Special Ridout Report January 2017- CQC consults on its next phase of regulation

CQC is currently consulting on proposals to change the way that it regulates and inspects providers of care. It has announced its intentions for the next phase of regulation for adult social care and primary medical services but this is largely as a precursor to the detail which will be contained in a forthcoming consultation which will focus on those areas in the Spring of this year. The current consultation does major on the changes that it intends to bring in for the regulation and inspection of NHS Trusts and independent healthcare providers.

The inspection of all NHS trusts in England has now been completed and the inspection of most independent healthcare providers will be completed in 2017. The next phase of regulation for independent healthcare providers is expected to begin in 2018/19. CQC has indicated that the approach to regulation for trusts will commence in April 2017; independent healthcare providers will largely follow the same principles so this consultation is of importance to future planning for independent healthcare providers equally.

CQC’s schedule of inspection for NHS trusts will change to target those areas where concerns have been identified and this will see a significant reduction in the number of comprehensive inspections it undertakes. CQC will commit to inspect at least one core service of each trust and will separately look to inspect trusts for overall leadership on an “approximately annual basis”. This could lead to the reduction of the regulatory burden placed on trusts and would be welcomed.  This move does seem to be primarily cost driven rather than one which is linked entirely towards ensuring the quality of service provision.

It would appear that comprehensive inspections as we know them will be a thing of the past for all providers except newly registered ones and trusts that raise significant concerns.  This will allow CQC to conduct more inspections with smaller teams and turn around such inspections in a more timely fashion.

Of the inspections of core services, the proposed timescales for re-inspection are: up to a year for an inadequate rating; up to two years for requires improvement; up to three and a half years for good ratings; and up to five years for an outstanding rating. Some may say that the retention of the timescale of twelve months for trusts to improve post-publication of the inspection report should be brought into line with that of independent healthcare and all other providers of care who are required to improve within six months as part of the special measures regime.  The importance of challenging inspection findings will be of increased importance owing to ratings effectively lying on the file until CQC gets around to re-inspecting a particular core service.  With all the will in the world, CQC’s own inspection schedule has been known not to run to schedule for the simple reason that it needs to inspect a vast number of providers on a shrinking budget.  Trusts and the public are entitled to accurate up-to-date accounts of the quality of a particular service. They provide a crucial part of the dialogue between the healthcare provider and the public whom they serve and a seemingly reduced schedule of inspection across the trust estate does not inspire confidence in the regulator.

Revisions to the way that inspections are carried out hope to reduce the information burden placed on providers. An example of a change to information gathering lies in the provider information request (PIR) which is proposed to only need to be submitted annually in contrast to the current two-part PIR required 20 weeks prior to a comprehensive inspection.  CQC will also seek to build up a body of evidence throughout the year to add to the PIR which will guide its focus on where inspections are required.  CQC will ask providers to rate themselves against each key question as part of the revised PIR.

More broadly in relation to information gathering to inform the focus of inspections, CQC is removing its model of “intelligent monitoring” and replacing it with “CQC Insight”.  This new model builds on its predecessor and hopes to continually make a note of changes to a provider between inspections by gathering evidence from service users, stakeholders, engagement with the provider and the revised PIR to inform its regulatory activities.

Another development relates to changes to the way that an overall trust is inspected for the new annual well-led inspection. An assessment of well-led in relation to a trust will begin with an assessment across the trust of leadership, management and culture. It will not be a simple aggregation of the findings of core services ratings for well-led.  Those sceptics among us may see this change in the policy on reviewing the question of well-led away from an inclusion of ratings at each core service level as budget driven. The risk is that judgements about trust-wide led leadership become more theoretical, subjective and less evidence based.

Reports are promised to be more concise and capable of being digested more readily by the wider public. An important development will be the publication, alongside inspection reports, of evidence which is relied upon within the report- something which is not currently done.  This may make inspectors more amenable to making changes to a draft reports when challenged, if the underlying evidence is to be made available to the wider public- time will tell.

This consultation in relation to NHS Trusts and independent healthcare providers sets out the direction that CQC wishes to now travel, emboldened by the completion of its trust inspection regime.  CQC wishes now to focus on leadership within trusts and on those providers who are underperforming. It will look to cherry-pick those providers that appear to be performing the worst and target its regulatory activities to maximise improvement within the sector. Much more information will be drawn upon to build up a picture of performance for a provider which will inform inspection schedules.  A forensic analysis of inspection report findings should be undertaken by Trusts and independent healthcare providers – if this is not already the case- to avoid negatively-rated core services and trust level ratings lying on the file.

At Ridouts we are well-versed in responding to trust-wide level and core services inspection reports as well as enforcement action that is proposed or taken by CQC. Please feel free to contact us for a free initial conversation.

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