The Care Quality Commission (CQC) is changing from “top to bottom,” and moving from being part of the system responsible for improvement to become, “above all else, being on the side of people who use services,” according to Dr Paul Bate, director of strategy and intelligence at the Commission.
The CQC has announced that it will be making radical changes to the way it inspects and regulates health and social care services during 2013-16, and has this week begun a consultation on the new strategy. These changes are not being introduced because of Mid-Staffs or Winterbourne View, but “because the model is broken,” Dr Bate told the Health+Care conference in London last week.
“We want to become a regulator that you can trust – a strong, independent regulator whose evidence-based judgements are welcomed and valued. Our reports will get better, clearer and more robust,” he said. “We will always be on the side of people who use services – we have had a bad track record on this in some respects,” he acknowledged.
And “the CQC is getting out of the enforcement business,” he added. Under the changes, providers and commissioners will have clear responsibility for making necessary improvements to services, while individuals at board level, as well as corporate bodies and registered managers, will be held to account.
The new strategy will introduce a more thorough test for organisations that are applying to provide care, and this will include making sure that named directors, managers and leaders commit to meeting CQC standards and are tested on their ability to do so.
But while the Commission will no longer be taking action where improvements are needed, it will trigger such action, said Dr Bate. “There has to be a sense that improvement can take place – that’s why we’ll keep coming back, and soft intelligence will be very important to us,” he noted.
From having 28 regulations and 16 outcomes, the Commission will in future be asking five simple key questions when conducting inspections – is the service safe, effective, caring, well-led and responsive to people’s needs? – and it will develop new fundamental standards which focus on these five areas. This approach is “not a million miles from Ofsted” – the official body for inspecting schools – “which has been very effective,” he told the conference.
The Commission will be appointing Chief Inspectors for hospitals and social care and support, and it is also considering the appointment of a Chief Inspector for primary and integrated care. CQC inspections will no longer be conducted by generalist inspectors – “that model is broken,” said Dr Bate. In future, these will be done by specialists in particular areas of care who will lead teams of clinical and other experts, including people who receive care. They will conduct longer, more thorough and people-focussed inspections, especially in hospitals, he said.
A new rating system will be developed to help people choose between services and to encourage services to make improvements. The Commission plans to issue the first ratings, of NHS acute hospitals, this December, with inspections commencing in October, and by 2016, all NHS providers will be regulated under the new model, he said.
Announcing the consultation, which runs until August 12, the Commission stated yesterday: “our role is to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and to encourage care services to make improvements. This consultation is the next step towards making the changes needed to deliver our purpose.”
