Understanding the CQC’s strategy and regulatory approach

The CQC is working to fulfil its strategy that was launched last year. Under the new strategy the regulator plans to continually monitor practices and also shorten inspection reports. So what does this all mean for practices?

What to expect and when

The CQC’s current strategy sets out its aims, aspirations and outcomes from 2021 to 2026. The strategy is made up of four key themes:

  • People and communities,
  • Smarter regulation,
  • Safety through learning,
  • Accelerating improvement;

And two core ambitions:

  • Assessing local systems,
  • Tackling inequalities in health and care.

The strategy document is very high level and contains aspirational outcomes. Most notably, there are no clear target dates for achievement of stated outcomes.

Since the strategy’s launch the CQC has taken a phased approach to development and implementation, which it hopes will enable it to learn. It is only most recently that we have had a clearer picture of what will happen and when.

In August 2022, the CQC worked with ‘early adopters’ – a small group of CQC colleagues and providers on the new approach. Then in September 2022, the CQC expanded the early adopter group to include a small number of GP practices, independent providers and care homes.

From October 2022 the CQC started carrying out assessments using its new approach. January 2023 is when the CQC plans to start the full roll-out of its new way of regulating.

Single Assessment Framework and Ongoing Assessment

Traditionally the CQC has used four assessment frameworks but has now decided to use one Single Assessment Framework for all sectors. This is in combination with plans to assess practices on an ongoing basis.

The CQC will move away from assessing services and updating ratings only as a result of site visits/inspections. Ongoing assessment means that the CQC will seek multiple opportunities to consider the quality of care using data and intelligence to monitor practices off-site and use site visits to observe care.

The Single Assessment Framework makes use of some of the CQC’s existing tools. The five key questions will remain – is the practice safe, well-Led, caring, effective and responsive to people’s needs? The ratings (Outstanding, Good, Requires Improvement and Inadequate) also remain

What will change is that the five key questions will be made of topic areas and quality statements. The quality statements, also known as ‘I’ and ‘We’ statements describe what ‘good’ care looks like and link to the regulations.

We still need more detail on this new regulatory approach, in particular the scoring system and evidence category system. It is understood that the CQC plans to implement a scoring system made up of an evidence score, quality statement score and key question score, which when combined will provide an overall score and rating.

Recent CQC webinars show that this is still in the development stages, but it looks as though it is proving to be a very complex system. It is also not yet clear how the CQC intends to illustrate this information for the public.

‘Smarter Regulation’

The strategic theme ‘Smarter Regulation’ relates to the CQC providing up-to-date and high-quality information to the public about the services it regulates. Practices need to be prepared for ongoing monitoring and alert to the possibility of ratings being changed based on data and intelligence not just inspections.

An element of Smarter Regulation involves changes to the way information about practices is displayed on the CQC’s website.  At present the CQC is considering how it will publish findings from its assessments and ensure that an up to date view is in the public domain.

This continuous assessment process enables the CQC to capture and publish improvements made by practices more regularly. What it does mean is that practices need to be on constant alert in the knowledge that potentially everything that takes place within a practice could be picked up by the CQC and possibly impact on their rating.

One concern we have is that the CQC believes that the inspection reports are currently too long and need to be streamlined. However, providers we work with often find that current inspection reports are vague and contain a disproportionate amount of standardized wording, which leaves one wondering how diluted the content of inspection reports will be if inspection reports are shortened.

The CQC’s website is expected to display the overall score for the service, as well as a section showing the improvements a practice has made in response to enforcement action. What has not yet been discussed is how providers will be able to challenge the CQC’s assessment of practices outside of the routine inspection process.

It is apparent that the current processes of factual accuracy checks and rating reviews will be insufficient for the new assessment approach that the CQC is planning. Ridouts is keeping a close eye on what the new processes of challenge will look like.

In the meantime practices should think of ways that it can showcase good care and practice. This includes having systems to draw out relevant data. It is important now more than ever before that providers try to manage the inspection process and be careful about all their interactions with the CQC.

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