The Care Quality Commission (CQC) announced a new strategy which will bring all health and social care providers under one single framework to provide more consistency across services. This new regime is currently being piloted with a small number of providers and a subsequent rollout across the board is expected in Autumn 2023.
As such, care providers will be expected to implement certain changes in the context of CQC’s four new areas of focus, as outlined in its publication, A new strategy for the changing world of health and social care:
People and communities: Regulation that’s driven by people’s needs and experiences, focusing on what’s important to people and communities when they access, use and move between services.
Smarter regulation: Smarter, more dynamic and flexible regulation that provides up-to-date and high-quality information and ratings, easier ways of working with CQC and a more proportionate response.
Safety through learning: Regulating for stronger safety cultures across health and care, prioritising learning and improvement and collaborating to value everyone’s perspectives.
Accelerating improvement: Enabling health and care services and local systems to access support to help improve the quality of care where it’s needed most.
Running through each theme are two core ambitions: Assessing local systems: Providing independent assurance to the public of the quality of care in
their area.
Tackling inequalities in health and care: Pushing for equality of access, experiences and outcomes from health and social care services.
For many care providers, the CQC regulations are the linchpin for how they operate their services – following these regulations ensures that high-quality, safe and compassionate care is being provided at all times. Here’s what you need to know to ensure your care service is prepared.
Why is CQC launching a new strategy?
In essence, the new strategy is designed to simplify and refine the oversight of risk that is happening within care services.
The COVID-19 pandemic highlighted that the existing CQC strategy wasn’t really fit for purpose, in that care providers were reactive to risk assessments, rather than identifying risk in services as they were happening and having the capacity to encounter and handle the risk.
In addition, in the past 12 months, health and care services across England have joined forces, regionally, to create integrated care systems (ICS). This is to help ensure that information is interoperable and to help improve the lives of people who work and live in the area.
It’s not surprising that CQC has taken a similar approach, with a focus on assessing local systems and also refining its framework to a single source, rather than having lots of different variations. Here’s what the regulator is planning to focus on and 13 ways you can prepare.
The format of inspections
The current timetable of on-site inspections will be replaced by frequent monitoring and engagement calls to assess risk. These are known as Direct Monitoring Activity (DMA) calls.
These phone calls are based on a set of questions with a focus around the key lines of enquiry (KLOEs). Questions will be asked around:
The continued relevance of the registered service user bands, checking that the service is providing the regulated activity appropriately.
- Mental Capacity Act (MCA), consent, best interests and Liberty Protection Safeguards.
- Risk management and safeguarding people.
- Care planning.
- Safe staffing.
- Infection control.
- Activities and lifestyle choices.
- Stakeholder feedback.
- Governance and provider oversight.
Inspectors will also ask service-specific questions around any other intelligence that they have received from third parties, such as the local authority.
CQC will inform you of the outcomes of the call. If your service is identified as ‘very high risk’, you will receive further engagement calls and can also expect on-site inspection activity.
Key lines of enquiry
The current service frameworks will be replaced by a single framework, which will be used across all providers from initial registration application. The aim is to simplify the process and provide a coherent and joined-up service history.
The key questions will remain, but the KLOEs will be replaced by ‘I’ statements. This will help the regulation to be driven by people’s needs and their experiences of the health and care service.
These ‘I’ statements will be underpinned by ‘We’ statements. These statements outline the expectations of how providers are meeting the ‘I’ statements. They are quality indicators and there will be between four and 10 ‘We’ statements beneath each ‘I’ statement.
Evidence will then be reviewed under one of six categories (more information on evidence categories below) to ascertain if the quality statements are being met.
Ratings
There will be no change to the current rating categories; however, there is the possibility of CQC having the ability to change a service’s rating without an on-site inspection, based on the findings and information gathered during a remote monitoring call.
Partnerships
There will be increased focus on information gathering from care providers’ partners and stakeholders and you may be asked for contact details of relatives and staff as part of the remote monitoring process.
Evidence categories
The evidence categories recently went to consultation, and it is proposed that each service type will be asked to provide a list of evidence under each of the five key questions and topics (Safe, Effective, Caring, Responsive and Well-led).
Evidence will fall under one of six categories:
- People’s experiences.
- Feedback from staff and leaders.
- Feedback from partner organisations and stakeholders.
- Observations.
- Processes.
- Outcomes.
The quality of the evidence will be reviewed by inspectors with an assessment made under the following:
- Compassion and dignity.
- Partnership working.
- Promoting healthier lives.
- Improving outcomes.
- Rights and equality of staff.
- Equality and access to care provision.
- Environmental sustainability.
- Governance and leadership.
- Best practice and innovation.
A score will be made against each of the six evidence categories, which will then be calculated and will determine a rating for the care service.
What can providers do to prepare?
Here are 13 things we recommend all care providers do ahead of time:
- Work with your care team and staff. Share information about the strategy with them as it becomes available. Add it as an item to your team meeting agendas, share the CQC resources with them, and make quality and compliance a cultural value in your care facility.
- Join CQC’s Citizen Lab. This gives you the opportunity to have early access to what CQC is thinking, as well as share your opinion on the upcoming changes.
- Keep your CQC presentation/Personal Information Record up to date. This will save you time in the long run as it will be requested!
- Look at the DMA questions for care providers. Start to gather evidence and write your answers before the call.
- Keep a record of innovation and creativity within your care service. Make sure you can evidence the impact on people and the wider facility.
- Reach out to other services. Are you part of leadership forums and healthcare groups in your area? Networking and sharing information and best practices helps to drive innovation and improvement across services.
- Make sure your audits are up to date and clearly reflect any changes made/actions taken in response to audit findings.
- Survey people who use your service, including friends, family and visiting professionals – how do you utilise this feedback?
- Treat external stakeholders and the local authority in the same way as you do the CQC – they will be asked for feedback.
- Ensure your evidence is well organised. Think about the new evidence categories and how you will present this to CQC.
- Consider implementing a compliance software system. Electronic systems and processes can save a significant amount
of time. - Involve people who use your service and their families as much as possible in your service’s development. Consider asking people who use services to join interview panels.
- Remember, CQC is looking at how care providers work together within systems to help achieve shared care goals, so:
- Increase your understanding and awareness of the care system you belong to.
- Identify local healthcare themes and trends.
- Consider the pressure points in secondary care – is there any way you can support with this?
- Look out for any initiatives in your area with which you could join forces to support the ongoing national aims of reduction in health inequalities, reducing hospital admissions due to Urinary Tract Infection, and early detection of pressure damage which could lead to tissue breakdown.
Positive outcomes
It is still difficult to ascertain the actual impact the new framework will have on managers and providers directly. The increased monitoring and contact activity will help to forge better relationships between the regulator and some providers, which will be a positive outcome. Also, the new model of inspection and monitoring will certainly demonstrate a stronger partnership with local authorities and external bodies and may well prove to be much more responsive to the risk level for each service.