- The second consultation is about how the CQC exercises its registration functions and how it regulates services at local and provider levels.
- A key theme is ensuring there is effective accountability in relation to quality and safety.
- CQC will be looking at the context in which services operate, and how wider system failings or weaknesses of a care group impact on particular services.
- Where a provider carries on multiple services, CQC will be scrutinising in more detail how the provider is operating across all of its services.
- The CQC plans to change the inspection frequency for well performing services.
In June 2017, CQC issued its second consultation on the regulation of adult social care services. The paper includes cross-sector proposals which, if implemented, would impact on adult social care, as well as specific adult social care proposals. The consultation closed on 8 August. A staggered introduction of the proposals (if adopted) would occur over the next two to three years.
The first consultation concerned itself in major part with aligning and streamlining the key lines of enquiry for health and social care services by reducing the number of Provider Handbooks from 11 to 2 – one for health and one for social care. While it was technically important, with an increased emphasis on leadership, partnership working, integration and sustainability, it was really about improving existing tools. The second consultation is fundamentally different in that CQC is proposing to change how it exercises its registration functions and how it regulates services at local and provider levels.
A key theme running through the second consultation is ensuring there is effective accountability in relation to quality and safety. This was a key issue arising out of the Mid Staffordshire Inquiry. CQC is clearly concerned that while it assesses and rates NHS organisations at provider level, it does not currently do that for providers who are part of wider groups. CQC states that there are some 2,300 registered providers (out of around 30,000 providers) who form part of 350 wider groups running services from about 11,300 locations. Currently, CQC does not register at the corporate or group level for the majority of these services. The intention is that providers who are currently registered with CQC will remain registered but CQC will look to register “any related organisations, such as parent companies, that also have accountability for quality.” To put it another way, who are the “controlling minds” of the organisation? As a matter of law, there is no reason why more than one legal entity cannot be registered in relation to a single service. CQC would be able to assess, rate and take enforcement action against the overall leadership of a group, not just particular services. This would be a significant regulatory change, addressing an imbalance between small providers and large ones.
Another potentially significant proposal is to “develop a framework to enable [CQC] to assess quality across a local system, with a focus on leadership, governance and collaboration between providers and commissioners across sectors.” There is a realisation that regulating single services has its limitations. It is important to appreciate the context in which services have to work, with wider system failings or weaknesses impacting on particular services. Equally where a provider carries on multiple services, CQC intends to scrutinise in more detail how the provider is operating across all of its services. CQC says that if more than half are rated requires improvement or inadequate, CQC will hold a management review meeting to “decide on the best course of action.” That could include enforcement action at a corporate level, subject to the proposed registration changes being implemented.
For all providers the intention is to change the inspection frequency for well performing services. Comprehensive inspections for outstanding services would be within three years and good services within 2.5 years, instead of the current two years. Those services rated requires improvement would still be inspected annually, while inadequate services would be visited every six months. If a service is rated requires improvement for a third time, CQC proposes that it would hold a management review meeting and consider next steps including enforcement action. This reflects a focus on dealing with services repeatedly rated requires improvement.
CQC is also developing a new way of collecting information from providers. Instead of the provider information return which can be requested in advance of an inspection, there will be a live online process. As a minimum, providers will need to complete the information collection once a year (including a statement of quality in relation to the five key questions). However, CQC states that “by keeping the information up-to-date, a provider can demonstrate an open culture and show that they are committed to continual learning.” Self-certification appears to be rearing its head again after being discredited during previous major service failures. It remains to be seen whether the CQC ongoing monitoring system is more robust than previous versions.
CQC has less money and inevitably will have to adapt if it is to survive in the longer term. It is hoped that CQC will truly deliver on its pledge to become more targeted, responsive and collaborative in the way it regulates services, with a focus on improvement. There are encouraging signs in this second consultation document that a more realistic and proportionate form of regulation is to be introduced over the next few years. By 2020 we will know if CQC has managed to deliver on these commitments. Providers should acquaint themselves with the proposed changes and look out for CQC’s response in the autumn to ensure their services are able to adapt to the changing regulatory framework.
- Consultation 2: Our next phase of regulation: A more targeted, responsive and collaborative approach to regulating in a changing landscape of health and social care, CQC, June 2017: https://tinyurl.com/ycxjl37y
About the author
Neil Grant is a Director at Ridouts Professional Services Plc, www.ridout-law.com