Care Quality Commission independence strategy and culture

Accepted.
The Care Quality Commission has begun implementing a new approach to inspection and enforcement that is fundamentally different. It has appointed chief inspectors to lead this new approach in each sector. Key means of assuring its effectiveness include the extensive consultation and engagement that has helped to shape it, and the appointment of a Chief Inspector of Hospitals who personally spearheads it, ensuring that it commands the support of the sector and the public.
The Department of Health will consult on new regulations which will come into effect during 2014. Subject to Parliamentary approval, these will set out clearly the fundamental standards below which care should never fall, and enable the Care Quality Commission to enforce against these standards without issuing a prior warning notice. The Care Quality Commission will consult on a new enforcement policy for all sectors (to sit alongside the failure regime for the NHS) so that these new regulations can be enforced effectively as they come into effect.
Chief Inspectors of General Practice and Adult Social Care have been appointed, who will now start a similar process of consultation and engagement on new regulatory approaches for their sectors.
An independent evaluation of the Care Quality Commission’s new approach to hospital inspections has been commissioned from the King’s Fund and Manchester Business School, and work began in October 2013. This will evaluate the effectiveness and efficiency of the new inspection model, and how inspection teams have used and acted upon the available surveillance information. The report of this evaluation will be published in May 2014.
The Care Quality Commission is also developing a set of new strategic measures, which from 2014 will be reported in its quarterly performance reports to the Board and in its monthly scorecards on the Care Quality Commission website. These measures will include: how quickly it has responded to risks identified through the surveillance model; the proportion of providers judged to be poor, but for whom no risk information had been available; and the impact of action taken when providers have been judged to be poor or requiring improvement.

CQC implemented an inspection framework post-Francis. Since the recommendation was made, a new single assessment framework (SAF) has been rolled out in a phased manner, since November 2023.

The interim Penny Dash Review findings highlighted clear areas where improvement is urgently needed for CQC to be an effective regulator. Interim recommendations included a review of CQC’s operational effectiveness linked to how CQC delivers its strategic objectives and regulatory responsibilities. CQC have prioritised the recommendations in the interim report and this is part of their work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what they have got wrong. CQC are working at pace and in consultation with their stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve. As this work is still ongoing, with additional reviews by Mike Richards and the final Dash Review to still be published, CQC are considering their responses to recommendations 55 and 56 alongside this wider piece of work, and hope to give a further update in due course.

The Care Quality Commission has put in place arrangements to evaluate its new approach to inspection and regulation. It has engaged Frontier Economics to undertake a review of its operations, enabling the Care Quality Commission to understand and demonstrate to its stakeholders the ongoing impact of the Care Quality Commission regulation; and to assess its value for money. The Care Quality Commission has commissioned Frontier Economics to develop a robust framework for assessing the costs and benefits of regulation. This is part of a wider programme of related work being undertaken by the Care Quality Commission. The next steps for this project are for Frontier Economics to continue to gather and analyse data and evidence, both from the Care Quality Commission and more widely, including:

● Total costs and the Care Quality Commission’s funding
● Timesheet data and activity recording tool - to a varying degree of accuracy and completeness (varies across sectors and whether the Care Quality Commission – both direct staff or indirect - or external staff are concerned)
● Resource modelling for the new regulatory approach (typical made up of inspections, lengths of inspection, datapacks prepared, time spent writing up inspection reports, etc.)
● Scheduling Project – national scheduling tool for inspections
● Costs of inspections - (salaries of inspectors, day rates of experts by experience and other specialists, indirect costs such as travel & subsistence costs or printing costs, overhead costs such as intelligent monitoring, admin support, other corporate services and executive team) and other activities carried out by the Care Quality Commission for the new and old model
● Impact assessments – data and analysis therein

Frontier Economics have acknowledged that the Care Quality Commission operates in a complex and changing environment which makes it more difficult to attribute any change in final outcomes to the existence of the Care Quality Commission, however the project hopes to demonstrate the impact of the Care Quality Commission on service users and providers.

The Care Quality Commission also commissioned the Manchester Business School (Kieran Walshe and Denham Phipps) to investigate how evidence and research can be used by the Care Quality Commission to evaluate how well its current regulatory arrangements in health and social care work. The findings of this report supported the restructure of the Care Quality Commission into sectoral based directorates and demonstrated the need for specialisation amongst inspectors. It also drove the development of the Care Quality Commission’s standards and ratings framework.

The Care Quality Commission also now has a programme board which monitors six internal projects, including:

• The Care Quality Commission’s operating model
• Quality framework
• National scheduling
• Cost of delivery
• Value for money
• Evaluation and benefits

This recommendation was accepted by the Government.

In the January 2014 Hard Truths report, the Government said that that an independent evaluation of the Care Quality Commission’s new approach to inspection had been commission from the King’s Fund and Manchester Business School. The final report was published in September 2018. In the February 2015 Culture Change report, the Government also said that the Care Quality Commission had commissioned Frontier Economics to undertake a review of its operations, including for it to develop a robust framework for assessing the costs and benefits of regulation.