CQC’s strategy towards Smarter Regulation: Is a change in culture on the cards?

As we have reported on previously, the CQC are currently considering their forward thinking strategy and aim to move towards a strategy of “Smarter Regulation”. Their goal is, they say:

“to make regulation simpler but dynamic to reflect the changes in health and social care we can anticipate, as well as those we cannot. We will be more effective and efficient and use intelligence to tailor our actions to individual services, targeting our resources where we can have the greatest impact.”

The CQC have been seeking views from the sector on aspects of its future strategy on its CitizenLab portal and are now mid-way through a series of webinars which are intended to shine some light on the details. Each webinar, which all sold out, covers one of the “strategic themes” which the CQC see emerging and those so far have offered some useful insight into the CQC plans.

The webinar on 14 July 2020 covered the second strategic theme “Promoting Safe Care for People” which the CQC considers will consist of:

  • Leading on the establishment of a universal safety culture across health and care, collaborating with others to make this a success
  • Setting an expectation that providers will actively and visibly promote ‘speaking up’ at all levels, using concerns as opportunities to learn and not blame
  • Being clear about what is a safe culture
  • Identifying priority areas where safety risks are present, and setting demanding standards for improvement
  • Working with partners to make oversight and regulation simpler, having joint expectations and sharing data
  • Collaborating with partners to identify safety issues that occur at the boundary between providers, and playing an active role in addressing these
  • Supporting health and social care professionals and people who use services to address safety as equal partners
  • Taking much swifter action if there is a risk to people’s safety.

To the CQC’s credit, there were some positive noises on how they see this strategic theme panning out.  They made it clear that they acknowledge that a significant shift in their own culture and approach to regulation will be needed, to one that puts users of health and social care services, and their views on safety, at the forefront of regulatory activity; or as they put it “putting the public at the heart of what we do”. They also played heavily on their desire to be more supportive of providers, to be “partners” with other stakeholders in the sector to encourage a more coordinated approach throughout the whole sector to try and help plug “gaps” in the system (which they say give rise to significant numbers of safety concerns), and be better able to listen to and respond to safety concerns quickly.

The CQC appears to have a genuine ambition to be more intelligence-led, play a more supportive role to providers and users of regulated services, and have a more integrated relationship with other players in the sector including commissioning groups, and other regulatory bodies. However, this is not the first time there has been the opportunity to establish a better regulatory landscape. Is this all just rhetoric to help foster support for the new strategy or will we actually see a fundamental shift in the CQC’s approach?

Perhaps the CQC is learning from its ESF that providers are open to working with them if they really do take a more supportive role? Provided the CQC keep to its mantra to support providers in future, rather than the tendency to adopt an “us-vs-them” approach we have seen in the past, we may see some good things coming out of the new strategy. If the CQC approach a sensible strategy and implement it successfully, it may well help drive improvements on a continuous basis.

If the CQC do, indeed, genuinely want a significant shift in how they are perceived, and how providers and service users interact with them, they will need to make substantial changes in their own culture and practices. Any significant shake up of the regulatory landscape is not without its downsides, particularly to providers and service users. It can cause a period of significant disruption and uncertainty (often made worse by a lack of transparency or unclear guidance) for all stakeholders concerned. If nothing else, the CQC will need to readdress and in some cases significantly overhaul its own policies, procedures and guidance to providers to meet any new strategy and it will take time for providers to get to grips with these at a time when, frankly, they don’t need it. With the best will in the world cultural change does not happen overnight. It will take time to filter out the legacy approach which often, for providers, feels like the CQC is against them, and not there to support them.

On balance, however, some uncertainty and inconsistency between new and old ways of working in the short to medium term is probably a price worth paying if providers really will see a better regulatory environment in the longer term.

The Smarter Regulation programme is ongoing and whilst the webinar series provide a helpful insight into the CQC’s current thinking, it’s clear that the final design of the strategy has yet to be determined. We watch with baited breath for further developments over the next few months.

Formal consultation on the final proposals for the new strategy is expected in winter 2020/2021, with implementation expected in spring 2021, but there are likely to be further more informal consultations and surveys in the intervening period.

We urge providers to get involved in the formal consultation once it is published and keep an eye on the CQC’s Citizenlab portal for more informal opportunities to contribute. This is to ensure they can contribute to any debate on the CQC’s proposed strategy, and help design the culture and approach their regulator will adopt going forwards. Otherwise providers may find that they will be stuck with a different – but no better – CQC strategy for a number of years to come.