• CQC’s consultation response to NHS Improvement single oversight framework said the regulators’ rating systems do not “align”
  • NHSI’s financial metrics would not be “suitable” for CQC to use despite plans to work together to on financial measurements
  • CQC also criticised the “narrow view” taken on how well led a trust is

The Care Quality Commission warned NHS Improvement that its new ratings system for trusts “risks creating a parallel definition of ‘success’”, HSJ can reveal.

In its response to NHS Improvement’s consultation on the single oversight framework, obtained using a freedom of information request, the CQC said it was “essential” for the regulators to present a “single shared definition of success”. It said “feedback from trusts support this direction”.

The CQC said as they stand NHS Improvement’s ratings cannot “act as predictors” for its own rating system and “it should be made clear” to providers that the two systems “are not intended to align” with each other. The CQC asked how NHS Improvement would target resources at trusts in special measures for quality concerns “within the context” of its new approach.

The consultation took place in the summer.

The framework is designed to identify what support individual NHS trusts need to improve the way they operate. All trusts have been placed into one of four categories of “support need” – from special measures to maximum autonomy – based on how they are performing across five categories. These are: quality of care; finance and use of resources; operational performance; strategic change; and leadership and improvement capability.

The framework has been developed by NHS Improvement to bring together oversight of trusts and foundation trusts, after it joined Monitor and the NHS Trust Development Authority. It will replace separate frameworks that were used for NHS trusts and foundation trusts later this month.

The CQC said in its consulation response that it would like “further conversations” to understand why NHS Improvement chose the metrics it is using to measure a trust’s performance, noting that the proposed metrics are a “subset” of those the CQC has developed for its own “intelligent monitoring” of providers.

The quality regulator’s response confirmed it intends to start incorporating a “use of resources” rating into inspection reports from April. It is “working together” with NHS Improvement to develop an approach. However, the CQC criticised NHS Improvement’s proposed finance metrics, which include agency spending and performance against plan, saying they would not be “suitable” for the CQC to use and the metrics would not “justify” a rating.

The submission added that NHS Improvement had not considered potential efficiency metrics such as cancellation rates, delayed discharges and waiting times.

The CQC also said it would like the scope of the leadership assessment to be “expanded”, criticising NHS Improvement for developing a “narrow view” of how well led a trust is.

In its overall response to the consultation, NHS Improvement said “no changes are proposed based on consultation feedback” to the financial metrics. However, it added: “We are co-developing with the CQC the approach to finance and use of resources (which will build on the metrics in the single oversight framework).”

It also said it will “proceed as proposed” in assessing the leadership of a trust but will “develop” its approach “particularly through working with the CQC”.

The FOI request also revealed the regulators plan to set out how they will work with each other in a memorandum of understanding.

An NHS Improvement spokesman said yesterday: “Our single oversight framework is closely aligned with the CQC’s regulation and inspection of NHS trusts, and we are working closely with them to achieve even greater alignment for the future. This includes working with the CQC on a shared approach to finance and use of resources. We will develop, and consult on, our proposals in the future.”