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LEGAL VIEW: CQC’s new strategy – what does it say and how will it be implemented?

Sam II

Ridouts Associate Solicitor Samantha Burges looks at how the CQC’s new strategy will be implement and how it could impact on providers on a day to day basis.

On 27 May 2021 the CQC launched its new strategy outlining how it plans to change and transform to deliver more effective regulation. While the strategy sets out various high level themes, little is said about how the strategy will actually be implemented and how it could impact registered providers on a day to day basis. It has now been just over a month since the strategy was launched and the CQC is starting to push forward with actions to implement the strategy through public collaboration.

What does the Strategy say?

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4 key themes have been set out to communicate the CQC’s ambitions as follows:

People & Communities – The CQC wants regulation to be driven by people’s needs and experiences, placing a focus on what’s important to people and communities as they access, use and move between services. A key outcome for this is the development of a clear definition of quality and safety that is in line with people’s changing needs and expectations. The definition is intended to be used consistently by all people, at all levels of the health and social care system.

Smarter Regulation – The CQC wants to use smarter, more dynamic and flexible regulation that provides up-to-date and high-quality information and ratings. It aims to be a proportionate and dynamic regulator and wants to develop easier ways of working together.

In achieving this the CQC aims to move away from inspection-reliant regulation by placing more focus on data and feedback from people on their experiences of care.

Safety through learning – CQC wants to regulate for stronger safety cultures across the sector, prioritising learning and improvement and collaboration. CQC wants its contribution to improve safety cultures across health and care services and local systems and ensure people receive safer care when using and moving between services.

Accelerating improvement – CQC aims to have accelerated improvements in the quality of care and encouraged and enabled safe innovation that benefits people or results in more effective and efficient services.

In addition, assessing local systems to provide independent assurances on quality to the public and tackling inequalities in health and care, including pushing for equality of access, experiences and outcomes from health and social care services, are ‘core ambitions’ of the strategy and run through each of the four themes. This demonstrates the CQC’s ambition to play a role in shaping the market to make the system work better and for everyone.

Unlike previous strategies, there is no end point to this strategy and no parameters for achievement of the four themes have been set publicly. This provides the CQC with a seemingly endless degree of flexibility.

How is the strategy being implemented?

The CQC has defined its broad ambitions through the strategy but many areas are lacking in detail as to how these will be achieved. In its public consultation response, the CQC acknowledges this lack of detail, confirms it won’t be implementing everything straight away and states it will be working in collaboration with the public in determining how the strategy will be implemented. An overall aim is for the CQC’s regulation to be flexible and to adapt their thinking throughout the duration of the strategy, making changes where they need to.

A new assessment framework

The CQC is currently engaged in discussions about the development of a new assessment framework through its public engagement platform. Discussions are still in their infancy but comments are currently being sought on the use of ‘I’, ‘We’ and ‘Quality’ statements and the public has until 19 July to contribute to the latest set of ideas.

The statements have been developed using CQC’s current assessment framework KLOEs, prompts and rating characteristics, and are wide-reaching overarching statements based at the level of Good. The clear message coming out of discussions so far is that the CQC wants to create a single new assessment framework that can be applied across all sectors, including health care, social care, local authority and integrated care systems. The framework will continue to focus on the 5 key questions but the existing KLOEs and ratings characteristics are likely to be replaced by a series of simpler, more succinct quality statements that link directly to the regulations making it clear to providers what minimum requirements are.

Quality of Life tool

In its most recent CQC Board meeting, Kate Terroni (Chief Inspector of ASC) spoke about CQC’s work around closed cultures and how CQC inspects services for those with learning disabilities and autism. In line with the theme around people and communities, as well as the core ambition of equality, the CQC is looking at ways to really understand as best it can what it feels like for these individuals to receive care. The CQC has developed a new quality of life tool which is now being piloted in hospital inspections. Moving forwards, the CQC will be looking to apply the toolkit as it embarks on future adult social care inspections of services for people with learning disabilities and autism.

How will physical inspections change?

Over the past 16 months there has been a seismic shift in the way the CQC carries out inspections in light of the COVID-19 pandemic with a focus on risk-based inspection. While some of these measures are temporary in response to the crisis, it is unlikely we will see inspection activity moving back to what it was like pre-pandemic, particularly given the strategies’ focus on smarter regulation and moving away from a reliance on inspections to rate services.

The CQC has stated they will be using a range of ways to assess quality and update ratings, which will still include on-site inspections. It will use its powers to visit services when needed in response to risk, when it needs specific information, when it needs to observe care or to ensure its view of quality is reliable. Inspectors will make the best use of their time on site, ensuring they carry out the activities they can only do in person, such as observing care and having conversations with care staff and service users. As a result, it is likely providers will experience less inspections where the inspectors shut themselves away in a room reviewing documentation all day. It is more likely that documentation will be requested remotely if required, so providers should ensure they have the facilities to process documentation in a timely manner for sending to the CQC as and when required. At Ridouts we have already seen an increase in document requests from inspectors following on-site inspections to inform their findings.

For some providers this development will mean fewer physical inspections. Where inspections are carried out, these are more likely to be in response to risk and, therefore, may be more challenging – the inspectors will already have pre-formed ideas about the service before walking through the door and providers should be prepared to respond accordingly.

However, for providers of services accommodating service users who may not be able to speak for themselves, for example those with learning disabilities and autism, it may mean CQC make more frequent site visits. This is in line with its focus on potential closed cultures. The CQC continues to explore the best methods for understanding people’s experiences in different care services.

What can providers be doing now to prepare for change?

The CQC is moving further towards remote information gathering and greater public sharing of data. There is a risk that some providers could fall behind if their systems are overly complex or not technologically advanced enough to keep up with changes in data sharing requirements. Therefore, providers should be taking a look at how their systems are structured to allow them to extract and present data clearly.

The strategy places a clear focus on the opinions and experiences of people who are involved with services, including service users, friends, families, advocates, staff members and external professionals. It would be sensible for providers to be proactive in reviewing how people feedback on experiences with their service and take ownership of the process, collecting and analysing feedback to inform learning and improvement.

Providers need to be keeping up to date with developments over the coming months to ensure they are aware of changes that could impact their services. We have already seen an unprecedented fast change in the CQC’s approach over the past year in response to the pandemic and it is unlikely things will be slowing down any time soon in light of the CQC’s new strategy.

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