Use of information about compliance by regulator from: Complaints

Accepted in principle.
Information from people who use care services about the quality and safety of their care, including concerns and complaints, is a vital source of information which needs to be available to the regulator. As part of the introduction of its new approach to inspection, the Care Quality Commission will ensure that it has access to this information so that it is a central part of how it focuses inspections. Through its engagement activity and refinement of its new approach, the Care Quality Commission will consider how best to ensure that it has access to this information.
The Care Quality Commission already accesses and uses a range of information about complaints to inform the timing and focus of its inspections. The information ranges from aggregated numbers and patterns of complaints, to individuals who contact it and tell inspectors about their experience. The Care Quality Commission also has a Memorandum of Understanding with Monitor that allows the two-way sharing of patient complaints information so that Monitor can act on it.
The Care Quality Commission started implementing its new approach to hospital inspection in September 2013. The approach is based around judging five dimensions of quality. In December 2013 it will set out information in more detail in a handbook for providers, so that there is transparency in how it will rate acute hospitals. This will build on the proposals in A new start – Consultation on changes to the way the Care Quality Commission regulates, inspects and monitors care by providing more detail on:
• what the five questions that the Care Quality Commission inspects* will cover;
• the definition of each level of the rating scale (outstanding, good, requires improvement inadequate);
• key lines of enquiry that will always be followed to ensure consistent ratings;
• any additional indicators and data that contribute to the rating (beyond those used for surveillance), and any methods or rules for aggregating them;
• how judgements are made from inspection findings and data, to place a provider in a ratings band.
In all inspections, the Care Quality Commission will use key information to identify priorities to check, and this will always include complaints information as an essential component. This is likely to require definition of a comprehensive, standardised information set which the Care Quality Commission can access as part of pre-inspection planning and as and when required for on-going monitoring.
The information could be required on a mandatory basis by incorporating it in regulations or through the Care Quality Commission’s general power to require access to whatever information it needs to exercise its functions. However, it is premature to make decisions on requiring mandatory information until the implications of Rt Hon Ann Clwyd MP and Professor Tricia Hart’s Review of the Handling of Complaints in NHS Hospitals are fully understood, until the NHS Confederation’s review of bureaucracy has reported, and the Care Quality Commission has evaluated its information requirements in light of its first inspections using its new approach. The Care Quality Commission will review whether to require routinely from providers a report on complaints, self-assessment or other form of declaration, in order to inform its monitoring and inspections, as it continues to test and engage on refining its new approach to inspection between now and April 2014.
*Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Please see response to recommendation 3 in relation to CQC’s ‘Provider Information Returns’. The CQC have moved away from mandated ‘Provider Information Returns’ in sectors apart from Adult Social Care (ASC), which includes some basic questions about complaint numbers under the Quality assurance and risk management section. In all sectors, evidence about complaints, and the complaints management process, is requested as part of ongoing assessment, and we have powers to compel providers to share details of complaints under Regulation 16(3) of the Heath and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Providers are required by regulation to investigate and take necessary and proportionate action in response to any failure identified by the complaint or the investigation. The CQC can request information about complaints and complaints procedures from providers and it is an offence to fail to comply with such a request. The information that CQC requires as a matter of course is about patient safety incidents, deaths or serious injury under treatment, but not, in the case of healthcare providers, complaints generally.

Ahead of any inspection, the Care Quality Commission requests a range of information relating to complaints from providers. This includes numbers of complaints, themes of complaints and the timeliness of resolution of complaints.

The Care Quality Commission will also ask providers to share with us any survey they have carried out of people who have complained to them in the last 12 months.

The new fundamental standards will place a legal requirement on registered providers to provide the Care Quality Commission with information about complaints.

This recommendation was accepted by the Government in principle.

In the January 2014 Hard Truths report, the Government said that as part of its new inspection regime, the Care Quality Commission would ensure it has access to information concerning complaints, which would also inform the timing and focus of its inspections. Reference to a two-way memorandum of understanding with Monitor to allow sharing of patient complaints information.

The Government said it would delay the decision on requiring mandatory information until the implications of the Clwyd/Hart Review of the Handling of Complaints in NHS Hospitals was fully understood, the NHS Confederation’s review of bureaucracy report was published, and the Care Quality Commission had evaluated its information requirements.

In the February 2015 Culture Change report, the Government said that Care Quality Information would ask providers to share any survey they had carried out of people who have complained to them in the last 12 months.