Prior to late-December 2022, Providers expected the CQC’s new inspection methodology would be ‘going live’ in Spring 2023. However, on 21 December 2022 the CQC released a news update setting out its ‘revised plan and approach for transformation’. This announced the CQC would be delaying full implementation of the new methodology and instead would be focusing on implementing its new approach in phases. It confirmed the CQC would be looking to gradually start using its new assessment framework ‘towards the end of 2023’.
The CQC’s delay in implementation comes as a welcome development at Ridouts (and likely for Providers too) given previously raised concerns related to a continued lack of information as to how the inspection methodology would actually be applied and work in practice. Information published by the CQC through 2022 failed to address the specifics, particularly in relation to information sharing and transparency on behalf of the CQC. If the CQC had ploughed ahead with full implementation this Spring it is likely there would have been significant confusion on behalf of both Providers and inspection teams as to what was actually happening. This would not support the CQC’s aim for the new regulatory model to ensure better consistency. It is hoped that the delay will ensure these concerns are considered and addressed appropriately prior to the new date for implementation.
This article analyses what we know about the CQC’s plans for further development of its new inspection methodology throughout 2023.
What has the CQC said about recent developments?
The CQC says it will continue to implement its new approach in phases, making sure each phase is implemented before moving to the next. Dates for the full roll-out of the inspection methodology have been kept very vague and no comprehensive timetable has been provided to date. It is believed this is intended to allow wiggle room for the CQC to extend deadlines should it feel the need to put more focus on developing a certain phase. This does nothing to allay the uncertainties Providers faced in 2022. However, what we do know is that the following key steps have been set out:
The CQC has confirmed it continues to develop its new approach in addition to its regular inspection programme to ensure it maintains a proper view of risk, In particular, the CQC is:
- Continuing to carry out inspections of maternity services under its national programme.
- Continuing to complete monthly desktop reviews of services and targeting inspection activity where it has concerns.
- Continuing to use its ‘People First’ resource to help assess all parts of the urgent and emergency care pathway.
From the Spring the CQC says it will be focusing on internal priorities including:
- Making sure the technology it needs is in place and that it is able to test it with Providers.
- Being confident that its new regulatory approach is ready to launch.
These priorities are very vague. The CQC states it has taken into account the reality that many services are currently under pressure and this shift in focus will minimise the changes it makes externally, therefore reducing the potential burden on Providers for the time being. Some might think this is a thoughtful step by the CQC but in reality it was very clear for many of us, as early as last Summer, that the CQC would not be ready to roll out its new methodology by Spring 2023.
Other developments Providers should expect during the Spring include:
- The new CQC Regulatory Leadership Teams will be setting out their priorities across their sectors, including thematic reviews.
- The CQC intends to be sharing further updates on its approach to local authority and integrated care systems in early 2023. This is linked to a perceived increase in understanding about what is happening locally as a result of looking at how care is provided at system level.
The key development announced for Summer 2023 is the launch of the CQC’s new online Provider Portal. This will be a staged launch and in the first stage the CQC says:
- Providers will be able to submit statutory notifications.
- The CQC will improve how its enforcement process works.
The CQC states it will provide support and guidance to Providers in relation to this. The first phase marks the start of the CQC gathering evidence in a new and structured way which is intended to help it inform its assessments. The intention is to make it much easier for Providers to interact with the CQC.
No further stages have been detailed to date. However, with the updated aim of using the new assessment framework by the end of 2023, surely the CQC should have fully developed the new provider portal by this time. A huge part of the new framework focuses on remote ‘evidence collecting activities’, with a move away from physical inspections. The CQC has previously said there will be much more transparency in relation to evidence collected to form judgements and arguably the most straight forward way of doing this is to share the information viewed by inspectors through the provider portal. The CQC has also previously spoken of further opportunities for Providers to share relevant information with the CQC. Again, it makes sense for this to happen through the portal. It is therefore envisaged that the Provider Portal will be much more complex than what currently exists, allowing the sharing of information both ways. It is likely that such software will take significant time to develop and fine tune.
The CQC states the new provider portal will be the only way the CQC and Providers will communicate electronically in the future so Providers will need to ensure they familiarise themselves with these technological changes when more information is forthcoming.
What key matters are still to be addressed by the CQC?
What is clear from the relatively scant information provided by the CQC to date is that there is a long way to go until Providers have clarity as to how the new regulatory model will work in practice. In particular, the following two key pieces of information are currently missing:
- There is no further information on what will happen to the current factual accuracy process and how this may be changed. Currently Providers have 10 working days to submit comments on the content of a draft inspection report before the CQC proceeds to publication. The CQC has said that Providers will be afforded with an opportunity to respond to its findings but no further information has been forthcoming. In particular, how will Providers be able to respond to updated ratings that are not based on a physical inspection?
- How will the CQC’s newly developed evidence categories be used in practice? Information published to date suggests the CQC may not always look at all evidence categories when assessing a Provider. Instead, this will be a discretionary determination by the CQC based on the Provider type and the level of assessment it has judged is required. This appears to give power to the CQC to determine the relevant evidence, rather than working collaboratively with the Provider. In addition, the majority of published evidence categories rely on the opinions of individuals so what mechanisms will be in place for objectivity to be applied to subjective opinions, particularly when the evidence collection is not linked to a physical inspection?
The CQC says it will be releasing more details ‘early in the New Year’, along with more user research and testing. Providers should keep up to date with the latest developments and involve themselves as much as possible in the CQC’s Provider engagement processes to ensure they seize the opportunity to have an impact on how they will be inspected and judged in the future.
If you have any questions about the CQC and its inspection process, then please contact Ridouts on 0207 317 0340 or you can email, email@example.com