The CQC’s Draft Strategy for 2021 and beyond

On 30 September 2020 the CQC published its draft strategy on how it  proposes to regulate the health and social care sector from 2021 and beyond.  Note some key takeaways from this draft document below:

  • The CQC intends to rely much more on data over inspections which will direct the CQC in terms of action that it wishes to take to regulate health and social care providers.
  • There is to be a drive to reduce the requests that are made of providers for information and data
  • Ratings will be updated more frequently based largely on the data given as opposed to attending to carry out full inspections of services.  This confirms the intention to largely abandon full inspections of care homes and such inspections in the future will in the main be led by a response to concerns raised in a targeted manner.  Inspections are to be conducted in respect of specific concerns or sampling is required for the CQC to assure it of its view of quality.
  • Reports as they have been in long form will be no more.  Instead the CQC plans to give information and data for ‘an audience’ and this is to be provided online or through an app. There is the clear indication that the CQC will focus its activities on analysing data rather than performing physical inspections within this draft strategy.
  • The strategy is silent on the provider’s opportunity to challenge such updates to ratings, reviews of data and limited inspections of services.  It is hoped that providers will be offered the opportunity to respond to the new in a meaningful way and such responses be considered properly by the CQC.
  • There are now computer systems in place at the CQC which will allow it to work with large amounts of data in a formulaic manner in order to provide a more consistent approach to providers.  This is an interesting development and we presume that this is going to result in a more rigid approach by CQC to align datasets to equate with ‘good’ or ‘bad’ services.  To give a rather crude example this could mean that a metric identified by the CQC for example the number of resolved safeguarding concerns raised by a provider could mean that they are deemed to be a ‘bad’ provider.  There will be data which sets out benchmarks which will point the CQC in the direction of the providers who need to improve.  Further we would expect there to be formulas as to how each piece of data is to be assessed more generally which will allow the risk profile of a provider to be identified.
  • There is to be a change in the way that information is provided on the quality of providers in order to make it more readily understandable to the public.  We interpret this as meaning that such information is likely to be in a much more reduced format from the inspection reports that we have been used to within the sector.  This could mean that the opportunity to challenge such findings may be significantly reduced if the statements that appear are not grounded in evidence of findings. This remains to be seen.
  • There will be an increased focus on assessing how services are working in a local area with comparisons to what matters to people in the local area- although there is little detail on how this is likely to be monitored and what the consequences might be if a provider is deemed to not be working well within a locality
  • There will be a new definition of quality and what good and outstanding care looks like are based on what people say matters to them- which is likely to be developed in future consultations.
  • Local teams will have a regular view of services based on their knowledge- this may have the unintended consequence of causing CQC inspectors who have opinions on services, focusing more acutely on services than would have been the case historically increasing the risk of bias creeping into the regulation of services which are based more heavily on their subjective opinions of services.
  • Safety is very much towards the top of the agenda in this proposed strategy for the CQC.  This could result in increased prosecutions and enforcement being brought with the CQC taking the torch passed to it by HSE several years ago to more strictly hold providers to account for their failings in respect of keeping people safe.  Zero avoidable harm is to be the CQC’s new mantra (which is a strong ambition) which could demonstrate the no nonsense approach to calling providers out where safety issues are identified.  Included within this renewed emphasis on safety is a focus on the culture of the provider to learn from its mistakes with action being taken if it does not. Action is also to be taken if a provider fails to learn from publicised failures which happen in the wider healthcare landscape.  This places an increased burden on providers to be outward looking and incorporate both best practice and an understanding of negative practice from other providers into their own practices focused on safety mitigation.
  • An improvement alliance is a suggested solution to provide support to providers of health and social care very much in line with that of the NHS whereby highly rated providers work with providers that have been placed in special measures to assist with their improvement.  The onus for improvement is still very much put in the hands of providers and there is a clear caveat that it isn’t the CQC’s role to precisely identify what a provider needs to do to improve but that it will work with providers who want to improve.  It will still look to call out those providers who are identified as providing poor care.
  • The threshold to be met for good services will be increased to meet the expectations of the public. To remain good a provider will need to be in the continual pursuit of improvement and to encourage such improvements within their local health and care systems.

Whilst this strategy is in draft format it is very much illustrative of the direction in which the CQC sees itself going from April 2021 onwards, as a data-led regulator for the post-pandemic age.  What is proposed is a sizeable step away from a regime typified by inspection reports on services in favour of short updates on providers and more regular ratings. We will keep you posted with updates on this strategy.

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