On 24 May, CQC published its strategy for 2016-2021 called Shaping the future (a link to the document can be found here: http://www.cqc.org.uk/content/our-strategy-2016-2021). There is much that is encouraging in the document as far as the care home sector is concerned, notably that CQC will focus its efforts “where risks of poor care are greatest” and where they see “significant improvements”. Over the last 18 months, the focus has been on completing large-scale, time-consuming and costly comprehensive inspections of adult social care services, an approach that is unsustainable in light of CQC’s reduced budget over the next five years.
CQC’s future inspections will therefore be targeted, as CQC focuses its resources on higher risk providers. At the same time it will commit resources to inspecting providers which appear to have made significant improvements, providing an opportunity for CQC to give these providers a higher rating. The success of this new approach will depend firstly on reliable intelligence and secondly on inspection teams being willing to rate improving providers higher.
Frequency of inspections
The new inspection process will focus on services that require improvement or are inadequate. The rating of a service will determine the length of time between inspections. CQC will also consider the likelihood that the quality of service would have changed since the last inspection. The intervals between inspections for good and outstanding services (68% as at May 2016) will be extended over the next five years, as CQC improves the quality of its monitoring information.
Services rated as inadequate will be inspected every six months and those rated as requires improvement, every year. CQC will inspect newly registered locations within 12 months of registration. Where CQC’s monitoring suggests that there has been a significant improvement or deterioration in care, they will inspect sooner. CQC may change ratings on the basis of evidence from either comprehensive or focused inspections.
For larger providers, CQC also aims to improve its understanding of how the head office culture affects the provision of care at individual locations.
The strategy highlights the importance of providers giving their views on the quality of care they are providing against the five key questions as part of annual reporting processes. There will therefore be an enhanced emphasis on self-assessment which CQC says will be “a core expectation of our regulatory relationship so that each provider’s view of the quality they provide is transparent”.
The weaknesses around self-assessment were highlighted as part of the Francis Report on Mid Staffordshire, although CQC will say it is merely one aspect of a more robust monitoring process. CQC talks about having a more mature relationship with providers “so that they are open and transparent with us and feel that they can highlight challenges as they occur.”
Nuanced rating information
On a positive note, CQC commits to being clearer when services are good with outstanding features and where the rating of requires improvement does and does not entail a breach of regulations. The hope is that this will provide a more nuanced impression of the quality of service provided.