• Consultation document reveals regulator will register all organisations with “direction and control of care”
  • Refreshed fit and proper person guidance will show how the CQC can use “enforcement policy” if there has been a breach
  • CQC will “consider reporting on a system as a whole” for future ACOs

The Care Quality Commission intends to expand the number of providers it registers.

This is despite “several respondents” to its consultation on the next phase of regulation being concerned that commissioners may be unintentionally brought into the CQC’s regulatory activities.

Responding to the reactions to the consultation, the regulator said it intends to “register all organisations with accountability for care”. It added that organisations involved in the “direction and control of care… will need to register with CQC”.

The CQC said it will apply “new criteria” to define which providers this will affect. Organisations will have to register if they “assess, monitor or drive” quality improvement; make “employment decisions”; or “directly develop and enforce common policies” such as governance, staffing and pay levels.

Concerns were raised by “several respondents” to the consultation that the new criteria might have the “unintended consequence of bringing investors and commissioners into regulation”.

A CQC spokesman told HSJ: “The regulated activities haven’t changed. Our focus is on regulating providers of health and adult social care and we are working to make sure that the criteria does not have unintended registration consequences. We will work with providers and other stakeholders across health and social care to further develop the criteria and this will be published in spring 2018.”

The first of these new types of registration will begin in 2018-19.

As part of changes to the next phase of inspection, the CQC also wants to introduce “provider level assessments in all sectors” so it can bring more accountability to parent companies or GP super partnerships, for example. As part of this, it said it is yet to decide whether to aggregate local ratings or not.

The document said the CQC will also publish the “ultimate economic owner” of each provider. Although it does not have the jurisdiction to register providers based outside of England, it intends to publish information about “providers with overseas owners that [it is] unable to register”.

It also said the CQC has the power to enforce breaches of the fit and proper person test, despite the regulator insisting last year it cannot force the removal of directors. Refreshed FPP guidance, due to be published at the end of the year, will “reference” how the CQC could use its “enforcement policy” to decide if there has been a breach of regulations 17 and 19. Regulation 17 on good governance gives the CQC the power to prosecute breaches.

It said the guidance will “detail… what will happen” if a provider makes a decision about the fitness of a director that “no reasonable person would have made”.

Accountable care organisations

As part of its regulatory changes, the CQC will also “consider reporting on a system as a whole” for future accountable care organisations or systems and other new care models. It added that when it assesses leadership in an NHS trust it will also be assessing “leadership and governance across all services” offered by the ACO or ACS.

It also said it will introduce a single regulatory plan for each “complex” provider it works with and a single CQC “relationship holder” for each of those types of providers who will liaise with “named leads” across the different services to coordinate inspections.

The document did not spell out how regulatory risk would be shared in the new care models but said it will “test” the new approach with a small number of ACSs and ACOs. It did recognise the CQC needs to do further work to ensure the public can easily understand what the regulator has inspected and how it affects the care they receive.