Are we there yet? The never ending
story of CQC regulation.
Neil Grant
Partner, Ridouts LLP
25 April 2013
Too much or too little?
There has been an endless swing of the pendulum
between perceived excessive regulation and insufficient
regulation (the first linked to arguments about cost to
business and the second to care scandals that emerge
every few years)
CQC has just issued its strategy for 2013 to 2016 which
gives some positive signs as far as regulation of the sector
is concerned.
Better inspections
• CQC intends to appoint a Chief Inspector of Social Care
and Support
• A move back to risk based inspection – this year all
services are to be inspected but that is likely to change
• There will be a greater focus on those services that are
seen as high risk and where people are vulnerable
• CQC will ask the following questions about services:
Are they safe?
Are they effective
Are they caring?
Are they well led
Are they responsive to people’s needs?
Better inspections (2)
• CQC will be developing fundamental standards (linked to
the 5 areas mentioned above)
• CQC will be working with the National Institute for Health
and Care Excellence to develop measures to use in CQC’s
assessments
• The standards and measures will depend on the type of
services being regulated. So it won’t be a one size fits all
approach.
• CQC will be looking at changing the regulations, where
necessary.
Encouraging improvement
CQC says that if a provider is open and honest about things
that go wrong, and has a willingness to take responsibility for
putting them right, CQC will not be heavy handed in its
response.
CQC will provide guidance, with clear measures, on meeting
new fundamental standards of quality and safety.
Assessments of services will give an organisation rating.
Encouraging improvement (2)
A clear, balanced report will be issued about the quality of care,
including what works well and what needs to improve.
Recommendations will be made, not just requirements
They will comment on the effectiveness of commissioning if it
affects the quality of services provided
Publicly make sure that managers, boards and leaders
answer for the safety and quality of the care they provide
Inspectors
CQC will create a training academy to support its staff
It will be developing a more specialist workforce
It will be increasing the level of training and guidance on
mental capacity – linking compliance with the Mental
Capacity Act and the Health and Social Care Act
It will be developing its ability to monitor the activity of
local authorities in their role as “supervisory
organisations” in the Deprivation of Liberty Safeguards
system.
Inspectors (2)
CQC says it will make sure staff “demonstrate
organisational values and behaviour that improves
organisational performance
It will introduce its own quality framework to show how
well it delivers against published standards of service
Enforcement
CQC will be working with the Department of Health in
reviewing its current enforcement powers
Functions from the Health and Safety Executive will be
transferring to CQC
In relation to the NHS, CQC is planning to transfer its
enforcement powers to Monitor and the NHS Trust
Development Authority
Take forward an enforcement improvement programme to
enable more efficient enforcement work
Warning Notices
CQC liberally serves warning notices on providers
They should be served within 14 days of the inspection.
CQC is proposing that the timescale for responding to
warning notices is amended from 5 to 10 working days
It is proposed that providers would be able to make
representations on publication AND factual accuracy of the
warning notice.
Consulting with the Department of Health and Healthwatch
England. Until then, no press releases about warning notices
will be issued.
Practical tips in dealing with inspections
Inspectors should inform you of the Outcomes and regulated
activities to be reviewed at the start of the inspection.
You should not feel pressurised into following a particular
approach of an inspector – you have a discretion about how
you go about achieving compliance.
You should assist the inspector by providing information and
documentation as required – it is your opportunity to
demonstrate the quality and safety of your service.
Practical tips in dealing with inspections (2)
You should ask the inspector for full feedback at the
end of the inspection and challenge any findings you
disagree with. There should be no surprises when
the draft inspection report arrives.
You should try to ensure inspectors put things in
context – there is a tendency for inspectors
sometimes to look at things in isolation.
Record your conversations with the inspector – it
will be an important record, alerting you to
any concerns that may require attention.
Practical tips in dealing with inspections (3)
You might want to arrange to send the inspector additional
information within 24-48 hours of the inspection and have a
follow up telephone call.
Reports should be balanced giving examples of compliance as
well as non-compliance.
Also if a provider is compliant and non-compliant with
different parts of a regulation, the inspector should report on
both.
Ensure you address any factual accuracy issues on time PLUS
findings and judgements with which you disagree in the
draft report. You should have 10 working days to respond.
Action Plans
You will have a date to submit an action plan by –
typically 7, 14 or 28 days after the final report is
published.
We would recommend that action plans are submitted
as soon as possible after the receipt of the draft
inspection report (or even following feedback) if noncompliance is accepted.
Ensure the actions are specific and realistic in terms of
time periods. Don’t be over ambitious.
Inform CQC when you have complied – they should
then follow up within 12 weeks.
The next two years
• Radical changes are afoot
• Familiarise yourself with CQC’s Strategy and
Business Plan
• Keep up-to-date with the changes as they
occur over the next 2 years
• We produce a monthly Ridout Report dealing
with major sector developments – please
contact us and we will sign you up to receive
this publication.
• Good luck!
Neil Grant – Partner
020 7317 0347
[email protected]
Paul Ridout – Partner
020 7317 0341
[email protected]
www.ridout-law.com