Caring Times: CQC- The Collaborator?

We are fast approaching the time for the publishing of CQC’s new strategy which will cover 2016-2021. It will outline CQC’s future regulatory ambitions within the health and social care sector and is of great importance to the sector.

CQC has embarked on a series of changes to its regulatory approach. Tools have been developed with the clear intention of changing the perception of the regulator to providers and the wider public. They have included the special measures process, the rating review process and more recently the piloting of the ‘quality of care in a place’ process. All of which point to the concerted attempt to alter the perception that the CQC is only the final arbiter in assessing the quality of care. It clearly has ambitions to work more closely with providers and gain a greater understanding of the work that providers are involved in.

Recently the Strategy Lead of CQC, Sarah Bickerstaffe spoke of this shift in approach looking forward to CQC’s new 2016-2021 strategy. She is responsible for the implementation of the new strategy which will be unveiled in April 2016 and spoke of the aims of the CQC more closely aligning with those of healthcare providers. A strategy, irrespective of how ambitious, is only as good as those that are responsible for implementing it in practice on the ground.

CQC’s system of special measures was introduced for all care providers on 1 April 2015 and certainly appeared to be a welcome move with the regulator playing a more supportive role. It was designed to target those providers that fail to meet CQC’s standards by setting out a schedule by which improvements must be made and signposting services that could assist the provider in meeting these targets.  Each provider is assessed for the following questions at each inspection; is the service safe, effective, caring, responsive and well-led.  For each of these questions the provider is awarded a rating; outstanding, good, requires improvement and inadequate.  The special measures regime provides a timeframe by which improvements must be made and puts the service on notice of the urgent need to improve services. This is demonstrative of CQC’s ambitions to step away from the ‘inspection only’ CQC model. The intention of CQC to work in partnership with providers at the lower end of the ratings scale appears to be a positive move.

This apparent culture shift in approach to collaboratively working with providers is couched against the assumption of the highest quality of inspection of a given service.  The inspection process does not always afford the provider the opportunity to show itself in the most reasonable light. Inspection reports can disproportionately focus on the instances of poor care without making adequate provisions for the instances of good care. There is certainly also a culture of deference within the care sector to accept the findings of the regulator without challenge especially within the NHS sector. As spending public funds in defending the organisation in question against the regulator is not viewed as the best value for money. Many see this approach as not the best way of protecting an organisation.

The other seemingly collaborative approach CQC has taken in relation to challenging its findings in the inspection report of a given service is the request for a rating review. On the face of it this appears to be another avenue through which providers can challenge the CQC’s decision-making process. It appears to tie in with the transition to a mature model of regulation by the CQC but when you unpick the grounds on which one may appeal it is an almost impenetrable process. The only grounds that one can challenge the ratings is that the inspection team has failed to follow CQC’s own processes- which afford the inspector the ability to apply their own professional judgment when coming to a decision. Coupled with this limited ground is the fact that a review can only be requested following publication of the report when the damage has essentially already been done. There is no place in the rating review process to further challenge the facts upon which the report is based- even if they are in dispute from earlier submissions. This process provides little real recourse to providers and is already being seen as a non-existent challenge route. We may see more judicial reviews into the process being raised as a result.

This deficit between the intention and the reality at the CQC does seem to be a reoccurring theme within the organization. There is a glimmer of hope though in the recent pilot of the ‘Quality of care in a place’ in Greater Manchester and North Lincolnshire. The project seeks to understand the issues faced by people who use a range healthcare services in a particular area with the objective of finding out the specific issues faced in the area.

CQC’s current regime relies on a forensic analysis of healthcare services through its inspection regime to ascertain the quality of a service at any given time. Unfortunately this is not always the case and the service can at times be unfairly tainted by an adverse inspection which is not representative of the services offered more generally. As the independent regulator of healthcare it might prove difficult to don both the inspector and friend caps at the same time however admirable the intentions. CQC can at times be seen to be overly defensive of its own conclusions drawn and not open to challenge. A more collaborative regulator is welcomed when the new strategy is unveiled next year let’s hope that strategy and reality work in better harmony in the future.

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