Many will now be aware that the CQC is set to switch to a new regulatory model. This will impact how the regulator conducts inspections on health and social care providers. It is proposed that the new regulatory model will be implemented from Spring 2023. The updated model will feature a new data driven approach, which will result in fewer on-site inspections and a greater use of data to assess a Providers service remotely. The data that will be used to assess a service will include patient / service user feedback, feedback from staff working at the service and feedback from partners aligned with the service such as Local Authorities and other stakeholders. Despite the changes being lined up to take effect as early as Spring 2023, we still have a lack of information available about what this will mean for providers. It seems that internal communications are equally as unclear with a recent survey of CQC staff revealing that just a fifth felt informed about changes happening as part of the transformation programme. This number has fallen from 54 per cent and 45 per cent respectively when compared to last year’s survey in which the same question was asked. This begs the question, if the CQCs own internal staff do not feel informed about the upcoming changes to the new regulatory model, then how can health and social care providers feel informed? The upcoming changes to the CQC’s new regulatory model remains ambiguous and lacks clarity. This is alarming, especially as many of the new regulatory model features are yet to be explained in detail publicly and have merely been outlined for health and social care providers. Concerning as the date for its adoption is rapidly approaching.
What information do we currently have on CQCs new inspection model?
In respect of the new regulatory model and inspection framework, the CQC are still as an organisation working out how to implement this. This means that some of the information is not yet finalised or published. However, the CQC has revealed that the new regulatory model will have a higher degree of focus on people’s experiences within care. There will be a larger emphasis on service users’ voices at the centre of CQC’s new regulatory approach. The CQC aims to achieve this through ‘smarter regulation’ which will include data collation, with the purpose of providing more flexible regulation. The CQC want to use the remote collection of data, to increase the frequency and fluctuation of Provider ratings. Currently, until a Provider is visited in an on-site inspection and a formal report produced, there is no possibility for changing the rating. The new inspection model, will allow for interchangeable ratings based on changing data that will be recorded as ‘high quality information’. The CQC believes that this approach will be more accurate and fair than outdated on-site inspection reports, which in many cases for Providers, can be several years out of date. This move to dynamic, smarter regulation, will also result in significantly condensed inspection reports compared to those currently being produced. Alongside this, there is also set to be a single risk assessment framework for all sectors bringing all providers under the same regime.
New inspection model – new inspection ratings?
Currently, the CQC will inspect a service and base its rating on five key questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? Each of these questions is rated either, Inadequate, Requires Improvement, Good, or Outstanding. The collective rating of these five individual questions forms an overall inspection report rating. This rating is subject to certain rating limiters currently. For example any regulation breach will limit a Providers overall rating to ‘Requires improvement’. Furthermore, having two questions rated ‘Requires Improvement’ will also bring the overall rating to no greater than ‘Requires Improvement’. In addition, the Well-Led question is also crucial and if this is determined to be ‘Requires Improvement’ or ‘Inadequate’ this will also have a limit on the ratings a Provider can achieve. It remains unclear whether these will be included in the new inspection model.
The CQC has indicated that it will be abandoning this system for key questions and introducing a new scoring system to deduce ratings.
The s new scoring system will retain the same individual key questions and same range of ratings. However, it will now involve the review of the following 6 ratings evidence categories:
- People’s experience of health and care services;
- Feedback from staff and leaders;
- Feedback from partners – people representing organisations that interact with the service;
- Observations – including inspection BUT also off-site observations which include interviews with various individuals (would also fall under 1-3);
- Processes – the series of steps or activities that are carried out to deliver care that is safe, and meets people’s needs; and
- Outcomes – or the impact of care processes on individuals.
At the beginning of the implementation of the new regime, the individual question ratings will only be published, and Providers may not notice much change between inspection models. However, the CQC has stated it will be publishing the scoring system and its percentages on its new inspection reports for all providers shortly after Spring 2023 (after initial implementation). There will be a score of 1-4 allocated using the above listed evidence categories, to formulate a score for each of the key questions of Safe, Effective, Caring, Responsive and Well-Led. The individual scores in these key questions will then be aggregated to give an overall rating score. The threshold and ratings scoring system will look like this:
- 25 to 38% = 1 / Inadequate – significant shortfalls in the standard of care.
- 39 to 62% = 2 / Requires Improvement – shortfalls in the standard of care.
- 63 to 87% = 3 / Good – good standard of care.
- Over 87% = 4 / Outstanding – exceptional standard of care.
These published scores are intended to increase transparency. The CQC argues that they are intended to ensure clarity and consistency around ratings between providers which will also help the CQC track whether quality is moving up or down within a rating. Therefore an inspection report will not just say ‘Good’. It will have a percentage range from 63-87% and it will demonstrate to readers whether the provider has improved, stagnated or decreased in its rating. This is one of the largest and most fundamental changes to the new inspection regime.
What do we anticipate will be the problems with the new inspection model?
With the adoption of a ‘risk based’ approach throughout and after the pandemic, we have already seen CQC Inspectors become more cynical in their approach on-site inspections. They are now no longer looking for ‘Good’ and are instead looking to corroborate negative feedback received from stakeholders that could be perceived as risk. We anticipate that this could get worse with the greater use of subjective opinions based on the review of standalone documents away from demonstrations of care. There are real questions about the validity of the information that the CQC will gather and its origins. For example, if a disgruntled family member of a service user, , made an allegation regarding a provider which has not been corroborated with factual evidence, will the CQC come into the providers service with a preconceived negative outlook, treating the allegation as fact?
This is not beyond the realms of possibility. The use of whistle-blowers, family feedback, and partner feedback can of course be useful if monitored correctly, but subjective opinions can also be dangerous if the provider is not being objectively assessed in a fair manner. There is a danger of over reliance on subjective opinions as opposed to objectively reviewing the Providers service and supporting, documentary evidence. This is the danger of ‘remote’ monitoring and the evidence categories listed. Subjective opinion cannot be the only basis for CQC to make a judgement and we at Ridouts will be keeping a close eye on how the CQC applies this approach. Furthermore, with the process coming into effect as early as Spring 2023 there still remains a number of outstanding questions thanks to a serious lack of clear information available and this will be of concern to providers.