In the context of the upcoming spending review, CQC has published a consultation paper “Building on Strong Foundations – shaping the future of health and care quality regulation” (“BSF”) aimed at developing a new strategy for 2016-21.
CQC’s strategy for 2013-16 contained fundamental changes to the way it regulates the health and social care sector in response to the public loss of confidence in its performance up to that point in time. CQC states that these changes have resulted in a more robust way of inspecting and rating providers, providing increased transparency and accountability within the sector.
One of the primary focuses of BSF is how CQC can work with providers to get the right balance between encouraging and supporting providers to improve their services whilst controlling quality by taking enforcement action where necessary.
The paper has an overall feel of deep reflection in its approach to regulation and a willingness to develop and work with providers. However, CQC asserts that being open to such ideas will not see a return of a light-touch regulator.
One of CQC’s main objectives is to become a more efficient and effective organisation by enabling risk-based registration, where low risk changes to registration will be handled in a more streamlined way. Smarter monitoring and insight from data is suggested, to help CQC develop a more comprehensive surveillance model.
Perhaps the more welcoming suggestion from CQC is their focus on co-regulating with providers. Co-regulating means that CQC would be supporting providers to assess and share evidence on their own quality of care against each key question. CQC suggests using the key lines of enquiry as a starting point and report on any changes to the quality of care provided since the previous inspection.
CQC would compare evidence from the provider with the monitoring data it holds about the service, alongside other data which includes the views of service users, staff and local partners. CQC hopes that this method of information sharing would help it target activity to ensure it prioritises the right things during inspections. However, CQC notes that it will never solely rely on information that providers give without challenge.
Co-regulation will enable providers to develop their own systems and processes which will align with the way they are inspected, thus it is anticipated that such systems will assist services in complying with the regulations.
The paper highlights the fact that CQC will be looking to move towards a more risk-based approach by moving towards more responsive and tailored inspections. For example, high performing services which have been rated “good” or “outstanding” would be inspected less frequently than those rated “requires improvement” or “inadequate”. There is no indication as to what the frequency of inspections should be, however it has been mentioned that some services regulated by Ofsted, which applies a similar style of rating system, are re-inspected within 3 years if they have received ‘Good’ or ‘Outstanding’ ratings. The frequency of inspection is likely to remain the same for poor performing services.
It has been just over a year since CQC rolled out the new inspection regime and CQCs states that it is already leading to improvement. The re-inspections carried out have led to 40% of inadequate ratings changing to a higher level. However, at Ridouts, we have dealt with cases where ratings that should have been changed for the better but were not because of the way CQC requires consistency of practice or sustainability. What is clear is that inspectors are taking a more robust approach but one that is often inflexible and rules driven. Imaginative and proportionate regulation is in short supply. It may be teething problems. In twelve months’ time it will be interesting to see if CQC’s approach has altered as BSF suggests it might.
Moving towards a collaborative and collegiate model of regulation will create less hostility between regulator and provider and more transparency for the public; it is imperative that CQC works with providers and local partners to ensure that high quality care is delivered to people.
The BSF consultation (open until 22 November 2015) will lead to a further round of consultation on CQC’s 2016-21 strategy which will be initiated in January 2016.
