CQC SAF: change is the only constant
Just as providers were getting to grips with the Care Quality Commission's (CQC) new Single Assessment Framework (SAF), Dr Penny Dash's interim report into the effectiveness of the CQC was published.
In response to the report's findings, the CQC has slowly started to make changes to its new regime. This article reminds us of some of the subtle changes between the old and new regimes and provides an update on the changes to the regime since the Dash report.
Old regime to new regime
First scores
The CQC streamlining its 24 Key Lines of Enquiry and 121 sub-Key Lines of Enquiry into 34 Quality Statements was welcomed. However, no one anticipated the small number of quality statements that would be assessed during a service's first assessment under the new regime. Assessments that took place at the start of this year saw services being re-rated when only five of the 34 quality statements had been assessed and the remaining quality statements being scored based on previous findings in a past inspection.
Commentary in the healthcare sector noted that the CQC was struggling to assess all 34 quality statements on day one and looked forward to the announcement of 'priority quality statements'; a set of quality statements out of the 34, that would be given priority and become the minimum scope for routine assessments. These are yet to be published. However, we have identified trends in the quality statements that have been assessed to date. Six months in, the CQC has upped the number of quality statements assessed at each inspection, with some services being inspected against all 34 quality statements. We hear that assessments against all 34 quality statements are intense, so preparation is needed (in the form of gap analysis, improvement plans and mock inspections).
Feedback evidence
Over 60% of the CQC's evidence categories relate to feedback. The CQC now has a wider mandate to collect feedback and will contact service users, staff and partners/stakeholders directly to ask questions which directly relate to the 34 quality statements. Often, as part of an assessment, the CQC will ask the provider for names and contact details of staff for them to be contacted directly for a telephone conversation, to be interviewed, or to join a focus group for example.
Providers can and should take control of this process. In particular, staff should be made aware of this new style of assessment. Staff can be informed and supported in one to ones, supervisions and team meetings. However, a provider cannot control what a staff member says to a CQC inspector. Having said that, a provider can control the amount of feedback it collates which can be presented to the CQC at the assessment or at any time via the portal. Take the same approach as the CQC and have three lines of survey - service users, staff and stakeholders and pin the feedback to the 34 quality statements within the framework.
We are not suggesting that you issue a lengthy survey with 34 questions, but recommend that you have the 34 quality statements in mind when preparing your list of questions. Be sure to analyse the data and present it clearly, preferably digitally, so that it can be uploaded to the portal or easily emailed to an inspector if requested. Most importantly, keep your feedback data up-to-date, the CQC is not likely to be interested in feedback data that is over a year old.
Factual accuracy checks
Nothing much has changed with the CQC's Factual Accuracy Check process. Providers are still given ten working days from the date they receive the draft report to submit factual accuracy comments (FAC). The difference now is that the report is an 'assessment' report not an 'inspection' report and the provider will receive an email with a link to review their draft assessment report, which can be read online or downloaded. Comments must be entered against the relevant section of the report and evidence to support comments uploaded.
It is still the case that for the best chance of upgrading a rating, factual accuracy comments must be supported with robust documentary evidence. Additional information supplied with the FAC that existed at the time of the assessment may prompt a better judgment or rating. However, evidence of action taken post-assessment will not form part of the CQC's final judgment or rating (but may get a mention in the published inspection report). VWV are very experienced in assisting clients to draft FACs. Legal input is not always needed, but do feel free to call our team to discuss whether it might be helpful in your case.
Since the Dash report
Inspector and assessor role
As part of the SAF, the CQC reorganised its operational teams, bringing together their specialist sector teams (adult social care, hospitals, primary medical services) into one operations group. As part of that reorganisation the CQC introduced new roles into assessment teams, including Assessors, Regulatory Co-ordinators and Regulatory Officers.
Since the Dash Report, the CQC has announced role changes. Not only was Professor Sir Mike Richards (a former Chief Inspector of Hospitals) appointed to review the SAF's effectiveness for NHS trusts. The CQC is committed to appointing three permanent Chief Inspectors and is progressing with recruitment.
The most talked about role change is the removal of the Assessor role. The Assessor worked remotely, carrying out off-site assessment activities including considering evidence. Providers often found that there was a disconnect between what the Inspector asked for when attending the service and the Assessor's comments when reviewing evidence without the context of visiting the service. According to the CQC, reverting to the single inspector role will increase the delivery of 'inspection activity'.
Frequency of inspection
The CQC no longer focuses on 'inspections', but has replaced that word with 'assessments' of which inspections are a part. Under the old regime, the CQC followed an inspection schedule which was determined by the service's previous rating. Under the new regime, assessments will either be planned (which factor in when the CQC last inspected, the level of risk and history of enforcement) or responsive (following information of concern which could include whistleblowing, notifications or national data).
Initially, providers were concerned that ratings could be updated at any time, without the need for a full inspection, resulting in them being constantly on their guard. In reality, many providers are still awaiting an assessment stuck with a rating of 'requires improvement' or 'inadequate'. Delays in assessments was criticised in the Dash report and, in response, the CQC stated that it would release more information on the frequency of assessments this August/September. This has been delayed and the only timescale the CQC has given regarding the release of this information is "as soon as possible".
Regulatory Handbook
The CQC has begun work on a new regulatory handbook which will include what ‘good’ looks like for each sector. The CQC is asking for your views on what the handbook should include. Don't miss out on this opportunity to have your voice heard. A survey to help shape the new handbook is available.
If you need assistance with any aspect of the CQC assessment framework, from understanding your assessment report to challenging ratings, please do not hesitate to contact our experienced Healthcare team who will be happy to help and have had significant success upgrading proposed ratings and downgrading proposed enforcement action.
I will be covering all of this and more at our CQC Single Assessment Framework webinar on 22 October 2024 at 1.00pm. Be sure to book your place.