversing and engaging with services and local systems around quality in a much more on-going fashion, and carrying out on-site inspections only when there is a clear need to do so. Then the focus of on-site inspections will be less on monitoring activity and analysing paperwork and more about talking with service users and staff. The proposed outcome of this new way of assessing quality will be more meaningful ratings.
The fact this will be supported by better data integration and better digital platforms should also make it easier for service providers to work with the CQC, via more efficient submitting of data. The aim is to minimise duplication and the creation of unnecessary workload.
3. Regulating organisational cultures to improve safety through learn- ing, focusing on improving expertise, listening and acting on people’s experiences, and taking clear and proactive action when safety does not improve.
The CQC is not alone as a regulator in attaching greater importance to culture. For the care sector of course a strong safety culture is important to ensure “risks aren’t overlooked, ignored or hidden – and staff can report concerns openly and honestly, confident that they won’t be blamed.”
The CQC will expect service providers it regulates to demonstrate that learning and improvement are the primary response when anyone raises concerns. It will also focus more on the types of care setting where there is a greater risk of a poor culture going undetected, acknowledging that people in particular services are often afraid or unable to speak up for themselves and more likely to be failed by a poor culture.
The strategy indicates a pragmatic and determined approach will be adopted, whereby the CQC will use its powers and act quickly where it deems improvements take too long or where the changes proposed by a service provider under investigation for poor culture will not be sustainable: “We’ll take action where services are unable to identify systemic issues in their own organisational culture or fail to learn lessons from widely publicised failures happening across health and care.”
4. Spotlighting priority areas to accelerate improvement by collaborating and strengthening its relationships with services and the people who use them.
We expect the CQC to be more heavily engaged in collaborating with local services and systems and offering greater clarity on the standards it expects. A new programme of activity is also suggested to drive change, involving the publication of new guidance, tools and frame- works to inform and support good practice. This is likely to include examples of what works based on findings from the CQC’s in-depth reviews, and more activity around research it undertakes to drive evidence-based improvements in practice. It is clear that the CQC intends to play a more active role in setting clear expectations, enabling access to support, and empowering services, in addition to its core regulatory and enforcement role where it observes poor care.
This is a strategy aligning the CQC with the aims of the recent Government white paper on Health and Social Care reform requiring increased collaboration between the CQC as regulator and the local community systems and services it regulates and supporting the shift to more integrated services.
As ever the proof of the pudding will be in how quickly the CQC gears up and evolves in practice to support these ambitions. For those work- ing in the care sector it is surely good news that greater engagement and collaboration underlie many of these changes and that the standards the CQC expects will be clearer. On the other hand, where poor practices and culture exists, there is a greater chance a light will be shone and continuous assessment will require a more concerted effort to meet obligations and deliver on improvements.