The CQC website has recently been updated to include ratings of hospitals and NHS Trusts that have been inspected as part of CQC’s pilot of the new inspection regime. Such ratings awarded under the pilot scheme are referred to by CQC as ‘shadow ratings’. The new regime is due to officially come into force from October 2014.
The new ‘ratings’ system will provide services with ratings of either ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’. For each location performance is rated at four levels:
- Level 1: Rate every core service for every key question (i.e. is the service safe, effective, caring, responsive and well-led)
- Level 2: An aggregated rating for each core service
- Level 3: An aggregated rating for each key question
- Level 4: An aggregated overall rating for the location as a whole
For the Trust as a whole, CQC will rate performance at two further levels:
- Level 5: Each of the key questions. This will be informed by CQC’s findings at level 3 for each location in the Trust, and information on the five key questions that is available at trust level only.
- Level 6: The Trust as a whole.
CQC’s website currently displays the shadow ratings for 16 inspections – some refer to NHS Trusts while others refer to individual locations – 7 of which have received an overall shadow rating of ‘good’ and 9 are listed as ‘requires improvement’. Where a Trust has received an overall shadow rating (i.e. a level 6 rating) it is apparent that not all of the services governed under the Trust have been inspected and therefore the reliability and applicability of the level 6 shadow rating comes into question.
The consultation process on the new inspection regime is currently underway and the consultation covering the ratings review process, i.e. a provider’s ability to challenge ratings, closed yesterday (4 June 2014). As part of the consultation CQC has produced a range of ‘provider handbooks’ describing CQC’s approach to regulating, inspecting and rating different providers such as NHS acute hospitals, specialist mental health services and residential adult social care services. The draft provider handbook for NHS acute hospitals indicates that procedures will be in place for individual locations to challenge level 1-4 ratings. In contrast, NHS Trusts will not be able to challenge CQC on ratings provided at levels 5 and 6. The draft provider handbook states “trusts can challenge our decisions elsewhere – for example by complaining to the Parliamentary Health Services Ombudsman or by applying for judicial review.” Therefore the remit for Trusts to challenge ratings is much narrower than for individual locations.
However, there is no publicly identified process allowing for the review of ratings reached as a result of the pilot inspections. The provider handbook states “during the period of testing, we will engage with trusts informally over any concerns they may have in relation to their shadow ratings. We will ensure a fair process for setting ratings and we will be transparent in investigating any concerns.” It is unclear whether providers inspected as part of the pilot scheme have been given an opportunity similar to that described in the provider handbooks or any opportunity to challenge such inspections before they have been published on CQC’s website.
We await CQC’s final response to the consultation in the next couple of months and will report in more detail on the process for challenging ratings once the consultation is concluded.