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‘Significant differences’ in impact of CQC inspections on different NHS sectors

Greater investment in recruitment and training of staff and more flexible rating systems were amongst the key findings in a landmark review of the CQC, published today.

Research carried out by think tank The King’s Fund and the Alliance Manchester Business School, funded by the National Institute for Health Research, examined how the CQC was working in four sectors between 2015 and 2018 – acute hospitals, mental health, general practice, and social care — in six areas of England.

The report found that despite there being major improvements in standards of inspection since Sir Robert Francis’ comments over failures in quality of care, there was still “room for improvement” in the CQC.

Findings included a number of areas for improvement in the CQC’s approach to regulation. Results from the report indicated “significant differences” in the way that inspections impact works across the four sectors studied.

A care provider’s capability of improvement and the availability of external improvement support, for example, was “more often present” in the acute and mental health sectors than in general practice and adult social care; something which the report conductors found to be “key determinants of impact,” the report authored by senior chair at The King’s Fund Ruth Robertson said.

Robertson commented: “We found that CQC’s approach works in different ways in different parts of the health and care system. When CQC identifies a problem in a large hospital there is a team of people who can help the organisation respond, but for a small GP surgery or care home the situation is very different.

“We recommend that CQC develops its approach in different ways in different parts of the health system with a focus on how it can have the biggest impact on quality.”

The relationships between CQC staff members and health and social care professionals and managers also “fundamentally affected” the way regulation worked and its impact on that provider, according to the findings.

The think tank and business school therefore highlighted the importance of the CQC investing in recruitment and training of its staff to create an inspection workforce with the credibility and skills necessary to “foster improvement through close relationships, while maintaining consistency and objectivity.”

The report also warned that the focus on inspection and rating could have crowded out other activity which could have a greater impact, and recommended that the CQC focus on regular, less formal contact with providers.

“Given the range of ways in which CQC can have an impact, our findings suggest that, to yield the maximum positive impact from its available resources, CQC should develop and use regulatory interactions other than comprehensive inspection,” the report said. It added that the CQC should “draw on its intelligence and insight to support providers, foster improvement and prioritise its use of resources.”

Ian Trenholm, chief executive at the CQC, said: “One of the key developments in our current strategy is the improved use of intelligence from the public, providers, other regulators and oversight bodies in order to target resources more effectively to where risk to the quality of care provided is greatest, or to where quality is likely to have changed. This means more use of targeted unannounced inspections, based on information that is constantly updated. 

“In an environment of pressure and change, we’ll continue to evolve our model to support the system to improve – and take action to protect people where necessary.

“We know our work is already leading to improved services and better care and there is strong support for what we are doing from the public and providers. With our next phase approach, we are building on this work and moving forward, to ensure that more people get good care, more of the time.”

Head of policy at NHS Providers Amber Jabbal said: “This is a helpful review which highlights the impact of the CQC regulatory approach and inspection regime on provider performance. We agree that the model CQC introduced in 2013 is a significant improvement on the system it replaced.

“We welcomed the CQC’s new strategy and the move towards a more targeted inspection regime with a greater focus on improvement. As the CQC moves into its next phase of regulation, it will need to strengthen its digital capabilities if it is to meet its ambition of becoming an intelligence-driven regulator and remain responsive to the evolving system architecture.

“We look forward to continue working with CQC as it embeds its new strategy and develops its model further to regulate a more integrated and joined up health and care system.”

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