CQC boss: 'We're not going to chase ratings'

In an interview with HSJ, Ian Trenholm discussed the future of the inspection regime, his views on prosecuting trusts, and how integrated care systems could be regulated.

Asked about the future of inspections, Mr Trenholm said he did not believe trust leaders would be satisfied with just looking at their overall rating.

He said: “My appeal to chief executives would be look at the broader suite of services that you’ve got in front of you.

“In [the] future, I think there’ll be much more emphasis on individual ratings of individual services. Exactly what the detail will look like I think remains to be seen…”

It follows questions about the accuracy of NHS acute trust ratings now, with the CQC having carried out fewer thorough inspections during the pandemic. There is now only one trust rated “inadequate”, despite huge concerns about service failings, particularly in acute care.

He said the “intention over the next few months” is to create a new CQC single assessment framework which incorporates inspection findings for health systems, as well as individual providers.

Last year, the government announced that the CQC would regulate and inspect integrated care systems, although there has been little detail around how that will work.

Asked about this, Mr Trenholm said the regulator’s intention was to try and produce a “comprehensive picture of an ICS that talks about the contribution that all partners are making”.

ICS ratings ‘a bit of a distraction’

However, he described conversations about rating ICSs as a “bit of a distraction”, and said the CQC was more interested in how they can help individual areas improve.

He added: “I think one of the big challenges around systems is going to be this transition from a standing start from 1 April 2023. There can’t be an assumption that everyone is going to get a rating on day one.”

The CQC will soon be launching a provider portal to make the “technical relationship” between a provider, the CQC, and the system “frictionless”, he added.

Mr Trenholm said it is important to recognise the pressure the NHS is currently under, and the CQC would be sticking with a “risk-based” inspection approach.

He said: “I don’t think anyone would thank us if we carried on with routine inspections. Our priority at the moment is not to chase ratings.”

He said it was “obvious” from conversations with ministers that there is no more money for the NHS and it therefore needs to look for ways to be as “innovative as possible”.

“I want to have a conversation with people around how risk can be managed differently in the system, and how safety can be delivered alongside what is going to be a financially tough time”, he said.

Mr Trenholm was interviewed at the HSJ Provider Summit at the start of April, under Chatham House rules, but afterwards agreed to place his comments on record.

Maternity

Mr Trenholm also addressed issues of care quality in the NHS and why in recent years there has been an increase in CQC prosecutions.

He said: “We [prosecute] very carefully, there’s a relatively small number of prosecutions taken in acute trusts, in comparison with social care… and I think usually somebody has died, or somebody has come to significant harm…

“We can’t in good conscience just simply not try to prosecute where somebody has died.”

The week before the interview, Donna Ockenden had published her final report into the maternity scandal at Shrewsbury and Telford Hospital Trust, which said it was concerned external reviews of SaTH’s maternity care by bodies including the CQC gave “false reassurance” about the state of its services.

Mr Trenholm said on this: “The standout for me was that the voices of people that were using services, the voices of the women in particular, were not being heard and the voices of some members of staff were also not being heard well enough.”

He said the CQC was trying to find ways to “constructively improve” the quality of maternity services in the NHS, as around 40 per cent of maternity services are rated “requires improvement” or worse for safety.

“The only action I can really take is a negative one, which is to start to take enforcement action. I don’t have any upside tools in my box,” Mr Trenholm said. “I can’t make investments in services.”