The Care Quality Commission (CQC), the regulator of health and adult social care in England and Wales, has published an update on its new plan and approach to assessing providers of regulated healthcare providers.
This follows CQC’s announcement on 18 July 2022 that it will be introducing its new single assessment framework (SAF) which would build on learnings from the necessary policy of hybrid in person and remote monitoring during Covid-19 (CQC also set out a revised plan and approach for transformation in December 2022).
In this post, we take a look at the key changes.
Overview of the changes and the new SAF proposed in July 2022
Why? The current regime (whereby CQC monitors Provider through ‘point-in-time inspections’ the regulatory of which is decided by performance in previous inspections or response to risk) has been broadly criticised for lacking clarity and being overly subjective, bureaucratic and rigid. CQC claims the SAF will make things simpler, more dynamic and data-led; reflect how care is actually delivered by different types of services as well as across a local area; and connect registration activity to assessments of quality.
What? A SAF for Health and Care Providers, Local Authorities, Integrated Care Systems and Integrated Care Boards (following reforms in the Health and Social Care Act 2022) with assessments of quality in all types of services, and at all levels. This will be to replace the existing four separate assessment frameworks. Registration is also proposed to be based on the SAF as the first assessment activity for Providers in an integrated process.
The vision The CQC says the SAF will:
- use a range of information (largely collected remotely) to assess Providers flexibly and frequently, where assessment is not tied to set dates or driven by a previous rating;
- collect evidence on an ongoing basis and be able to update ratings at any time;
- tailor assessment to different types of providers and services;
- score evidence to make judgements more structured and consistent;
- use inspections (site visits) as a vital tool to gather evidence to assess quality;
- use data and insight from stakeholders and service users to decide which services to visit. When on site, CQC will observe care and talk to staff and people who use services; and
- produce shorter and simpler reports, showing the most up-to-date assessment.
How? The SAF is proposed to involve:
- a new online Provider Portal for all online interactions between CQC and Providers;
- for registration, Providers will be required to submit baseline data against which they will be monitored going forwards;
- rolling ‘multi-point’ rather than periodic ‘point-in time’ inspections;
- the current five key questions (safe, effective, caring, responsive, well-led) will remain and under each question there will be :
- topic areas (34 in total); and
- ‘quality statements’ / ‘we statements’ (from the Provider’s perspective) which will replace the current ‘key lines of enquiry’ (KLOEs), prompts and ratings characteristics;
- six new evidence categories to organise information under the quality statements (what evidence will depend on service type (e.g. GP practice vs home care service) and level (e.g. new registration vs one that has been operating for some time));
- the four point ratings scale (outstanding, good, requires improvement and inadequate) will remain with a numerical score for each evidence category and quality statement aggregated to reach a score for each question which together will produce the overall rating as a move away from the longer, descriptive reports allowing clearer analysis and comparison between Providers.
Timeline for implementation
The CQC had originally said that it would introduce the new SAF for Providers in January 2023. However, in December 2022 it announced this would not happen until later in 2023. In the interim CQC has maintained its post-Covid-19 risk-based approach to inspection, which has been suggested to be unfair for some Providers as it may be resulting in some cases in inaccurate or out of date ratings.
The CQC says it has been focussing on: putting the technology and testing in place; engaging with stakeholders and the public; establishing a new Regulatory Leadership; changing how its operational teams are structured to better deliver regulatory activity; and delivering a new and improved provider portal.
Update in April 2023
CQC stated it was making good progress against its plan.
Over the coming months, CQC’s new operational teams will begin to reach out to Providers and other local stakeholders. During this period there won’t be large-scale changes to existing relationships.
- CQC will start to roll out its new Provider portal, notifying Providers individually when they’re able to sign up. It will do this in stages and provide support and guidance. In this initial period, it will be quicker to submit information such as statutory notifications as CQC moves away from using email.
- CQC will work to improve how it uses the information it gets through the Give feedback on care service.
- CQC will review published evidence from all local authorities and integrated care systems across specific thematic areas, alongside the early piloting of its approach.
Later in 2023:
- CQC will gradually start to carry out assessments of Providers using the new SAF, powered by its integrated assessment teams and supported by new technology.
- At this stage, Providers will also be able to apply to register with CQC and make ongoing changes to registration through the portal. By this point all CQC’s online interactions with Providers will be on the portal.
- Providers will also be able to review draft judgements through an improved process for checking the factual accuracy of draft reports.
- To allow more time for testing, CQC has taken the decision to move back the rollout of its improved enforcement processes.
- Changes will take time and will continue into 2024.
- Over the coming months CQC says it will provide more detail about how it will use the new assessment approach including: what ‘good’ looks like under the new assessment framework, the evidence that CQC will prioritise and how Providers will interact with the new operational teams.
- CQC will also start to share case studies from its engagement work on its provider portal.
It will not be until CQC publishes further updates and/or guidance that Providers can know exactly what will be required of them under the SAF e.g. in relation to the baseline data required of new Providers or the information Providers are required to feed in to the rolling multi-point inspections.
However, there is cause for optimism for greater clarity, simplicity, consistency and flexibility in the proposed new SAF which should lead to more efficient, data-driven regulation of health and social care, better suited to modern society and resource constraints and insights to drive improvement in service delivery and policy.