2 Purpose of the CQC
6. The CQC's new approach to registration and inspection
was established in their strategy document 'Raising standards,
putting people first' published in April 2013. A subsequent consultation
document, 'A new start' was published by the CQC in July 2013.
The CQC's strategy contains six strategic priorities:
i. Better use of information and inspection
ii. Working better with our partners in the health
and social care system
iii. Building better relationships with the public
iv. Building relationships with those we regulate
v. Strengthening how we deliver our responsibilities
in terms of mental health and mental capacity
vi. Building a high performing organisation
7. The CQC said that it now has a clear purpose
- "to make sure health and social care services provide people
with safe, effective, compassionate, high-quality care and to
encourage care services to improve".[7]
Allied to this is the CQC's role which they said is to:
monitor, inspect and regulate services to make
sure they meet fundamental standards of quality and safety, and
to publish what we find, including performance ratings to help
people choose care.[8]
8. The Department of Health said in its written evidence
that it believes "the CQC has made good progress and now
has a coherent plan to build its capability and consolidate its
role as an effective regulator."[9]
The Department concludes that the work the CQC has undertaken
to revise its registration and inspection process means "the
foundations are in place on which a reformed and more effective
regulator of health and adult social care can be built."[10]
9. Lack of clarity and direction has previously undermined
the CQC's attempts to establish itself as an authoritative regulator.
David Behan, CQC, Chief Executive, said in evidence that "public
and professional confidence has been shaky in the CQC"[11]
and this can be attributed to a failure of the CQC to establish
its purpose and role. In our report following the 2012 accountability
hearing, the Committee found that CQC had failed to establish
its core purpose or to describe what it intended to achieve through
its regulatory activity. The Committee reported that:
The Department of Health's performance and capability
review of the CQC recommended that "CQC's strategy needs
to be revised, explaining what role and impact its regulatory
action is intended to have in specific sectors over time."
In its memoranda to the committee the CQC says that its purpose
is to "drive improvements in the quality of care", but
in itself, we were not satisfied that this would address the serious
criticism contained in the performance and capability review that
"strategic prioritisation of essential standards is not understood
at all levels within the Commission."
In failing to understand its essential purpose,
the CQC risks undermining its own attempts to realign its strategic
priorities following a period of sustained criticism and review.[12]
10. The Department of Health said in its memorandum
to the Committee that the "Department believes the CQC has
made good progress and now has a coherent plan to build its capability
and consolidate its role as an effective regulator."[13]
The Kings Fund noted in their evidence that the CQC's work to
establish its strategic direction has created a "strong
foundation for its future work"[14]
11. The Committee welcomes the fact that the CQC
has now set out its objectives in clear terms. This in turn has
helped to provide clarity to a regulatory landscape the committee
described in 2012 as "cluttered and opaque".[15]
The Committee believes that the CQC is now ready to undertake
a programme of substantial reform to develop and improve its regulatory
functions.
Strategic reform
12. Having defined its purpose and role, the CQC
is now in the process of developing a reformed regulatory methodology.
A new set of standards examined through a system of differentiated
inspection are at the heart of the reformed regulatory system.
The CQC's strategy outlining the reforms said:
How often we inspect, how long we spend on an
inspection, and the size and membership of the inspection team
will be based on the 'risk' of the service - the type of care
being offered, the vulnerability of the circumstances of people
who use it, the information we have about a service, and its current
rating. We will inspect services less often if we are confident
that they are offering safe, high-quality care and can continue
to do so. We will focus less on the number of inspections we carry
out and more on the number of days we spend inspecting services.[16]
13. Once inspections are completed providers will
be awarded a rating. The CQC's evidence stated that:
Initially, ratings will be given to hospital
trusts and we will explore how quickly we can also rate individual
services such as critical care or A&E. We will begin to award
ratings for adult social care and primary care in line with the
roll out of our new regulatory approach in these sectors.[17]
14. By January 2016 all NHS and independent hospitals
will have received a rating and by April 2016 this will be extended
to all NHS and social care services.[18]
In advance of this the CQC believe that by April 2014 thirty-five
hospitals will have been inspected using the new 'in-depth model'
"with the majority of these receiving an overall rating,
as well as ratings of specific services, and against each of our
five key questions".[19]
The CQC's proposals for regulatory reform are explored
in sections three and four.
7 CQC, A New Start, June 2013, p 2 Back
8
CQC, July 2013, HC 374, p 2 Back
9
Department of Health (ACQ 01), para 2 Back
10
Ibid. Back
11
Q2 Back
12
Health Committee, Seventh Report of Session 2012-13, 2012 accountability hearing with the Care Quality Commission,
HC 592, paras 16-17 Back
13
Department of Health (ACQ 01), para 2 Back
14
The King's Fund (ACQ 16), para 4 Back
15
HC 592, para 37 Back
16
CQC, A New Start, June 2013, p 17 Back
17
CQC (ACQ 02), para 24 Back
18
Ibid. Back
19
Ibid. Back
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