Trusts could get new CQC ratings without inspection

The CQC has said it wants to “move away from using comprehensive, on-site inspection as the main way of updating ratings” and instead use other sources like data and feedback from the public, to update ratings more regularly.

At present — under the tough ratings regime introduced in 2014 in the wake of the Mid Staffs inquiry findings — it cannot change a provider’s score without carrying out a full inspection.

It said in a recently published consultation that inspections “will remain an important part of how we assess quality,” but this will mostly be through more “targeted” inspections linked to significant risks to people’s safety, and the rights of vulnerable people.

During the covid pandemic, CQC has targeted its on-site inspections at services where potential risks are identified, or where improvements are needed.

Professor Ted Baker, the CQC’s chief inspector of hospitals, told HSJ the regulator wanted to move away from its current “fairly rigid” timetable of inspections in favour of a more “flexible” approach.

He said: “We’re not moving away from inspections. We’re looking to build on what we have learned from covid and to be much more focused on using inspections in a specific, targeted way to deal with risk, and to look at other ways of assessing quality.

“We know a lot of services out there would like us to update our ratings. Our present rules around ratings were built around our routine, timetabled inspection programme and they are fairly rigid and we can’t just change [ratings] without doing a whole, full inspection.

“What we want to do is introduce more flexibility into the ratings so that we can update providers’ ratings more regularly and more quickly and make sure providers have their latest ratings, but also so that the public have the latest assessment of quality. We won’t use just inspections to drive ratings, we will also use other evidence where it’s appropriate.”

Jeremy Hunt, who introduced the existing ratings regime when he was health secretary, said that while the CQC’s plans “sound reasonable… I wouldn’t want trusts to be able to go years and years without on-site inspections because even outstanding ones benefit from these”.

Professor Baker said more frequent on-site inspections would still take place at “inadequate”-rated providers and “almost certainly” at services where major concerns have been raised.

He said that, pre-pandemic, inspectors typically returned to services every three years but the CQC wanted to update ratings “much more frequently” than that as “we think that’s too big an interval to assess quality”.

Professor Baker added: “We’re going to be basing the timings of inspections on risk, and one of the determinants of risk is going to be how long since we’ve last done an inspection.

“We’re not envisaging as situation where some services are never inspected, but those services we have the least concern about are likely to be inspected less frequently. And those services we have more concern about are likely to be inspected more frequently.”

The CQC also plans to publish “simplified” overall ratings for trusts, and no longer publish separate trust-level ratings for the safe, effective, caring and responsive key questions. However, the regulator will still publish those ratings at service and location level.

For GP practices, the regulator plans to stop providing ratings for individual population groups as it admits “our current approach to rating GP practices is too complex”.

Professor Baker said the CQC hoped to implement the new ratings policy “as soon as the pandemic allows us to do it”, without putting services under “undue pressure”.

The consultation runs until 5pm on 23 March.