On 27 January 2022, the CQC announced that, following the easing of Covid restriction across the country, it has reviewed and updated its regulatory approach, with the changes to take effect from 1 February 2022.
What is changing?
The main changes relate to providers of acute hospitals, ambulance services and general practice. In December 2021, in light of the Omicron variant and the pressure of the rapid roll out of the Covid-19 vaccination booster programme, CQC postponed on-site inspection activity in these sectors with immediate effect (except in cases where there was evidence of risk to life, or the immediate risk of serious harm to people). These inspections are to resume from 1 Feb 2022.
Across the period of the Omicron variant, risk-based inspection activity continued in other sectors, including adult social care, mental health, independent health and dentists. This will remain largely unchanged. From 1 Feb 2022, CQC has confirmed it will inspect where:
- there is evidence that people are at risk of harm. This applies to all health and social care services, including those where inspections were previously postponed except in cases where CQC had evidence of risk to life;
- CQC can support increasing capacity across the system, particularly in adult social care
- a focus on the urgent and emergency care system will help CQC understand the pressures, where local or national support is needed, and share good practice to drive improvement.
CQC is also going to restart its work to coordinate its approach to inspecting urgent and emergency care pathways.
None of these announcements are particularly ground breaking and the vast majority of this “updated approach” reflects that which was published in its update from its Chief Inspectors in December 2021 although some aspects of the changes are worth a reminder.
Over the last year CQC has continued to inspect predominantly only where there were serious risks to people’s safety, a shift from previous methodologies which looked at improvement as well as risk.
One of the most fundamental aspects of the December 2021 update to CQC’s regulatory approach was the categorical clarification by CQC that it does not intend to return to routine frequency-based inspections. Reference to re-inspection timeframes has been removed from the latest versions of Provider handbooks and so it appears this change is here to stay. No longer will Providers have an idea of when CQC might return to re-inspect them.
It appears that, for the most part, CQC’s inspection model will continue to be focused on being reactive to evidence that people are at risk of harm. Providers should take heed of this and consider the type of information that might therefore trigger an inspection.
In its annual report which was published on 20 January 2022, CQC highlight that Information of concern (safeguarding, whistleblowing, concerns and complaints) was the most common inspection trigger in 54% of inspections. The report also notes that it has recorded 44% more whistleblowing enquiries than 2019/20. CQC’s definition of what it treats as a whistleblowing is very wide – basically any concern. Therefore even the smallest of complaints or a single disgruntled staff member could lead to an inspector calling. When this happens, Providers have told us that often what starts off as a targeted inspection in relation to a complaint soon spirals once CQC are onsite and decide to expand its scope to a type of inspection that can alter ratings. If that leads to a downgrade in ratings, Providers now are left in limbo about when CQC might return to re-rate. In these circumstances a robust and timely factual accuracy response could be vital. It would also be worth Providers ensuring that they are on top of their own policies and procedures for complaints handling, gathering feedback and whistleblowing to try and avoid any unwanted and unnecessary inspection activity.
What about requires-improvement settings?
In December 2021 CQC committed to monitoring to identify services currently rated as Requires Improvement who may have improved and then, from January, to begin a programme of activity to inspect these providers to identify where improvement has taken place and where possible re-rate.
Historically, services rated as requires improvement would normally have been re-inspected within 12 months of the last comprehensive inspection report being published but under the latest risk based inspection model these services would only be inspected if there was evidence of concern. However, if a service had improved there would not be evidence of concern and therefore no mechanism to trigger an inspection which would allow them to improve their rating from Requires Improvement. This difficulty was only compounded by the removal of re-inspection timeframes.
Providers of services rated as Requires Improvement have been voicing their concerns about this dilemma for some time as Requires Improvement ratings often cause commissioning problems as well as negative implications for borrowing, insurance and marketing to increase occupancy.
With all inspection activity now back on the cards from this month it is hoped that CQC will press ahead with this commitment to re-rate Requires Improvement services although, anecdotally at least, this appears to have gotten off to a slow start.
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