What has happened to the CQC’s Transitional Monitoring Approach?

In the wake of the pandemic, the CQC changed its entire approach to inspections in order to limit inspectors “crossing the threshold”. The CQC initiated remote monitoring through initial conversations with Providers which could result in a site visit if the CQC had concerns, and enforcement action if the CQC found the service to be in breach of the regulations. This remote monitoring has taken two different forms, the first being the Emergency Support Framework (ESF) launched in May 2020. The ESF then morphed into the Transitional Monitoring Approach which was launched in October 2020 and was to be used from that date until at least May this year. However, in the CQC’s January 2021 Board meeting Ian Trenholm announced that CQC’s priorities have changed. This article explores CQC’s re-focus and what that means for Providers.

CQC’s 2021 priorities

The CQC is again reminding the public that throughout the pandemic, their “regulatory role has not changed”. Whilst their regulatory role has not changed, their approach certainly has. As explained by Jenny Wilde in a recent Ridouts webinar, the TMA is a more arm’s length approach to regulation. The CQC engage in remote monitoring through initial conversations by telephone or online with Providers.  During the conversation the inspector asks questions which focus on specific KLOEs in addition to a specific focus on safety, access and leadership. These conversations can be followed up with the inspector requesting documents and information from the Provider by email. Following a review of the information received remotely, the CQC decides whether the service is high or low risk and whether an inspection will take place or not.

However, at the January 2021 Board meeting, Ian Trenholm mentioned that the CQC will be “doing less of TMA” that means less contacting Providers proactively. The CQC predict that TMA calls will decrease as resources are deployed in other areas, but have said that they will continue to review how the TMA, specifically how it will evolve into, what they call the “Future Regulatory Platform”. Ian made the statement whilst announcing the CQC’s priorities for the first quarter of 2021. Their priorities have been grouped into three main categories which are aimed at either adding capacity or responding to risk in the system.

  1. Proactive – Planned pieces of work in areas such as Infection Prevention and Control (IPC) or areas where they know that they have specific and longstanding risks.
  2. Reactive – Reacting to information from the public or whistleblowers.
  3. Supportive – Working with other agencies and organisations such as Department of Health and Social Care, NHS England and NHS Improvement to deal with COVID-19.

What does this mean for Providers?

Whilst the CQC is “doing less TMA” and has made it clear that they will “only undertake inspection activity in response to a serious risk of harm or where it supports the system’s response to the pandemic”; the CQC will be continuing its IPC inspections in full force. They had committed to undertaking 1200 IPC inspections by the end of January 2021 and had completed 900 of those by 21 January 2021; and they have planned to undertake 600 IPC inspections each month from February to April 2021.  Furthermore, the CQC will continue to monitor and assess services where there is a risk of closed cultures developing.

It is obvious that the CQC has abandoned that supportive approach that Providers benefited from in the early days of the pandemic; as their priority now is to support other agencies and organisations such as Department of Health and Social Care, NHS England and NHS Improvement to deal with COVID-19. Moreover, any inspections carried out will be focused on evidencing serious risks or concerns, IPC inspections are no longer focused on “looking for good” and despite the CQC pausing Provider Collaboration Reviews, they will continue to run their Give Feedback on Care programme. I am not saying that the CQC should not divert resources and prioritise areas of work, and it is obviously the duty as a regulator to listen to the views of the public, respond to risk and identify poor practice. But it does seem that now it is more important than ever for Providers to keep channels of communication open with the CQC. If the CQC are no longer having conversations with Providers, Providers need to find opportunities to put forward to the CQC evidence of the best practice taking place within their service to help the CQC build a well-rounded picture and not one solely based on negative views.  And for Providers whose services are inspected, and are unhappy with their draft report, Ridouts can support you through the factual accuracy process.  Providers should check and challenge the completeness of the information that the CQC has used to reach its decision and ratings.

Ratings

Previous CQC guidance, pre-pandemic, gave Providers comfort of knowing when the CQC would revisit and re-inspect. Inspections were expected to take place within 30 months of publication of a report for a service rated ‘Good’ or ‘Outstanding’, within 12 months for a service rated ‘Requires Improvement’ and within 6 months for a service rated ‘Inadequate’. However, the CQC is no longer following timetabled inspections and as the TMA conversation was not an inspection, the CQC did not rate services following the call. Unless the CQC inspected because they had concerns about the service, Providers with lower ratings of ‘Requires Improvement’ or ‘Inadequate’ have not been afforded the opportunity to showcase improvements to the CQC and obtain a re-rating. It looks like this may be set to change.

In the January 2021 CQC Board meeting Kate Terroni, Chief Inspector of Adult Social Care, spoke of the CQC looking to free up capacity in the system to help with COVID-19 and how that would benefit social care providers. The system is currently being freed up through the rapid inspections of potential designated sites under the Designated Setting Scheme allowing people who have COVID-19 to be discharged from hospital in a timely way. But the CQC is also planning to help free up the system by inspecting services “where there is the ability to award a new rating, supporting local authorities to commission care where needed”.  They will be looking at services that are ‘Inadequate’ or ‘Requires Improvement’ where there is evidence that, if they were to go out and re-rate those services the rating would improve. They plan to carry out those inspections so that commissioners can buy care from those services, thereby opening the floodgates. It is impossible to predict the proportion of Providers who will receive an inspection for the purpose of re-rating to ‘open the floodgates’ and the CQC has given no indication of the criteria that will be used to select those services that are ‘Inadequate’ or ‘Requires Improvement’ that will be inspected and re-rated. It may be a small minority of services that are re-rated, on the basis that in the very same meeting Ian expressed that the CQC will not be reviewing ratings for the next few months. It’s not the first time we are receiving unclear messages from the CQC, and as always we have to just wait and see.

Ridouts Professional Services will be hosting a free webinar on 9 March 2021 looking at, amongst other topics, CQC’ most recent approach to inspections, providing practical guidance on how to prepare for this. To book your place please visit: https://us02web.zoom.us/webinar/register/WN_OtAmtsO9QgW0PQKXEnjnIw

 

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