The new year marks a fresh chapter for the CQC with the continued roll out of its new single assessment framework. Providers should be familiar with the quality statements and evidence categories by now and will have begun to see how the CQC is applying them in practice through the publication of new style inspection reports. While the new framework is being rolled-out, the CQC continues to fine-tune and develop certain areas while questions still remain in others.
This article covers what we know so far about the CQC’s plans for 2024 to help providers prepare for this new chapter.
Change To Legislation: New Visiting Regulation For Care Homes, Hospitals And Hospices
The Health and Social Care 2008 (Regulated Activities) (Amendment) Regulations 2023 will come into force on 6 April 2024. The legislation inserts a new fundamental standard, by virtue of Regulation 9A, into the existing Regulated Activities Regulations addressing the matter of visiting requirements for care homes, hospitals and hospices, the necessity of which became more apparent as a result of the Covid-19 pandemic.
The regulation aims to make sure that:
- people staying in a care home, hospital or hospice can receive visits from people they want to see;
- People living in a care home are not discouraged from making social visits outside the home; and
- People attending appointments in a hospital or hospice, that do not require an overnight stay, are accompanied by a family member, friend or advocate if they want someone with them.
It sets out what providers must do to make sure they respect the rights of each person to receive visits and to be accompanied, following an assessment of their needs and preferences.
On 9 January 2024 the CQC opened a new consultation on its supporting guidance for Regulation 9A. Providers have until midday on 20 February 2024 to respond.
Once the guidance is finalised, providers should ensure their internal policies, procedures and care plans reflect practices that are in line with the new regulation and guidance. This will help demonstrate compliance with Regulation 9A as well as Regulation 17 (good governance).
The regulation is clear that it does not place an obligation on providers to require someone to receive visits, take a visit out of a care home or be accompanied if they don’t want to. This is reflected in the CQC’s draft guidance which refers to providers taking all reasonable steps to support service users unless it is against the service users wishes or, if they lack mental capacity, it’s not in their best interests. Providers policies should be sufficiently robust enough to guide staff on what to do (including keeping clear records) when faced with such decisions.
The New CQC Assessment Framework
The CQC has spent the past couple of years developing its new assessment framework and, following significant delays to its initial targets, it began the gradual roll-out to providers in November 2023. This follows a staged process linked to geographical networks – the CQC will continue to assess services using its existing processes until the roll-out reaches a particular region.
Since the roll-out began we have seen the CQC publishing new short-form inspection reports linking findings to the new quality statements and applying the new scoring system to reach ratings. The CQC is starting by looking at certain priority statements designated for each service type and scoring these under its new assessment process. Importantly, for any quality statements not specifically reviewed the scores will be based on previous inspection findings. This approach could be concerning for some providers, particularly if their previous ratings were Inadequate or Requires Improvement and they have received improved scores following a more recent review of select quality statements by the CQC. Transposing the old ratings into the new quality statements scores could skew the scores (and resultant ratings) to show a less favourable overall rating than the service may deserve as a result of the CQC’s reliance on historic data. If someone were to read the latest assessment report for a service they would be able to see when a quality statement has been based on a previous key question rating. However, not everyone reviews services in this level of detail and the headline rating will be the first thing people see when reviewing a service. This has the potential to mislead people as to the actual quality of a service.
The CQC recently revealed it has now developed a new provider portal to support its single assessment framework and it is currently being rolled out in stages. From 27 February all providers will be able to sign up to it. Until then, providers must wait for an invitation from the CQC.
Currently the new provider portal allows providers to submit all notifications, make registration applications and submit applications to vary registration. Providers will also have the ability to view a clear history of notifications and registration activity.
The CQC’s future intention is for the portal to support the sharing of information through the new assessment framework. This is expected to include the submitting of factual accuracy comments to draft inspection findings and evidence linked to the quality standards as well as representations to enforcement action and improvements to Provider Information Returns (intended to continue annually for adult social care services). It remains to be seen how providers may be able to actively demonstrate positive care provision through the portal but the CQC has previously indicated its intention for the portal to be the central method of communication between providers and the CQC.
Currently, Nominated Individuals are able to set up accounts on behalf of a provider (upon invitation). The CQC intends this to be extended to registered managers and other individuals delegated access within an organisation later in the year.
The existing portal will stop operating on 27 February 2024 and from that date until 31 March 2024 providers will be able to view their data but not make any changes or submissions. Historic data will not transfer to the new portal and providers will need to download this if they wish to keep a record. We recommend that providers do this to ensure they have a clear record of their data – if the CQC were to consider enforcement action in the future it would look at the historic position to help inform its decision making.
The CQC intends to regularly review how well the single assessment framework is working in relation to timescales until the end of June 2024, making any necessary adjustments in response to feedback. It will then consider new frequencies of assessment for each sector. It is currently expected further information on this will be published in July 2024.
Focus Of Assessments
During the roll-out period the CQC is using a preliminary set of priorities for each service type. Moving forwards the CQC intends to define a set of priority quality statements for each service type on an annual basis. The intention is for the priority statements to be assessed as a minimum in each assessment, although the CQC states it can be flexible depending on circumstances.
While the CQC is yet to officially published priority statements, two inspection reports published under the new framework (both domiciliary care services) both looked at the following statements indicating these may be being treated by the CQC as priority statements for these service types:
- Involving people to management risk (Safe)
- Safe and effective staffing (Safe)
- Safeguarding (Safe)
- Independence, choice and control (Caring); and
- Equity in experiences and outcomes (Responsive)
Factual Accuracy Comments Process
The existing factual accuracy comments process, where providers submit their comments via factual accuracy tables within 10 working days of receipt of a draft inspection report, continues to be in place. The CQC has indicated an intention to move away from the table format in due course suggesting a move towards the submission of comments in the body of any draft inspection report through the provider portal. However, it still remains unclear what exactly the new process will look like and when it will be implemented. Of particular interest is how it will be applied to changes in ratings that aren’t linked to physical inspections. Detailed information on this has not been forthcoming to date and providers will need to keep an eye out for further developments in this area.
While it could be considered that the CQC has made significant progress with the roll-out of the new single assessment framework over recent months, there still continue to be many question marks around how matters such as factual accuracy comments and information sharing will be facilitated in the future. Providers are encouraged to engage with the CQC’s continued feedback and consultation processes to ensure they have a say in how they will be regulated in the future.
Ridouts has extensive experience assisting providers with CQC related matters. If you require advice do not hesitate to give Ridouts Professional Services a call on 0207 317 0340 or send us an email at email@example.com.