Analysis and latest reaction to the Care Quality Commission’s proposals for the future of regulation

Live logo

6.02pm Health secretary Jeremy Hunt has offered a pay guarantee to junior doctors as part of plans to end the impasse between the government and the British Medical Association. Read Shaun Lintern’s full report.

5.28pm Here’s the letter which Mr Hunt has sent to the BMA:

5.18pm Here’s HSJ workforce correspondent Shaun Lintern’s take on Mr Hunt’s announcement:

5.11pm Jeremy Hunt has just spoken in the House of Commons about the junior doctors contract. The health secretary has committed that no junior doctor working within legal limits for hours will have their pay cut.

3.55pm Conservative MP Stephen Phillips:

3.52pm David Behan and Una O’Brien, DH permanent secretary, are being grilled at the Public Accounts Committee:

3.27pm Neil Grant says IPSIS is a “welcome development”.

3.20pm In response to a question about whether the CQC and NHS Improvement, Sir Mike says: “This is not the time… the CQC is not an improvement agency, but it is an agent for improvement.”

Hugo Mascie-Taylor adds that Monitor and the TDA coming together while staying effective is a massive challenge, so it is not time to throw in CQC.

3.16pm Sir Mike says the CQC has considered prosecution in several cases and has cancelled registrations. “We’re not frightened to take this action,” he adds.

3.14pm NeilGrant and Hugo Mascie-Taylor say they do not want a “blame culture” in the NHS. Dr Mascie-Taylor says “the majority of NHS improvement’s don’t happen because of a stick, they happen becase people in organisations want to improve”.

3.09pm Hugo Mascie-Taylor adds that in changing health systems CCGs have a key role, but he says “I’m not advocating immediately regulating them.”

3.05pm Hugo Mascie-Taylor says where there’s a failing provider there’s usually a problem in the local health economy, which is why there needs to be a discussion abour regulating health systems.

2.55pm Neil Grant says regulators have “tended not to go down the prosecution route” in recent years. Inspectors may not have felt comfortable going down that route, he adds.

2.54pm Sir Mike Richards says the CQC has received a “considerable number” of referrals to it under the fit and proper person regulation.

2.50pm Sir Mike on Addenbrooke’s:

2.43pm Sir Mike says the CQC is behind on its NHS inspections because it has had to return to trusts where quality was not good enough.

2.39pm Neil Grant, a partner at Ridouts Solicitors, says that the term “co-regulation” is unhelpful, because under statute the CQC is an independent regulator.

2.37pm Sir Mike Richards: “Don’t worry” CQC will not move away from inspection.

2.33pm The webinar has now started.

2.20pm HSJ’s Shaun Lintern will shortly be quizzing Sir Mike Richards, the CQC’s chief inspector of hospitals, and Hugo Mascie Taylor, Monitor’s medical director on the future of hospital regulation. We’ll cover it here on HSJ Live, but you can also register to watch the webinar here.

1.40pm As well as improving the efficiency of the current inspection model, the regulator’s proposals for the future of health and care regulation include assessing quality in geographical areas and across pathways. This will involve the CQC using its powers to look at commissioning.

However, Mr Behan said the regulator was not going to start inspecting or rating clinical commissioning groups: “We’ve not been given a role to assess the quality of CCG’s… there’s nobody asking us to do that,” he said.

1.35pm Discussing the likely cut to CQC’s grant, chief executive David Behan said the organisation was “modelling” scenarios and would have “choices” about how to deal with any cuts.

“Twenty-five and 40 per cent – they’re big numbers. You’re not going to be able to carry on doing everything we’re doing in exactly the same way, so there’s no point me sitting here and pretending that that’s what we can do.”

When asked whether funding cuts would affect the CQC’s inspector headcount, which is due to peak in December, Mr Behan said: “I see it having some impact, I don’t necessarily see it at the moment having a huge impact. But we need to model this and look at the various options and scenarios, and we’re not at that point.”

12.30pm Kay Sheldon, another CQC NED, appears to be concerned about potential changes to the regulator’s budget following the spending review:

12.25pm Alan Rosenbach, a former CQC strategy lead, has a sense of déjà vu:

12.14pm HSJ’s Will Hazell has written a piece looking at whether the CQC’s proposals are the latest swing of the care inspection pendulum.

He argues that “making a more hands-off approach work will be a tough test for the ability of the CQC, and the wider health and care system, to use information to protect quality and guide inspection”.

12.04pm Here’s CQC non executive director, Louis Appleby, on self-assessment:

12.03pm The idea behind co-regulation is to “encourage providers to develop their own systems and processes for understanding quality”, which the CQC says is “an essential step in developing a culture of continuous improvement”.

The CQC says it will be able to protect against providers “marking their own homework” by checking self-assessments against its own data. But as Sir Robert Francis (now a CQC board member) wrote in his report on Mid Staffs “of necessity, only a small proportion of such assessments could be checked or audited by a national regulator”.

11.54am Under the co-regulation proposals, providers who have already been inspected could use the CQC’s own key lines of enquiry to report on any changes to the quality of care since their inspection.

The CQC would then compare this evidence with its own monitoring data and other information, including the views of patients and staff. The regulator says it would use the self-assessments to target its activity and prioritise the right things on inspection but “would never rely solely on the information that providers give us without challenge”.

11.53am There’s already been a lot of reaction on Twitter to the CQC’s report.

HSJ’s Shaun Lintern asks whether the regulator is repeating the mistakes of the past in suggesting a move to provider self-assessment. Shaun, who broke the scandal at Mid Staffs, quotes from the Francis report:

11.41am The CQC’s proposals are at least in part an acknowledgement that its going to have less resources with which to work with over the next few years. The regulator has been asked to model cuts of between 25 and 40 per cent to its grant. However, in an exclusive interview with HSJ, the CQC’s chief executive, David Behan, pledged to protect its “frontline and statutory responsibilities”.

11.33am Here’s our story on the CQC’s proposals for regulating health and care between 2016 and 2021. The key points:

  • Inspecting high performing providers less frequently
  • ‘Co-regulation’ via provider self-assessment
  • A more “risk based” approach to registration
  • Better use of data
  • Assessing quality in “places” and across “pathways” as well as inspecting individual institutions

11.30am Good morning and welcome to HSJ Live.

The Care Quality Commission has published a document outlining options for the future of health and care regulation, including a move to a more risk based approach to inspection and “co-regulation” with providers.

We’ll keep you up to date with the latest analysis and reaction.