CQC inspection and regulation

Hospital corridor

The government’s response to the Francis inquiry covered a range of new measures aimed at improving openness and transparency, and setting fundamental standards of care.

This included a more comprehensive approach to quality inspections by the Care Quality Commission (CQC), with providers rated along a four point scale ('outstanding', 'good', 'requires improvement' or 'inadequate').

It is currently intended that all NHS trusts and NHS foundation trusts should have been subject to this new inspection model by June 2016.

New CQC strategy for 2016-21 

The CQC's new strategy, entitled Shaping the future , outlines four overarching priorities:

  • Encourage improvement, innovation and sustainability – This includes: the new ratings for providers’ use of resources (being developed with NHS Improvement); inspections of new care models; and plans to publish ratings by area “to inform planning and improvement.”
  • Intelligence-driven regulation – This encompasses a more risk-based approach to inspections and the establishment of the new CQC Insight system among other areas. 
  • Ensuring quality is defined and measured consistently – A "single shared view of quality" will be developed through engagement with partners, providers and the public, based around the CQC’s five key questions.
  • Efficiency and effectiveness – The regulator needs to plan for income reductions of around £32m by 2019/20 and also aims to deliver “shorter, more consistent” reports following inspections.

In our response to the consultation, we highlighted that our members are generally positive about the proposed direction of travel, but also raised a number of significant challenges and concerns that the regulator would need to address on issues such as value for money and the need for a consistent approach to inspections.  

What members say

In our most recent membership survey, members from across the system were generally positive about the CQC’s proposals:

  • 94 per cent endorsed fewer and targeted inspections (including 64 per cent ‘strongly support’).
  • 92 per cent supported what was then described as ‘co-regulation’ but has subsequently evolved into a ‘single shared view of quality’.
  • 87 per cent supported the assessment of quality being undertaken across a local health economy rather than for individual organisations.
  • 80 per cent endorsed the development of a different regulatory approach for new models of care.

What we will be doing

Ninety-four per cent of members also wished to see providers being able to exercise more say over the design of regulation in future, particularly in a context where the regulator is moving rapidly towards full chargeable cost recovery. 

We will be working with the CQC on a number of areas in 2016/17 and beyond:

  • The development of a model for rating use of resources, which is being piloted in 2016/17 prior to rollout across acute trusts initially from 2017/18.
  • Examining and sense-checking the CQC’s assessment of its progress in delivering value for money, which is due to be published in October each year throughout the period covered by the strategy.
  • Development of the "single shared view of quality" – consideration of how quality should be defined consistently across the NHS and the information that could be supplied by providers and commissioners that would have the most significant impact.
  • The CQC’s review of how trusts investigate and learn from deaths. We are a member of the expert advisory group for this project, which is due to report by the end of March 2017.

Please let Sam Hunt know if you would like to be involved in any of the issues above: Sam.hunt@nhsconfed.org

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