Enhancement of monitoring and the importance of inspection

Accepted.
The Care Quality Commission is fundamentally changing the way it monitors providers on the quality of their services. Through its Chief Inspector of Hospitals, it has introduced a new system in the hospital sector. The Chief Inspectors of General Practice and Adult Social Care have been appointed, and will similarly lead the development of new approaches in their sectors.
The Care Quality Commission has consulted on and started implementing a new approach to monitoring providers, based on identification of the indicators that are most important in signalling potential concerns in each type of care. This has started in the hospital sector, and the Chief Inspector of Hospitals has been clear that information from people who use the service, or their representatives, information from accreditation and peer review, and information from other oversight bodies are also important alongside indicators from national data. In October 2013 the Care Quality Commission began regularly publishing its analyses of the indicators for each hospital trust.
The Care Quality Commission will continue to develop the approach to monitoring hospitals, and extend it to mental health, community health and ambulance providers both in the NHS and the independent sector. The Chief Inspector of General Practice, on behalf of the Care Quality Commission, will bring forward proposals for his sector and consult on them. A signposting document on adult social care, A fresh start for the regulation and inspection of adult social care, was issued in October 2013 by the Chief Inspector of Social Care.
The Care Quality Commission is engaged in a review of quality accounts that the National Quality Board has requested and will play its part in ensuring that quality accounts add value, are robust and have accountability for inaccurate or inappropriate information.
The Care Quality Commission is developing Memoranda of Understanding with all the medical, nursing and midwifery Royal Colleges in order to explore the potential to use their accreditation schemes in its monitoring, where that can encourage achievement of best practice standards and avoid duplicated inspection.
The Care Quality Commission is reviewing its approach to themed inspections, including how they can contribute to its broader monitoring of providers.

CQC's new assessment framework, the Single Assessment Framework, allows CQC inspectors to receive evidence about a provider they regulate at all times - this could be through feedback from people using a service, data returns, feedback from staff and leaders and feedback from other partners in the health and care system. This allows CQC to monitor the risk of a service at all times, as opposed to relying on findings at on-site inspections for an understanding of the quality of care being delivered.

Please see response to recommendation 31 for information on the wider quality surveillance approach.

The National Quality Board has published guidance on Quality Risk Response and Escalation in ICSs.

Please see response to recommendation 56 on the Dash review into the operational effectiveness of the CQC.

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 receives an individual report and banding, similar to those for acute hospitals. The bandings range from one to four. In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs

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 Care Quality Commission’s Board agreed a new, strategic approach to thematic work in February 2014 that will enable the Care Quality Commission to develop an independent voice through bespoke thematic activity on priority topics. The Care Quality Commission will develop bespoke methods for each project, and this will mean that thematic findings can inform its surveillance, inspection and ratings when appropriate. Thematic work goes beyond inspection, and may include for example a data review which looks at information sources which are not part of the Care Quality Commission’s routine intelligence monitoring.

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government referred to the Care Quality Commission’s new inspection regime.

The Government also said that the Care Quality Commission had begun a new approach to monitoring based on identification of certain indicators and that it had engaged in review of quality accounts.

In the February 2015 Culture Change report, the Government referred to the Care Quality Commission’s Intelligent Monitoring system, which looked at data from staff, patient surveys mortality rates and other hospital performance information.

The Government said that the Care Quality Commission’s Board agreed a new, strategic approach to thematic work in February 2014, to enable it to develop an independent voice through thematic activity on priority topics, with a view for thematic findings to inform its surveillance, inspection and ratings when appropriated.