On 28 October 2015 CQC published its ‘Building on Strong Foundations’ report requesting public input into its vision for the future of CQC regulation over the next 5 years. We discuss below some of the pertinent points resulting from the report.
The report outlines two main objectives, the first of which focuses on how CQC can be more efficient and effective as an organisation. A number of ways of achieving this are proposed and the public are asked to provide their opinions on the feasibility of the proposals and any further suggestions.
More responsive and tailored inspections
In particular the report refers to more responsive and tailored inspections. CQC is required by regulation to have regard to the risks posed by individual services before making decisions about the action it may take. This is being brought further to the forefront through the suggestion in the report that CQC will move to a more risk based regime.
Proposals for achieving this include reducing the frequency and intensity of inspections for services rated as ‘Good’ or ‘Outstanding’. This is intended to help CQC target its resources towards providers that are higher risk. The report suggests that CQC could rely more on other sources of information and assurances besides inspection for services rated as ‘Good’ or higher. Currently ‘Good’ and ‘Outstanding’ services are meant to be inspected within 18 months and 24 months of their previous inspection respectively. The report does not suggest a specific time period for the reduced frequency but it has been mentioned that some services regulated by Ofsted, which applies a similar style of rating system, are re-inspected within 3 years if they have received ‘Good’ or ‘Outstanding’ ratings.
A greater focus on co-regulating with providers
Coming hand-in-hand with the potential changes to the frequency of inspections linked to ratings discussed above, CQC has also suggested that ‘co-regulation’ including ‘self-assessments’ will play a part in its move to more risk based regulation. The report states that CQC could support providers to assess and share evidence on their own quality of care against each of CQC’s key questions. This would indicate that CQC expects providers to be adopting CQC’s inspection framework as part of its internal monitoring procedures. The report states that co-regulation could work to encourage providers to develop their own quality monitoring systems. It is likely that providers rated as ‘Good’ or above will have robust quality monitoring systems in place already and this could incentivise those services rated as ‘requires improvement’ and ‘inadequate’ to further review and revise their systems.
The introduction of co-regulation suggests that CQC will be putting its trust in information provided by providers (albeit that it states that it will also collect information from other sources such as its own data, the views of people who use services, staff and local partners). To date we have noted a lack of trust displayed by some inspectors within individual inspection teams. Will this move indicate a shift in the attitude of some inspectors to the services they regulate? And how practicable is the collaborative regulation suggested? While we welcome the opportunity for CQC to allow providers to report on changes to the service and the quality of care provided, appropriate implementation of the initiative, including clear channels of communication, is key to ensuring that the information is used effectively. CQC states it intends to use the information collected to target its activity to ensure it prioritises the right areas on inspection, hopefully this can lead to more collaborative working between providers and the regulator.
The report follows the revelation at the latest CQC board meeting that CQC will fail to meet its target for inspecting all regulated services by September 2016. This is now hoped to be achieved by December 2016. One of the reasons suggested for the delay was the unanticipated number of services rated as ‘inadequate’ or ‘requires improvement’ which led to the requirement to inspect these services more frequently. This, placed alongside the target to inspect services rated as ‘Good’ within 18 months of the previous inspection, appears to have put increased strain on inspection teams which have historically been widely understaffed.
Separately, it has also been revealed that CQC is preparing for a reduction in its government funding of between 25 to 40% over the next year. CQC’s Chief Executive David Behan has already stated that the cuts will have ‘implications’ for the delivery of next year’s inspection programme.
CQC has said that the changes do not indicate a return to ‘light touch’ regulation, however one may question the extent of influence the recent announcements of failed targets and reduced budgets have had on the proposals. Whilst it is agreed that CQC needs to run a more efficient cost effective operation, and it should be commended for any successes in achieving this, it raises the question of whether CQC is being forced to make these changes in response to the financial situation it finds itself in. Has the pendulum swung yet again from quality of care to finances? Only time will tell.
CQC is collecting responses to the report until 22 November 2015. Providers should ensure that they review and provide their views on the document where relevant to ensure CQC receives a comprehensive reflection of public opinion. CQC will use the public responses to assist it in setting out its views for consultation on its strategy in January 2016. The finalised strategy, which will set out CQC’s future direction for the next 5 years, is expected to be released in April 2016.