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An ambitious strategy: CQC’s bold regulatory approach

Earlier this year, the Care Quality Commission (CQC) published its draft regulatory approach setting out the focus for change as we enter 2021. Here, Errol Archer of Scott Moncrieff & Associates shares the key details of the plans and asks, is it too bold an approach?

CQC’s executive directors have been busier than usual this year, for obvious reasons. The COVID-19 pandemic forced the regulator to stop in its tracks: inspections ceased, staff scrambled to work remotely, enforcement actions and registration decisions slowed dramatically.

Notably, there was a lack of guidance on infection prevention and control and providers looked to Public Health England for a lead.

Despite CQC’s lacklustre response in the immediate aftermath of the virus and lockdown, much-needed leadership eventually came in the form of its Emergency Support Framework coupled with targeted on-site inspections, the latter of which stepped up a gear in September. In addition, CQC’s Provider Collaboration Reviews (PCRs) have highlighted how collaboration has worked to meet the challenges caused by the pandemic.

Fortunately, many of the regulator’s staff have worked remotely for years and, within months of the lockdown, it became clear that the cogs and wheels of the regulator were still turning. CQC has since issued ambitious new regulatory guidance, publishing on 8th October the widely anticipated update on how it will regulate providers who support autistic people and people with a learning disability, Right support, right care, right culture. On 16th October, it published its annual State of Care 2019/20 report.

Of broader significance for providers, CQC published details of the emerging themes that will direct its regulatory strategy from 2021 onwards, The world of health and social care is changing. So are we.

Where the focus will lie

The regulator raises four themes in its draft strategy for discussion and CQC’s Chief Executive, Ian Trenholme, has hinted that a seismic shift is on its way. In his 1st October blog, he says, ‘As the regulator of health and social care, we need to cement our place in th[e] new world. As I’ve said previously, we’re not going to return to the way we worked previously,’ adding, ‘This will mean some big changes…[and]…bold thinking.’

The future strategy paper is influenced and driven by the changes necessitated by the COVID-19 pandemic. It is unusual for a regulator to express quite such ambitious aims in a strategy proposal, but an ambitious approach driven by creative thinking makes for a welcomed departure from the norm.

 CQC’s draft strategy reflects its overarching ambition of health and care systems working together to reduce inequalities. This begs the question as to how CQC would monitor, inspect, rate and support systems instead of single providers, when it was created to regulate solely the latter. However, this aside, the draft strategy explores four themes:

  • People.
  • Smart.
  • Safe.
  • Improve.

Putting people first

CQC is keen to ensure that the way it regulates is informed by what people want from providers rather than by what providers wish to deliver. To support this, CQC is seeking ways to enhance how it obtains and acts on feedback from people who use health and care services. The strategy highlights CQC’s aim of ‘listening and acting’. This is likely to mean that inspectors will seek evidence that providers have good systems and practices in place to obtain frequent and meaningful feedback from clients and others. In particular, providers would be expected to encourage people to speak up confidently and share their experience of care with the provider, especially when the experience has been negative.

Inspectors would also seek evidence, as they do now, that providers have acted comprehensively on the feedback in a timely manner. The stated aim is for CQC to build a culture in the sector which values and acts on feedback to drive continuous improvement.

Significantly, CQC proposes that a provider would not be able to achieve a rating of Good or Outstanding unless it had evidence of best practice in gaining and acting on people’s feedback.

A smart approach

CQC’s second theme emphasises the regulator’s desire to use data, IT and provider information in innovative ways. It aspires to be more flexible and dynamic in how it registers, monitors, inspects and supports providers. At the same time, CQC refers repeatedly to its aim to reach decisions that are both consistent across its different regional and sectoral teams and proportionate to the circumstances of the provider in question.

The regulator anticipates that its ‘smart’ approach to inspecting and rating providers will make it less reliant on scheduled, all-inclusive, on-site inspection visits. Its provider ratings would be ‘updated more often’ and better reflect people’s feedback and their experience of the care, not only the quality of care provided. IT would play a central role in CQC’s evolving approach, with an emphasis on making the most of artificial intelligence and data science to monitor, analyse and interpret data. Findings would be used by CQC to better target its resources and to better identify which providers to inspect, when and how to inspect and the issues to focus on. It would also inform how to rate providers. The aim is to replace lengthy inspection reports with ones that are more relevant and informative to people.

CQC’s ‘smart’ approach would also mean providing a clear definition of what good care and bad care look like. It intends to put ‘this definition at the heart of [its] regulatory processes’ and use the definition to help with more consistent decision making.

Avoiding harm

The draft strategy stresses that the provision of safe care starts with CQC’s registration function which will focus on whether providers have a ‘culture of learning and improving’. CQC’s vision is to achieve an attitude and approach amongst providers and stakeholders that strives for ‘zero avoidable harm’. The regulator aspires to be more proactive to protect people from harm before it happens.

The regulator proposes to achieve these aims through:

  • Keeping safety at the forefront of its relationships with providers.
  • Intervening earlier where safety is compromised.
  • Taking enforcement action quicker if providers fail to improve safety.

Striving to improve

CQC lays out ambitious aims to establish an ‘improvement alliance’ with the aims of spotlighting areas for improvement and providing support to services when needed. The draft strategy envisages the regulator taking a leadership role in driving improvements. This would involve CQC providing consistent, nationwide support to providers to facilitate services raising their standards and moving out of ‘special measures’.

The regulator’s focus would be on enabling an ‘improvement culture’ based on evidence-based research, in which it would seek to invest. It aspires to make direct, tailored, hands-on support available to services, and to:

  • Share good practice with providers.
  • Co-ordinate improvement activity.
  • Provide benchmarking information to services in different sectors.
  • Champion innovation.
  • Encourage the use of technology enabled services.

A bold, ambitious vision

The draft strategy lays out a hugely ambitious vision of CQC’s future role. This is to be applauded and welcomed. CQC will follow up on its draft strategy with sector-wide engagement in the coming months and a planned consultation in early 2021. If there is to be a realistic prospect of CQC realising its ambitions, which represent a step-change in its approach to regulating the sectors, CQC must bring people, providers, government and stakeholders with it.

An obvious challenge in the context of a falling budget for the regulator in recent years is how CQC will effect change without additional resource. This will need further creative thinking as well as culture change both within the regulator and the sectors. But without further significant government money, in particular in social care, the regulator will struggle to see its broadly welcomed, new approach translate to better experiences for people using services.

It remains to be seen whether legislation would be needed to facilitate CQC’s proposed new vision, but CQC’s draft strategy lays out an ambitious roadmap. Providers are encouraged to contribute their views and ideas through CQC’s planned consultation and engagement in the coming months.


Errol Archer is a Regulatory Solicitor at Scott Moncrieff & Associates. Email: errol.archer@scomo.com

What are your views on CQC’s draft regulatory approach and the direction it’s heading? Share your thoughts in our comments section below.

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