31 / 01 / 2017
Our next phase of regulation – A more targeted, responsive and collaborative approach
Care Quality Commission, December 2016
The CQC is consulting on a number of proposals aimed at supporting delivery of its 2016-21 strategy and the next phase of quality regulation. Its approach is intended to be more flexible, in response to an evolving provider landscape, while also targeted on significant concerns and improvements. Moreover, provider leadership will be afforded more emphasis and the regulator is responding to concerns the Confederation have raised about alignment with NHS Improvement and other national bodies. This summary will focus on the most pertinent issues covered in the document, upon which we would very much welcome member views.
Regulating new care models and complex providers
- It is stressed that the CQC will “make sure that regulation is not a barrier to innovation”, but also that providers need to demonstrate clear direction regarding quality maintenance and risk management.
- A set of nine principles have been developed, covering issues such as accountability, proportionality, alignment, transparency and comparable assessment.
- Further consultation in the spring will consider how the CQC should best register the ‘guiding mind’ of complex providers.
- A range of specialist teams should all be involved in the inspection of providers offering a broad number of services.
- The CQC is clear that they “will not penalise providers that have taken over poor services because they want to improve them.”
- Eleven sets of key lines of enquiry (KLOEs), prompts and rating characteristics have been streamlined into two – one for health and one for social care. The framework for NHS and independent hospitals, specialist mental health, community services and ambulance services will be introduced from April.
- It is emphasised that “the majority of content is very similar” in the new frameworks and the amendments are not intended to “raise the bar” in relation to attaining ‘good’ or ‘outstanding’ ratings. The proposals are also aimed at achieving greater alignment and supporting the introduction of the single view of quality.
- The five key questions will be retained and continue to carry equal weight. Learning from inspections has prompted revisions in areas such as recruitment, safeguarding, discrimination, medicines management, information sharing (safe) and the support of a caring culture (caring).
- A jointly-produced framework with NHS Improvement will evaluate the leadership of all healthcare providers, with the CQC unequivocal that “there is a demonstrable link between leadership, culture and the delivery of safe, high-quality care.” As a result, the number of KLOEs in this area will increase from five to eight.
- A number of KLOEs and prompts have been added across each of the five key questions, encompassing themes such as: system leadership, integration and information-sharing; information governance; technology; medicines; end of life care; and personalisation.
- Other priority areas are also to be reflected in the revised assessment framework including equality for staff, supporting healthier lives and seven-day services (acutes only).
Next phase of regulation – NHS trusts
- It is expected that the CQC will inspect at least one core service in each trust and assess the well-led question at trust level ‘approximately annually’, with the focus on either those where the regulator has ‘greatest concerns’ or where they most expect quality to have improved. In keeping with the assessment framework changes outlined above, the proposals below would apply from April.
- Further consultation is planned with independent sector providers during 2017/18, but it is stated that the main elements will be uniform across NHS and independent providers.
- CQC and NHSI have issued a separate joint consultation on proposals around trusts’ use of resources and the well-led framework (response deadline is 14 February).
- There is a commitment to “reduce the reporting requirements on trusts”, with each organisation only expected to complete one provider information request (PIR) annually on average. It is noted that some additional requirements are likely post-inspection, but that data available elsewhere will also not be requested.
- Intelligent Monitoring is to be superseded by a new ‘CQC Insight’ system, which is to encompass a broader range of data and subject to more frequent updates. Providers will be able to utilise their own ‘Insight dashboard.’
- The CQC aims to “develop more mature relationships” with providers on an ongoing basis throughout each year, enabling a more open and transparent dialogue.
- Previous ratings will be used to determine maximum intervals between core service inspections as follows: one year for inadequate; two years for requires improvement; three and half years for good and five years for outstanding. ‘Additional services’ may also be subject to inspection if they represent a “significant part” of a provider’s services of if it has been identified through monitoring “as potentially outstanding or high risk.”
- The new approach to inspecting ‘well-led’ will shift the focus on to “trust-wide leadership, governance, management and culture as the starting point”, as opposed to an aggregation of location-level assessments.
- The CQC commits to producing more concise reports and to consider how best to report on organisations that span a wide area. Reports will be subject to peer review and an appendix of evidence will be published alongside the main document.
- The use of resources rating being jointly developed by CQC and NHSI will be subject to further testing and refinement during 2017.
- It is acknowledged there are two particular situations whereby ratings aggregation may pose issues for providers – trusts offering more than one service type and takeovers. The regulator is seeking feedback about the most appropriate method for responding to this concern and offers some suggestions: greater utilisation of professional judgement; more flexibility about the determination of where best to offer aggregated ratings; and rating merged trusts separately for a specified period.
The deadline for responses is 14 February and if you would like to feed views into the NHS Confederation’s overarching submission, please email email@example.com by the end of Tuesday 7 February.