CQC Changes and the Impact It Will Have on Inspections

9th June 2022

Why are the CQC changing what they do?

 The CQC published a new strategy last year for the whole of the Health and Social Care sector. This covered what they are trying to do and how they are going to be doing inspections as well as the framework they work on.

In the future the framework for inspections will focus on the themes embedded within the strategy, for example, people and communities. They want regulation to be more about developing safety through learning, and accelerating improvement. CQC are also going to be changing the way they do inspections, this is after having learnt a great deal during the pandemic.

The pandemic forced a new inspection framework, moving the way they operate to being remotely. This therefore means that they are checking and maintaining a continuous relationship with you rather than that ‘exam day’ feel to inspections.

Another priority is to support the development of the integrated care system. This is achieved by pooling together the knowledge and the experience of the whole community, for example services such as GPs, Dentists, Hospitals, Social Care and Local Authorities. CQC want to have an oversight and see how well the integrated care system is working for the sector. 

CQC have always been focused on outcomes, therefore the intention of the new format puts emphasis on users being at the centre of everything. It also talks about evolution not revolution – building on what you are currently doing and not having to start again.

Five key questions

The Five Key questions will remain, however they are now phrased to be from perspective of the service users – making them ‘I’ statements. The rating scales will remain the same, however the way they will be achieved will be different.

Currently we have the characteristics of ratings, where they detail what’s outstanding, good, requires improvement and inadequate. This will change and we expect that in the future they will be looking at where the evidence comes from and rate the evidence itself.

The provider information will stay but will be even more important. If they find issues and concerns, they will still use enforcement, this doesn’t seem to be changing at this stage.

We expect that there will be one set of high level criteria for all Health and Social Services, linking them together. There will eventually just be one set of quality statements, these statements will be used against everyone when carrying out an inspection. These Quality Statements will replace the ‘Key Lines of Enquiry’, and there will be between five and eight points under each of the questions. They will be phrased as good and we statements, this means that the quality statement is a narrative of what ‘good’ looks like under each of the statements as well as giving you ownership as providers – you will be telling them what you will be doing to deliver the service.

The key question or phrases, are I statements, coming from perspective of the service user.  An example quality statement under the theme ‘Assessing needs’ could be:

‘We maximise the effectiveness of care and treatment people receive, by regularly assessing people’s health, care and well-being and communication needs’

There will be around 40 of these quality statements in place. And several themes in areas of increasing focus for the CQC in the new framework, for example ‘independence’ and ‘partnership working’, ‘improving outcomes for people’ this will include rights and equality. There is a new emphasis on looking at the equality of staff and the rights of staff as well as the rights and equality of people using the services. Good governance and leadership remain, although the emphasis is more on you showing how you ensure the quality of your service.

How are the CQC going to get the information to inform their decisions on ratings?

There will be six sources of evidence:

1. Service users experience of care
2. Feedback from staff and leaders
3. Observations of care
4. Feedback from partners
5. Processes
6. Outcomes of care

The sources of evidence will be rated, based upon the information provided for a quality statement. Beneath the quality statements there will be Quality indicators, these are currently being consulted on. Overall there will be much less focus on, on-site inspections, instead they will be studying evidence, recorded information, complaints, and feedback from other Health Services, Local Authorities, etc.

The time scale for site visits to ratings is changing as well. In future it will be based upon risk, so a service rated as inadequate, could expect more visits than once every three months, and a service rated as outstanding, may not be visited for four or five years.

CQC reports

They have made a commitment to shorten the reports, to make them more focused and relevant. There is an expectation that the CQC will be able to change ratings without a site visit.

When are the changes coming into force?

This whole new system will go live in the summer of 2023, subject to consultations and the testing is taking place summer 2022. The CQC citizen lab provides a good way of keeping up to date with changes and gives you an opportunity to comment on it, and to influence the direction of travel.

What can I do now to start preparing?

1. Audit and address issues
2. Survey everyone, staff, partners in care as well as service users.
3. If you are making changes to your service, involve staff and service users
4. Treat everybody that comes into your service, as the CQC as information from these people will get back to the CQC, and inform their decision-making process.
5. Monitor your local area. What are the issues for your local hospital, what are you doing to address the issues and how these could affect you?
6. How are you supporting other Health and Social Care Services in your area, CQC will like to see this.

Press Release is written by ASH Healthcare, visit them on their website here.