Responsibility for regulating and monitoring compliance

Accepted in principle.
The Care Quality Commission already has powers to require information and explanations, with failure to provide these or obstructing an inspector constituting an offence, and has started to put steps in place to improve its monitoring. The Care Quality Commission will not be wholly reliant on one information source; its new surveillance model, combined with the existing information resources available to it, will allow it to cross- refer concerns and build up a picture of care. It is also a condition of Monitor’s licence that information provided to Monitor is accurate, complete and not misleading. Monitor can and has pursued cases where information provided to it has been inaccurate.
The Care Quality Commission has developed a new approach to monitoring hospitals’ performance, which helps direct the timing and focus of inspection. It includes measures of data quality, which may prompt assessment of culture, leadership and governance and, within that, information governance. The Care Quality Commission has a strong key role in that area through its National Information Governance Committee. The Care Quality Commission’s monitoring of hospitals includes a range of systemic indicators, such as outliers on different measures over time), and individual events (examples include reports from whistle blowers, safeguarding incidents, notifiable deaths and incidents). All of these are able to trigger interventions, including inspection.
The Care Quality Commission will consider further measures related to data quality as its new system for monitoring providers matures, in order continuously to improve its sensitivity to this aspect of quality of care. Taken together, therefore, the Care Quality Commission already take a range of robust approaches to assessing and verifying the extent to which providers are complying with standards; it is therefore unnecessary to impose a new duty on it.

The update set out below refers to the intelligence model that CQC ran from 2013-2016.

The recommendation refers to how CQC are monitoring quality of information used by providers to assess their quality of care. This is now covered under the Single Assessment Framework within the Well led quality statements CQC have also developed a set of data quality indicators for high coverage/priority datasets and track these as part of the set of indicators that inspection teams review for each service - e.g. there is a suite of indicators relating to data quality from the mental health services dataset. The NHS Provider License requires that a Trust must take all reasonable steps to ensure that information is accurate, complete and not misleading.

Duty of Candour

On 6 November 2014, the government introduced a statutory (organisational) duty of candour for health service bodies - NHS trusts and NHS foundation trusts. The duty places a direct obligation upon trusts to be open and honest with patients and service users, and their families, when something goes wrong that appears to have caused or could lead to moderate harm or worse in the future (known as a ‘notifiable safety incident’) .

Regulation 20 set a clear requirement that candour is not optional for health service bodies and withholding of information relating to harm is not acceptable. When a specified safety incident has occurred in respect of care provided, the regulation sets out a clear set of legal duties about how and when to notify service users (or relevant representatives) and what threshold of harm constitutes a safety incident for which notification is required. The CQC can take both civil and criminal enforcement action against providers who are found to be non-compliant, including in respect of the duty of candour.

The Care Quality Commission has put in place a system of Intelligent Monitoring to help decide when, where and what to inspect. This draws information and data from a range of sources to identify providers and services where there may be a greater risk of providing poor care. The evidence from the Intelligent Monitoring system is used to prioritise which providers will be inspected and the lines of enquiry during an investigation. The system triggers a response, for example, where there are a statistically significant number of severe harm incidents or avoidable deaths at a provider. “Never events” trigger an automated elevated risk in Intelligent Monitoring which inspectors follow up individually. The data it looks at includes information from:

• Staff
• Patient surveys
• Mortality rates
• Hospital performance information such as waiting times and infection rates

In October 2013 the Care Quality Commission began a pilot of its Intelligent Monitoring programme for acute and specialist NHS trusts. The pilot looked at more than 150 different sets of data (indicators), which related to the five key questions the Care Quality Commission asks of all services – are they safe, effective, caring, responsive, and well-led? Using this data, the Care Quality Commission grouped all acute NHS trusts into six priority bands for inspection. In March and July 2014, the Care Quality Commission updated its surveillance model for acute and specialist NHS trusts.

In November 2014, the Care Quality Commission published Mental Health Intelligent Monitoring reports, which display the results of its analysis of Tier 1 indicators for all Mental Health NHS trusts. Each trust will receive an individual report and banding, similar to those for acute hospitals. The bandings will range from one to four.

In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs made up of different types of evidence on patient experience, care and treatment, based on sources including surveys and official statistics

The Care Quality Commission has always used important information in statutory notifications as an indicator of quality and safety in the adult social care sector, alongside other information about safeguarding alerts and information provided by others such as people who use services, staff and the public. The Care Quality Commission does not have a lot of quantitative data consistently collected across the sector but it is taking steps to improve this. With a new, more thorough model, the Care Quality Commission intends to use all the available information to check whether there is a risk that services do not provide either safe or quality care.

Draft Intelligent Monitoring models for the Adult Social Care sector have been in place since October 2014, with separate sets of indicators for residential, community and hospice services. The Care Quality Commission will continue to develop these models with providers and stakeholders to develop a more robust Intelligent Monitoring system within Adult Social Care during 2015/16 and beyond.

The Government accepted this recommendation in principle.

In the January 2014 Hard Truths report, the Government referred to the Care Quality Commission’s powers to require information and explanations, as well as its system of intelligent monitoring to help decide when, where and what to inspect. The Government said this drew information and data from a range of sources, which enabled it to cross-refer concerns and build up a picture of care. The Government also said that it was a condition of Monitor’s licence that information provided to Monitor was accurate, complete and not misleading. There was no mention of the Care Quality Commission being put under a duty to monitor the accuracy of information disseminated by providers.