One year on: How is CQC’s regulatory model working in practice and what will change?

As a result of the COVID-19 pandemic, the health and social care landscape has changed dramatically including in relation to the way in which the CQC regulates the sector. In May 2021, the CQC published its strategy, A new strategy for the changing world of health and social care – CQC’s strategy from 2021’ which set out its new approach to regulation and its risk-based model of inspections. In this article I consider how the CQC’s regulatory model has worked in practice over the past year and consider how its future regulatory model might work.

The CQC’s current regulatory model

As many providers will be aware, the CQC’s current regulatory model is risk-based and often informed by information of concern which includes information relating to whistleblowing, safeguarding and complaints. In practice, this often means that the CQC go into services with a negative mind set as they are looking for information to support the concerns.

As a firm we have heard anecdotally from providers and seen in various CQC inspection reports and other enforcement action that there are particular ‘hot topics’ which appear to be of interest to CQC inspectors under the current regulatory model.

What are some of the ‘hot topics’?

There are various ‘hot topics’ that appear to be at the forefront of the CQC’s mind and this article will consider the main ones. The main topics are Infection Prevention Control (“IPC”), health and safety risks, and staffing issues. These topics are expanded on below:

  • Infection Prevention Control

In the CQC Board Meeting which took place on 23 February 2022, the CQC confirmed that it will continue to focus on and respond to risk, including IPC inspections. During this meeting, the CQC explained that one of the areas which required the most improvement was in relation to providers’ IPC policies. This also reflects what Ridouts has seen in inspection reports.

To combat this issue, providers should ensure that their IPC policies are up to date and in line with the latest Government guidance. Providers will also want to ensure that staff are adhering to the service’s IPC policy and following processes at all times. This includes during night shifts and at weekends. Carrying out provider ‘spot checks’ to see if staff are adhering to the IPC policy is a useful auditing tool and helps demonstrate to the CQC that a provider has processes in place to monitor staff compliance.

  • Health and safety risks

One of the themes of the CQC’s 2021 strategy is ‘safety through learning’ with the CQC focusing on ‘regulating for stronger safety cultures’ and focusing on providers who fail to prevent harm. As part of the CQC’s approach to regulating for stronger safety cultures, there appears to be a lot of scrutiny from the CQC in relation to perceived health and safety risks in a service.

One of the health and safety risks that I often come across in CQC inspection reports is in relation to fire safety management. Inspectors review providers’ fire records to see if regular fire alarm testing is taking place and to see if recent fire evacuation drills have been carried out. They also want to see evidence of fire doors and fire equipment being tested.

Another perceived health and safety risk that is featuring more in CQC inspection reports is in relation to the storage of medication and temperatures. One of the criticisms I have read in a report is, “The temperature was not monitored or recorded where medicines were stored in both the refrigerator and medicine storage room. This posed a risk as if medicines are not stored at a temperature recommended by the manufacturer, they may not have the desired effect.” Temperature records are a useful tool for providers to ensure that the service is monitoring temperatures. Of course, as with any records try to ensure that any gaps in the records are identified during weekly and monthly audits. This will help to alleviate the CQC’s concerns.

  • Workforce and staffing issues

The CQC state that it recognises the recruitment and retention challenges that providers face and appears to be supportive. However, as a firm we have seen that inspectors still criticise providers for using agency staff in their services. This is unfair because the requirements of Regulation 18 are that there are, Sufficient numbers of suitably qualified, competent, skilled and experienced persons.” As long as there are sufficient numbers of competent staff on duty it should not matter if they are permanent staff or agency staff.

The CQC confirmed in its March 2022 Board Meeting that it will continue to focus on the impact that workforce recruitment issues are having on the quality and continuity of care, so this is an area of focus that providers should be aware of.

The CQC’s future regulatory model

The CQC is slowly developing its future regulatory model through consultation and engagement with stakeholders. Based on recent CQC webinars and consultations, it appears that the proposed changes to the existing regulatory model are as follows:

  Existing regulatory model Future regulatory model
1. Four  Assessment Frameworks

The CQC currently has four assessment frameworks for Health, Adult Social Care and two registration frameworks.

Single Assessment Framework

The CQC’s aim is that there will be one assessment framework for all sectors in order to simplify the current system. The CQC is hoping to implement this in or around April 2023.

2. Ongoing monitoring

The CQC plans to move from ongoing monitoring to ongoing assessment.

Ongoing assessment

It is not entirely clear what the difference is between ongoing monitoring and ongoing assessment but it appears to involve inspection timetables no longer being based on previous ratings and there being a more fluid approach which involves risk based regulation.

3. Inspection

Before the COVID-19 pandemic, the CQC carried out a number of comprehensive inspections but when the pandemic happened there was a move towards focused inspections.

Remote monitoring and site visits

Going forwards the CQC want to have multiple opportunities to consider the quality of care provided in services.

They will continue using data and intelligence to monitor services off site and use site visits to observe care.

4. Ratings characteristics

The CQC uses ratings characteristics to determine if a  service is:

·         Outstanding

·         Good

·         Requires Improvement

·         Inadequate

Six point scoring system

We await the detail but going forward, the CQC has said that it wants to be clearer about what evidence is required to gain a particular rating through a scoring system.

5. Narrative report

The CQC’s narrative inspection reports describe the inspector’s findings during an inspection.

Streamline short statements

The CQC want, in the future, to be able to update ratings more frequently and to do away with long narrative reports and produce reports which are more succinct.

Conclusion

This article has considered the CQC’s current regulatory model, its focus on risk based inspections and the types of ‘hot topics’ which currently appear to be of interest to CQC inspectors. It would be useful for providers to familiarise themselves with the aforementioned ‘hot topics’ prior to their next CQC inspection.

We still need further detail in relation to how the CQC’s future regulatory model will work in practice but whatever the future regulatory approach might look like, the principals remain the same. Providers should remember that the best way to manage any CQC inspection process is to question findings, clarify issues and challenge where necessary.

If providers would like help with or advice on how to deal with the CQC’s risk-based approach or on the CQC’s inspection activity more generally Ridouts can help. Please contact our specialist team of solicitors on 0207 317 0340 or ask for a call back via the website.

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