On 15 February 2012, the CQC Board discussed the proposals for the reform of the CQC judgement framework and the enforcement policy following the recent consultation. Some of the major proposed changes are set out below.
The end of Improvement actions
One of the key proposals is to stop setting improvement actions given CQC’s admission that there is a real confusion around their use. At present an improvement action can be set either:
1. Where the provider is compliant but CQC suggest changes to ensure the provider remains complaint or
2. Where a provider is not compliant but CQC has confidence in the provider’s capacity to improve and therefore sets an improvement action as opposed to a compliance action.
In future, all providers will be judged as either compliant or non-compliant with inspected outcomes. CQC estimates that there is likely to be an increase of around 9% in levels of non-compliance in the first 12 months of operating the new policy assuming all those currently falling under 1 above fail to meet their improvement actions.
Annual Inspections and Key Outcomes
Under the proposed new system, there will be a move to annual inspections of all care homes, domiciliary care providers and hospitals with inspectors inspecting against a minimum of 5 outcomes, one of which will always be outcome 4. The outcomes will be drawn from each of the 5 domains/chapters as set out in the Guidance to the Essential Standards. In contrast, other service types such as dentists will have bi-annual inspections and are likely to cover fewer outcomes.
In terms of the responses to the pilot inspections that CQC conducted over July to December 2011, the main outcomes inspected were:
Outcome 1 – Respecting and involving people who use services
Outcome 4 – Care and welfare
Outcome 7 – Safeguarding
Outcome 14 – Supporting workers
Outcome 16 – Assessing and monitoring the quality of service provision
CQC says that it “will usually inspect all the essential standards over a 3 year period. Inspection is only one part of our toolkit, continuous monitoring of all the essential standards by looking at the information we hold is also a key element.” This indicates that the Quality and Risk Profile will continue for each location. We are not aware of a date when social care providers will have access to their Quality and Risk Profiles. NHS providers have had access to their Quality and Risk Profiles for some time. This is a matter that the social care sector should be pressing CQC for an answer on as access to QRPs is now long overdue.
CQC proposes to no longer carry out “reviews of compliance.” Instead CQC will carry out inspections which will always include a site visit. Significantly, CQC says that “inspectors [will] continuously review all the information we hold about a service to inform our regulatory activity but this reviewing work does not result in a published judgement. This is different to our current ‘review’ approach where a compliance review may be a desk top exercise that results in a change to judgement.” It is not clear how this would sit with the current policy of changing judgements if a provider provides evidence of compliance after the inspection which satisfies CQC as part of a desk top review, rather than a re-inspection.
A focus on non-compliance?
CQC proposed in the consultation to focus on identifying non-compliance during inspections, not compliance. The majority of respondents to the consultation felt this was a negative approach. CQC therefore is proposing to “describe compliance where we see it.” CQC adds, “Our inspections should be focussed o identifying non-compliance and triangulating our evidence to reach a judgement, but if we see compliance we should report that to ensure we provide a balanced view of our findings. Therefore our reports will contain information about compliance and non-compliance” However, the indication is that CQC inspectors will not be going out of their way to look for compliance. This emphasises the importance of providers providing evidence of compliance to inspectors during and after the inspection to ensure a balanced and fair picture is presented in the report.
The generic regulatory model
CQC proposes to stick with a generic regulatory model. It refers to information guides and supporting notes that have been issued to inspectors about specific services. We can request these under FOI.
CQC anticipates issuing “more detailed sector specific guidance on certain outcomes where we know that the issues we need to inspect to assure ourselves of compliance are different, and that what compliance looks like will be different, for example outcome 4, care and welfare will be very different in a hospital to a community mental health team.” This would be positive given our experience of CQC inspecting district general hospitals as though they were care homes.
The enforcement escalator
There was broad support for the “enforcement escalator” provided it was not used in a rigid way. It is to be called the“regulatory response escalator” as it includes compliance actions which are a precursor to enforcement action.
Next steps
Providers will need to be extra vigilant in terms of what comes out of CQC over the coming weeks given that a new compliance system is likely to be in place from 1 April 2012.
The new approach (if adopted) will in all likelihood lead to more regulatory action as there will only be compliance actions in relation to non-compliance, not improvement actions and compliance actions. The intention is to give providers one chance to comply with a compliance action. If a provider fails to comply with a compliance action, CQC will consider enforcement action – presumably, in most cases, a warning notice.
The intention is for the CQC Board to make a final decision on the proposed changes in March. CQC plans to “roll out a communications plan so that providers and other stakeholders are sighted on the approach.”
It follows from the above that the next month or so will be a hectic period for the regulator and the sector in general. At Ridouts we will be monitoring developments and posting up-dates on our website.
