HSJ care quality correspondent Will Hazell says the Care Quality Commission’s proposal to move to a less hands-on inspection system will be a tough test for its ability to use information.

The CQC’s unveiling today of its proposals for moving to a regulation system with less reliance on intensive on the ground inspections inevitably invokes the metaphor of the swinging pendulum.

The regulators that preceded the CQC, the Commission for Health Improvement and the Healthcare Commission, used inspection as an integral part of their assessment process.

When the CQC came into being in 2009 it had a much smaller budget and a remit to carry out “risk based” regulation. The number of inspections it conducted collapsed.

Then the pendulum began to swing: the CQC was accused, in light of scandalous quality failures like those at Winterbourne View and Morecambe Bay and other concerns, of not having a sufficiently robust inspection approach or style. Responding, in 2011, the CQC’s then chief executive, Cynthia Bower, pledged to shift away from “light touch” regulation to annual inspection of NHS trusts.

Will Hazell

Will Hazell

This change of direction to a more intensive approach to inspection was cemented by David Behan, who took over as chief executive in July 2012 with a mandate to fix a “broken” regulatory system.

In 2013 the tough approach went further, with the CQC launching a system of beefed up, clinically led inspections and ratings based on Ofsted’s four point scale.

The new model, championed by health secretary Jeremy Hunt, was paid for by generous increases to the CQC’s government grant, which rose by a third in 2013-14 and a further 50 per cent in 2014-15.

However, with the health and care system required to make enormous savings in coming years, it was inevitable the financial tide would eventually turn against the CQC. HSJ reported last week that it has been asked to model cuts of 25 and 40 per cent to its grant.

The CQC today responds to its impending cut and accusations that its regime is burdensome and doesn’t add value, by setting out options for moving to a more risk based system, including “co-regulation” via provider self-assessment.

Mr Behan, in an interview with HSJ this morning, insists the regulator has learned from past mistakes, and that the change is not a swing of the pendulum back to ineffective “light touch” regulation. He argues his proposals reflect the CQC’s model evolving with the times.

He stresses that many elements of the CQC’s methodology, such as clinically led inspection and the rejection of a “tick box” compliance based approach, will stay the same.

The CQC also points out that provider self-assessments will be validated by its own monitoring data and information from patients and staff.

Critically, making a more hands-off approach work will be a tough test for the ability of the CQC, and the wider health and care system, to use information to protect quality and guide inspection.

Exclusive: CQC proposes move to risk based regime