On 27 May 2021, CQC launched what it described as its “ambitious new strategy” for 2021 onwards.
The strategy aims to achieve 12 outcomes across the following four themes:
- People and communities;
- Smarter regulation;
- Safety through learning; and
- Accelerating improvement
From a regulatory perspective, the theme of “Smarter Regulation” will be of particular interest to Providers and Managers.
Under this theme CQC promise “Smarter, more dynamic and flexible regulation that provides up-to-date and high-quality information and ratings, easier ways of working with us and a more proportionate response.”
CQC also outlines here its intention to make smarter use of data to target its resources where it can have the greatest impact, focusing on risk and where care is poor, to ensure CQC is an effective, proportionate and efficient regulator.
What does this all mean in practice for Care Home Managers?
Changes to inspection frequencies is one of the proposed changes Providers can expect. Whilst CQC recognise that on-site inspections are a vital part of performance assessment it wants to move away from relying on a set schedule of inspections to a more flexible, targeted approach where CQC will visit “when there is a clear need to do so”. These circumstances include: responding to risk; where they have limited data or need specific information; where they need to speak to service users face to face or when they need to ensure that their view of quality is reliable.
Ratings Changes without Inspection
More dynamic ratings are also promised which appears to suggest more frequent ratings changes. Very interestingly, the strategy provides for the ability to change ratings without the need for an inspection visit, a model which CQC has been reluctant to adopt in the past. Nevertheless, CQC state that they will update ratings when they have evidence that shows a change in quality and won’t always need an inspection to do this.
Updating ratings more frequently without an inspection might be a good thing for providers which have been rated as ‘Requires Improvement’ or ‘Inadequate’ because they have more opportunity to get re-rated but providers rated as ‘Good’ or ‘Outstanding’, might prefer certainty about how long they can expect that rating to remain in place.
In addition, there are likely to be concerns raised if a service has its rating downgraded without a physical inspection. In those circumstances the CQC may find a challenge to this from a Provider through the factual accuracy process difficult to defend if they have not physically visited the service to verify the assessment that it ought to be downgraded. The Provider will want to be clear exactly what evidence and data the CQC has relied upon to reach that conclusion.
Emphasis on Data
On evidence and data, the strategy commits to better use and interpretation of data. CQC says it will use innovative analysis, artificial intelligence and data science techniques proactively to support robust and proportionate decision making based on the best evidence available.
This ought to be met with caution. Data systems can be flawed and open to misinterpretation. It is vital that the data and information gathered by CQC through its IT systems is verified before it is allowed to impact on CQC’s assessment of the rating of a service. This is particularly important where CQC is relying on information provided by third parties and/ or visiting services less frequently to verify the information gathered. If CQC inspectors become more reliant on data gathered through IT systems, it is possible that good care being provided by a service on the ground may be overlooked which could lead to errors in rating judgments. CQC must continue to triangulate its evidence and, if providers are unhappy with the evidence relied upon to reach a rating judgment they should ensure to challenge this through the factual accuracy process.
Shorter inspection reports
The new strategy also states that CQC will “move away from long reports written after inspections, and instead provide information and data to better meet the needs of all audiences”. The risk with shorter inspection reports is that they are likely to contain less detail and may miss important and necessary contextual details or evidence of good practice.
Again it is vital for Providers to challenge misleading or inaccurate CQC draft inspection reports through the factual accuracy comments process. This is the only opportunity to challenge the content of a report and if goes unchallenged and it is subsequently published, there is a presumption that the report is accurate which could be very damaging. In addition with a move away from timetabled inspection frequency the Provider has no way of knowing when they will have the opportunity to be re-rated.
Out of its strategy commitments in the theme of smarter regulation, CQC seek to achieve the following outcomes:
- To be an effective, proportionate, targeted, and dynamic regulator.
- To provide an up-to-date and accurate picture of quality.
- That it is easy for health and care services, the people who use them and stakeholders to exchange relevant information with CQC, and the information CQC provide is accessible, relevant, and useful.
Many of the changes proposed above represent a new way of working for the regulator however, the outcomes sought are broadly similar to those under its previous strategy. Only time will tell whether these outcomes will be achieved this time round.