Update on CQC’s regulatory approach

Content originally from Care Quality Commission

We want to start this message by again thanking everyone working in health and social care for your continued hard work and dedication. This winter has been one of the most challenging the country has ever seen, but your response has meant people have continued to receive care despite the difficult circumstances.

Throughout the pandemic, our regulatory role has not changed. Our core purpose to ensure that the public receive safe, effective, compassionate and high-quality care has remained at the centre of our activities – and this will continue.

In March 2020, we paused routine inspections and focused our activity where there was a risk to people’s safety. This was the right thing to do and we have kept that decision under review. This year we have continued to only undertake inspection activity where there were serious risks to people’s safety or where it supported the health and care system’s response to the pandemic.

We want to have an active role in encouraging system-wide recovery. As we move into the spring, we are looking to the future and how we can support this. We will continue responding to risk to keep people safe from harm and protect their human rights by proactively seeking out and addressing safety and quality concerns.

We also want to ensure our future approach to regulation is right and meets the challenges of a changing health and social care sector. The recent consultations on our new strategy and on changes for more flexible regulation set out our ambitions to regulate in a more dynamic and flexible way – moving away from using comprehensive on-site inspection as the main way of updating ratings. We will continue to have on-site inspection as a core part of our activity. However, as well as this we will develop tools to inspect quality and risk proportionately. We are delivering change and improvement across CQC, which will make it much easier for the public and service providers to work with us, and to enable us to help you as you work towards recovery and accelerate improvements in care.

What this means for providers of health and social care

We will continue to undertake inspection activity that either helps create capacity to respond to COVID-19 or that responds to risk of harm to the public. From April 2021, we will also be undertaking the following activity:

Adult social care services

For adult social care services, in addition to undertaking inspection activity where there is a clear risk to safety, we will:

  • undertake infection, prevention and control (IPC) inspections in care homes to ensure people are receiving safe care
  • adapt our care home IPC method to use in community settings such as supported living and extra care
  • rapidly inspect potential designated sites so that people who have COVID-19 can be discharged from hospital in a timely way, freeing up capacity in acute care
  • inspect and re-rate services where appropriate and where it may create additional capacity in the system (including those services that are registered and not yet rated), supporting local authorities to commission care where needed.

Hospital services

For hospital services (including independent health and mental health services), we will be continuing with our current risk-based approach to regulation, undertaking inspection activity where there is a clear risk to safety. We will also:

  • return to inspect and rate NHS trusts and independent healthcare services that are rated as inadequate or requires improvement, or where new risks have come to light, and develop plans to review ratings for all hospital providers to make sure they are still appropriate based upon our latest assessment of risk
  • carry out some core service with well-led inspections of mental health trusts and independent mental health providers
  • prioritise high risk independent healthcare services for inspection, for example, cosmetic surgery services, independent ambulance services, and those where closed cultures may exist
  • closely monitor how hospitals are ensuring robust infection prevention and control and carry out focused IPC inspections where we have concerns about a provider’s oversight of infection risk
  • conduct Mental Health Act (MHA) monitoring visits to ensure the rights of vulnerable people are protected
  • carry out focused inspection activity in emergency departments where our data monitoring and local intelligence indicates that increased pressure is having a direct impact on the quality and safety of care
  • roll out a programme of focused inspections of safety in NHS maternity services where data and local intelligence identifies concerns about the quality of care; these inspections will look closely at issues such as teamworking and culture, and experiences of staff and patients.

Primary medical services

For primary medical services, in addition to undertaking inspection activity where there is a clear risk to safety, we will:

  • work jointly with Ofsted to deliver multi-agency inspections of children’s services and review approaches
  • work jointly with HM Inspectorate of Prisons (HMIP) and other inspectorates to inspect health and social care in secure settings
  • resume inspections of independent primary care providers, focusing on high/medium risk providers that have never been inspected or that were inspected but not rated
  • resume inspections of GP, out-of-hours and NHS 111 services where we have identified breaches of regulations, including those rated as inadequate, requires improvement and good, along with services rated as requires improvement where there are no breaches of regulations. These will be focused inspections looking at three key questions (safe, effective and well-led), as well as any other key questions rated as requires improvement/inadequate, and any other areas identified as a concern from previous inspection
  • inspect services that are newly-registered and have not been inspected during the 12 months since registration, or during the three months since registration for online services
  • commence a programme of focused inspections for oral health providers exploring an increased use of technology
  • continue to develop the transitional monitoring approach.

Registration

For registration, we will:

  • continue to prioritise registration applications that are critical to the COVID-19 response
  • focus on improving our registration service so providers experience a faster and more efficient process.

All services

Across all services, we will monitor and assess where there is a risk of a closed culture developing, which includes monitoring and acting on information of concern about blanket bans on visiting. We will also review our approach to inspections of services for people with a learning disability and autistic people – this is part of our work on transforming the way CQC regulates these services.

Provider collaboration reviews

Our programme of provider collaboration reviews will continue. These explore how health and care services have worked together as a system throughout the pandemic to deliver positive outcomes and experiences for people using their services.

The first phase of these reviews looked to understand how providers collaborated to improve care for older people. We shared our findings in last year’s State of Care report. We have since completed a review of urgent and emergency care services and have shared examples of the innovation and creative approaches we found. This will be followed by a full report shortly.

Three further phases will focus on the experiences of people with a learning disability; people who have used and are using cancer care services and pathways; and people with a mental health condition. We continue to evolve our approach, and the learning from these reviews will inform our approach to how we look at health and care systems.

Protect, respect, connect

Last week, we published a report that found worrying variation in people’s experiences of do not attempt cardiopulmonary resuscitation (DNACPR) decisions during the pandemic. While there were some examples of good practice, we also heard from people who were not properly involved in decisions, or were unaware that such an important decision about their care had been made.

Our approach

Throughout the pandemic, our approach has been informed by feedback and intelligence. This has come from stakeholders, providers and the public, and we’d like to thank you for the contributions that have helped develop appropriate regulation during this time.

We’ll continue to share detailed information about our approach with providers through our bulletins over the next few weeks.

Thank you again for all the work you do.

Ted Baker, Chief Inspector of Hospitals
Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care
Kate Terroni, Chief Inspector of Adult Social Care