The Care Quality Commission will adapt its approach to regulation to reflect the new provider landscape outlined in the NHS Five Year Forward View, the watchdog’s chief executive has said.

Speaking exclusively to HSJ, David Behan said the CQC would update its oversight in line with the growth of new provider models and would begin looking at care quality along pathways to a greater degree and, for the first time, across localities.

David Behan

David Behan said the CQC would not accept a drop in quality standards or an ‘inspection holiday’

“Clearly if we’re going to have a radical redesign of services we need to think about what that means for the work which we undertake,” Mr Behan said.

He said the CQC would work with the vanguard sites announced today to “understand how we can assure the quality and safety of the care they provide” while not “getting in the way of innovation”.

New providers registering with the CQC will be urged to work closely with other organisations to deliver joined up care and will have to supply evidence at the point of registration about how they will do this.

Mr Behan said future CQC inspections of integrated care models will include “mixed teams” from the regulator’s hospitals, primary medical services and adult social care directorates as necessary.

While the CQC would “flex” its inspection model to “accommodate” the evolution of new provider models, this would not entail the acceptance of a drop in quality standards or an “inspection holiday”.

“I don’t think we can get into a position over these next couple of years… where standards of quality and safety can drop because the system’s changing,” he said.

To reflect the increasing integration between different services, Mr Behan said the CQC would expand its focus beyond individual “institutions and organisations” to “systems”.

The CQC will ramp up its work looking at care quality along pathways by launching a number of “thematic reviews” in 2015-16, including of urgent care pathways, mental health crisis care, end of life care, care for older people and diabetes in the community.

For the first time it will also look at “care in a locality”, Mr Behan added.

He said: “By the end of 2015 we’ll have inspected the majority of all health and adult social care services in some communities across England.

“I think we’ll be able to bring together our inspection findings across those sectors to describe how well people in those communities are being covered.”

The CQC will report on two areas in 2015-16, commenting on the impact of health economy-wide issues on quality, including leadership, funding and commissioning.

However, Mr Behan was careful to state that this enlarged focus would not stop the CQC from regulating and taking action against individual organisations.

“A number of issues we’ve flagged in our reports on the NHS to date around safety for instance are in our view not necessarily systemic issues,” he said.

“These are issues about how individual organisations operate and how the leadership of those organisations take responsibility for ensuring the services are safe and effective.”

Commenting on Greater Manchester’s ambition to play a “leadership role” in the oversight of its providers as part of the region’s devolution deal, Mr Behan said he saw this as “an opportunity not as a threat to regulation”.

He said the CQC would work with the conurbation as it took forward its ideas, but added the CQC was a “national regulator” and that he did not envisage it delegating any formal regulatory responsibilities to the region “at the present time”.

Behan: CQC making progress on recruitment

David Behan hailed the progress the Care Quality Commission has made on the recruitment of inspectors.

In December the watchdog said it needed to address a long running workforce shortage by recruiting 600 inspectors in two tranches of 300 by April, and a further 300 between April and December 2015.

Mr Behan told HSJ the CQC had recruited 256 inspectors to date and would be “there or thereabouts” on its target by the end of April.

He said progress had been made after the CQC brought its recruitment function back in house, and that he was “cautiously optimistic” about the situation.

Mr Behan said that the CQC was “working hard” to hit its target of inspecting all acute trusts by December, but that it was “very, very challenging” and so he “not quite sure” whether it would be achieved.

“To be honest, if we did it for January or February… actually it would not be the end of the world,” he said.

“What is more important is that we get the right people in to do the job and what we deliver is high quality inspection that people, members of the public and professionals, the people we inspect, can have confidence in.”

NHS England reveals new care model 'vanguard'