CQC plans 'far fewer comprehensive inspections'

CQC yesterday published proposals for consultation on a new approach to inspections.

The consultation document says: ”The nature and timing of our interactions with trusts is evolving, and the changes to our monitoring and inspection activity are intended to reduce the overall time required from trusts in their interactions with us.

“In particular, we are shifting our emphasis by strengthening our ongoing monitoring and relationship management, and adopting a more targeted approach to inspections – carrying out far fewer comprehensive inspections.”

It proposes to only carry out comprehensive inspections for new providers or for those which it has “significant concerns” about.  

The regulator said this ”more targeted approach to inspections” would enable it to be more “efficient and effective” and more “responsive” to risk. The CQC will see a cumulative budget cut of £32m by 2020.

The move comes as the CQC expects to complete its first comprehensive inspections of all NHS providers within its initial scope by April next year. 

The regulator will now annually assess how well-led an organisation is alongside at least one core service in each trust per year. It will decide which service to inspect based on information from previous inspections, its “CQC Insight” information system, and information from the provider.

Providers will be asked annually to “set out their view” of the quality of their services against the five key questions against which the CQC inspects. This will include any changes in quality they believe has occurred since their last inspection.

A spokeswoman for the CQC said: “This information will feed into ‘CQC Insight’ [new data monitoring tool also being introduced by the regulator] and the wider intelligence held about the trust and used to help inform where and when to inspect.”

The consultation said it wanted the new approach to allow the CQC to “build on the relationships we have already established with trusts and develop more mature relationships so that providers feel they can be open and highlight challenges or concerns as they occur”.

A reliance on self-assessment was criticised in the final report of the Mid Staffs Public Inquiry in February 2013. It said the assessment process of the Healthcare Commission, the forerunner of the CQC, ”suffered a number of defects”. It continued: ”Principal among them was the reliance on self-assessment… experience shows that not all organisations are competently or honestly led.”

Asked about the shift to more use of providers’ assessments of their own quality - apparently a form of self-assessment - a CQC spokewoman told HSJ: ”This isn’t going back to any previous model and it is not a self assessment. We wouldn’t be forming a view based on information a provider has sent us. It would contribute to discussions [about which services to inspect] but it wouldn’t trump other information.”

The increased focus on leadership in the inspections is based on evidence the CQC has collected from the previous three years of inspections that “effective leadership” is an important “driver” for delivery safety and quality improvement. The well-led framework for healthcare providers will also include a clearer emphasis on ensuring the sustainability of services. A consultation on how to assess the leadership of a trust as well as its use of resources, was also jointly published today by NHS Improvement and the CQC.

The CQC has set maximum intervals for re-inspecting core services, with those core services rated inadequate being reinspected yearly. Those rated requires improvement will be visited every two years, good every three and a half years and those seen as outstanding visited every five years. The new framework will implemented from April 2017 and will “fully embedded” by April 2019. The new inspection regime will be implemented from October next year for GP practices, out-of-hours services and NHS 111 services.

The consultation also announced:

• The overall team involved in inspections will be smaller and will produce shorter reports which will include a separate evidence appendix
• It will continue to rate recently acquired or merged providers separately for two to three years to allow the absorbing trust time to address quality issues
• The CQC will consider how well acute hospitals are offering seven day services as part of its rating system
• It may refuse to register new providers of learning disability services that do not comply with NHS England’s national learning disability framework Building the right support
• Service planning for population needs will now form part of the well-led assessment instead of sitting under the responsiveness category
• The gynaecology and diagnostics will no longer be considered as part of the core services
• The regulator intends to move from 11 to two assessment frameworks and have just one for health care and one adult social care.
• Hospices will now be assessed under the healthcare, not social care, framework with Sir Mike Richards, CQC’s chief inspector of hospitals taking overall responsibility for them

The regulator will also go to consultation in the spring to look at how to register providers at “the level of the organisation’s ‘guiding mind’ to help better reflect new care model structures. The consultation also said that in the future it “may wish” to provide organisational level ratings for providers other than trusts.

The consultation closes on 14 February 2017.