Evaluating the CQC inspection regime

September 28, 2018

The King's Fund has published a report evaluating the CQC inspection regime.

Impact of the Care Quality Commission on provider performance: room for improvement? has found that the Care Quality Commission's (CQC's) inspection and rating regime is a significant improvement on the system it replaced, but says that it could be made more effective. This is the first major evaluation of the approach since it was introduced in 2013.

This research, carried out by The King’s Fund and Alliance Manchester Business School between 2015 and 2018, examined how it was working in four sectors in six areas of England.

These four sectors were:

  • Acute care.
  • Mental health care.
  • General practice.
  • Adult social care.

The research was funded by the National Institute for Health Research. The report suggests that relationships are critical, with an importance on mutual credibility, respect and trust. It argues that CQC should invest more in the recruitment and training of its workforce, and calls on providers to encourage and support their staff to engage openly with inspection teams.

Several areas for improvement have been highlighted in evaluating the CQC inspection regime. The report states that the focus on inspection and rating may have crowded out other activity which might have more impact. It recommends that CQC should consider more regular, less formal contact with providers, helping to drive improvement before, during and after inspections.

The evaluation also found significant differences in how CQC’s inspection and ratings work across the four sectors it regulates. Acute care and mental health care providers were more likely to have the capacity to improve. They also had better access to external improvement support than general practice and adult social care providers. The report has recommended that CQC considers changing its inspection model for different sectors, taking into account differences in capability and support.

CQC is now implementing a revised strategy for regulation which addresses some of the issues raised in the report. In response to the report, Ian Trenholm, Chief Executive at CQC, said, 'We welcome the findings of this report on the regulatory model we introduced in 2013, the recommendations it offers and the support it gives to the changes we have already made and are continuing to make in line with our strategy.

'We are already placing greater emphasis on relationship management, the development of system-wide approaches to monitoring quality, and the introduction of CQC insight and intelligence driven assessment.

'In an environment of pressure and change, we’ll continue to evolve our model to support the system to improve - and take action to protect people where necessary.'

Ruth Robertson, report author and Senior Fellow at The King’s Fund said, ‘Over the past few years, the CQC has completed a herculean task by inspecting and rating every hospital, general practice and adult social care provider in England. Although we heard general support for their new approach, we also uncovered frustrations with the process, some unintended consequences and clear room for improvement.

Kieran Walshe, report author and Professor of Health Policy and Management at Alliance Manchester Business School, the University of Manchester said, ‘CQC can now build on its experience and database from the first full cycle of inspection and rating, to create a more targeted and responsive regulatory model.

‘But CQC cannot do this alone. It is just as much up to health and social care providers and other stakeholders, like NHS England and NHS Improvement, to make regulation work in improving services for patients.’

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