Findings from CQC’s first consultation on its next phase of regulation

Since publishing its 2016-2020 strategy in May 2016, the Care Quality Commission has been seeking feedback from providers and stakeholders through consultations.

CQC’s first consultation on its next phase of regulation, launched in December 2016 and published in June 2017, sought views on how it should develop its approach as it implements its five year strategy. The consultation focused on: 

• The principles for how CQC will regulate new models of care and complex providers;
• Changes to CQC’s assessment frameworks across all sectors to reduce complexity and create more consistency;
• How CQC will register services for people with learning disabilities; and
• The way CQC will regulate NHS trusts and foundation trusts from April 2017 – including how CQC’s approach to rating them might change.

CQC received 496 responses from individuals and representatives of organisations during the consultation period.

We focus in this article on some of CQC’s proposed regulatory changes discussed in its response to its first consultation that will affect NHS trusts.

CQC Insight

One element on which CQC sought feedback was what it should consider in implementing its new “Insight” approach. As most readers will already be aware, CQC Insight is CQC’s recently introduced model in which information about providers is collated from multiple sources, thereby (hopefully) reducing administrative burdens on providers to provide duplicate information to multiple agencies.

CQC will use such information to monitor potential changes to the quality of care provided, to prioritise its inspections and to support evidence in its inspection reports. CQC will produce monitoring reports which it will share with NHS trusts, and other organisations including NHS England, NHS Improvement, clinical commissioning groups and Healthwatch.

Whilst some respondents were positive about the prospect of reduced administration and data sharing between partners, some NHS trusts were concerned that the CQC Insight model might increase administrative requirements and asked for confirmation that existing data would be used as much as possible.

CQC has said that it will aim to minimise the costs for providers and that the content of CQC Insight will initially focus on existing data collections that are available nationally, supplemented with qualitative analysis of information gathered directly from staff and people who use the services.

Additional monitoring information from providers will only be required where information is not available from other sources.

Relationship management

The feedback that CQC received on the question of what it should consider in strengthening its relationship management has prompted CQC to state that it will improve the consistency of engagement with providers.

CQC has acknowledged that this is an area for improvement and has stated that relationship management meetings will be held between providers (usually senior and/or executive members of a trust’s management team) and their designated relationship holder (which will be a trust’s local CQC inspector or inspection manager) quarterly, with an improved structure and format.

In addition, CQC states that a trust’s relationship holder will seek to attend two of the trust’s board meetings per annum.

Provider Information Requests (PIRs)

Providers were apparently positive about CQC’s proposed new standardised PIR template, which is significantly shorter than CQC’s old-style PIR.

The new PIRs will have two parts: a trust level request which relates to the five key questions and a sector request which asks trusts to report on a limited number of key information items for core service provided by each trust. CQC envisages that the PIR will be updated based on feedback and from CQC’s own learning and will be sent to each trust’s nominated individual once a year.

CQC emphasises that self-reported information in a provider’s PIR, (as the statement of quality), will always be tested and corroborated with other information sources, including information from people who use services and those organisations that represent them, as well as through its inspection activities, before it is taken into account by CQC in making its judgements and ratings.

Each PIR will mark the start of the annual inspection cycle and CQC envisages that providers will receive their first new PIR between June 2017 and autumn 2018.

Inspections

In response to CQC’s proposal that trust inspections would include an assessment of at least one core service and an assessment of the well-led question at trust level, (which CQC aims to complete on an annual basis), respondents raised concerns that it may prove challenging for CQC to assess ‘well-led’ at trust level in a consistent and effective way, particularly across large providers with different types of services.

Respondents also raised concerns that annual inspections of the well-led question could be too frequent and could increase administration or duplicate work with NHS Improvement.

Whilst CQC sought to assure providers that it will always collect evidence against all KLOEs and make consistent judgements against corresponding characteristics, it does not explain how it will do so beyond stating that it will ensure that its teams have the right expertise to ensure its approach is effective. Providers may have to wait to see how such consistency will be achieved in practice.

CQC states that inspections will be more targeted, depending on what CQC has learned about changes to the quality of care through its Insight model and envisages that the level of inspection activity will be proportionate to the level of risk identified at each organisation.

CQC has announced that it aims to inspect each trust at least once between June 2017 and Spring 2019 and approximately annually thereafter. CQC acknowledges that the appropriate frequency of inspections will however be subject to review as its model is rolled out.

Ratings

The consultation also asked stakeholders for their views on CQC’s current approach to trust-level ratings. It is clear that whilst CQC received some support for its current ratings model, many respondents suggested that CQC could improve transparency in relation to its decisions, the rationale behind such decisions and an improvement in how ratings were communicated to the public.

Respondents also commented that inspection reports needed to be more succinct and presented in a more accessible format.

CQC sought to reassure providers that it will improve transparency, clarity and communications by setting out how it reaches its decisions on trust level ratings in its inspection reports and that it will include the factors the inspection team considered and how they influence the overall rating.

It is likely that assessments will be based more on professional judgement which could lead to greater inconsistencies. CQC added that it aims to produce shorter reports, with evidence that presents the facts and figures in a separate report, to make reports more clear and concise.

Conclusion

It is of concern that elements of the consultation highlight CQC’s shortcomings in respect of transparency, clarity and communication; such competencies should be entrenched features of any competent regulator.

In spite of such apparent shortcomings, CQC’s responses to its latest consultation do at least suggest that CQC is trying to work with providers and stakeholders to respond to their concerns and to improve its practice generally. It remains to be seen whether CQC’s laudable intentions deliver in all respects.