Rebuilding trust - what does the CQC have planned?
The Care Roadshow South 2024 and Healthcare Summit 2024 both provided many insights into recent sector developments - most notably on the CQC developments and what providers can anticipate as CQC attempts to rebuild trust with the sector and the public.
Simplifying and clarifying the single assessment framework
Providers have been growing ever frustrated by the CQC's apparent refusal to provide clarity and tangible, objective guidance on their approach to inspection and assessment of services. Complaints have been made that the CQC cannot keep resetting and repackaging their regime every few years with little to no meaningful improvement in the process.
Helpfully, at the Care Roadshow 2024, the CQC pledged to do better in light of growing dissent in the sector, being cognisant that much of the feedback received was that inspection reports are fragmented and hard to follow.
The CQC is committed to making the quality statements clearer so that providers can better understand what will be looked at during inspections.
Regulatory handbook
The CQC will also be introducing a new 'Regulatory Handbook' to guide providers on what will be assessed and how, as well as provide contact information to get in touch with the CQC.
Development of the handbook will bear in mind the CQC's recent call for provider collaboration to develop a definition of 'what good looks like' and there are promises of formulating a full set of rating characteristics to guide providers during inspections.
The CQC hopes to make this a truly co-produced document and will be hosting breakfast roundtables and Test and Learn Pilots with providers.
Evidence categories
As many providers are aware, the CQC has now scrapped the scoring of evidence categories to opt for a more discretionary approach. While providers have no issue with this approach, there are concerns over the consistency between 'professional judgments' of individual inspectors and how these can be objectively tested in the event where there is a dispute over the evidence relied on to form a judgment.
The CQC explained its recent change in position, stating that they were concerned that adding the scores in so many different categories diluted the actual position of the provider. Rather, the CQC wishes to look at evidence in the whole and benchmark nationally so that there is more consistency between ratings and to enable the public to truly compare services on a level playing field.
The evidence categories will still exist, but they will not have an associated individual score. So where does this leave providers in terms of preparing for an inspection?
Sir Mike Richards Report has suggested that the evidence categories be scrapped altogether. Further, many providers maintain their concerns over the discretionary powers afforded to inspectors, not in the least due to historic problems experienced where inspectors do not fully understand or appreciate the nuances of the individual services they are assessing.
Single word judgments?
Providers are beginning to raise concerns over single word judgments in light of Ofsted's rationale for scrapping them, citing that they are an, over simplified approach to reporting on a provider's service delivery.
The CQC has commented that, whilst there is a public interest in inspection reports providing a clear and concise overview of the service, they are aware of the faults with this approach. This will be on the agenda to discuss on an ongoing basis.
It was noted that what sits under these single word judgments is a much more detailed matrix of ratings. Moving forward, the CQC will work to make sure this is much more visible and prominent so that the public and providers alike can understand how an individual rating was calculated. Hopefully this leads to more detailed and individualised narratives in lieu of the stock statements we saw in prior inspection reports.
Importantly, the CQC has said that they want to ensure that providers understand the link between the regulations and quality statements and how this feeds into evidence gathering and assessment, and ultimately the final judgments. This will be a welcome change to the sector, which has previously raised concerns over the transparency in the CQC's approach to reaching a judgment.
Organisational changes
As many will be aware, the CQC has appointed a new Chief Executive, Sir Julian Hartley, who has a long and diverse career across the health sector and a demonstrated history of transforming leadership.
In addition to this, the CQC intends to appoint at least three chief inspectors to cover specialist areas, including social care and primary medical care.
Sir Mike Richards has recommended that a fourth be appointed specifically for mental health services, and the CQC will be considering this recommendation.
Further, to address sector wide concerns over inspector expertise, the CQC has committed to placing the right people with the right expertise in services and bring back the inspector specialism.
Finally, to foster better relationships between the CQC and the services they inspect, the CQC aims to bring back designated points of contact for services, which are not facilitated by the current approach, to reduce the risk of duplication of work and feelings of fragmentation in their approach.
Timescales
It is hoped that, as the above changes are implemented, this will pave the way for more efficient and effective inspection of services, decreasing the time between inspection of services and publication of the final report.
Additionally, the CQC is continuing to make improvements to the provider portal so that it is not only easier for providers to access, but also to enable the CQC to review evidence quicker.
Final thoughts
Whilst the above all appears to be a move in the right direction and reflective and responsive to provider feedback, it should be remembered that the CQC is still in the process of change.
The CQC still possesses the power to come in and inspect at any time under its current operational framework, despite the flaws it may have. Therefore, it is vital that providers remain aware and abreast of ongoing developments to the SAF as well as an understanding of how it works.
It is always recommended that providers keep clear and detailed records of all inspection activity they undergo, including what records were reviewed and who was spoken to, to ensure that inspections are conducted in accordance with the existing framework.
Finally, the Health and Social Care Act 2008 (Regulates Activities) Regulations 2014 has not changed and remain the foundation against which providers are assessed. These must be at the forefront of any approach to inspection, including preparation, or service improvement.
Our team of expert healthcare lawyers can assist you with preparing for, as well as challenging the outcome of, a CQC assessment.