CQC – A New Start

Janet Pearson, CPEA Director attends a consultation meeting: CQC – A new start

CQC has been re-invented, with the aim of being a strong independent regulator on the side of the people who use services. It’s moving away from the previous pass/fail approach to one of helping services to improve, ensuring that they are safe, effective, caring, responsive to people’s needs and well led. Sir Mike Richards is Chief Inspector for hospitals and Andrea Sutcliffe was appointed for social care recently, while a third Chief Inspector for general practice will also be appointed.

CQC has been consulting on how it inspects the NHS and independent acute hospitals and as a result anticipates new legal powers to award ratings for hospitals and re-introduce them for social care. The reformed regulator’s new approach to regulation will therefore be based on:

• Registration – a more rigorous test with named accountable leaders

• Surveillance – continuous monitoring to identify failures and risk of failure using local and national information sources and qualitative information from people(hopefully including Healthwatch)

• Expert inspection teams, with longer inspections for hospitals possibly spending 5 days on site rather than the current 1 day format and more time talking to people

• Simple clear standards based on three levels – the fundamentals of care, expected standards and high quality care

• Ratings to help people choose between services – outstanding, good, requires improvement and inadequate

In terms of the new legislation, the new regulations become law in April 2014 and changes to inspections for adult social care, mental health and learning disability services, including ratings will commence in 2014 – 2015 (and 2015 – 2016 for community health care and ambulance trusts). Inspections of acute hospitals are commencing ahead of the legislation and 10 trusts have already been identified for early inspections.

The model of three levels of care will apply to all services though specific expected standards will be drawn up for different service areas when the Chief Inspectors are in post. At this stage CQC are consulting on the suggested Fundamentals of care – based on the Francis Review of Mid Staffs NHS Trust:

1. I will be cared for in a clean environment

2. I will be protected from abuse and discrimination

3. I will be protected from harm during my care and treatment

4. I will be given pain relief or other prescribed medication when I need it

5. When I am discharged my ongoing care will have been organised properly first

6. I will be helped to use the toilet and to wash when I need it

7. I will be given enough food and drink and helped to eat and drink if I need it

8. If I complain about my care, I will be listened to and not victimised as a result

9. I will not be held against my will, coerced or denied care and treatment without my consent or the proper legal authority.

The fundamentals read as a ‘bill of human rights,’ however missing in many people’s eyes is the key point of person centred approaches, of people being treated with dignity and respect and working in partnership with professionals to co-determine treatment and support plans.

At the consultation strong views were expressed about obvious omissions of user and carer involvement and that the focus of questions was not right. The audience was not confident that CQC is really listening. CQC was however interested in opinions regarding the length and frequency of hospital inspections and whether these should be announced or unannounced.

The new ratings will be based upon standards found at inspections.

The three levels are represented in the diagram below.

More details on the consultation can be found in the CQC report – A new start. www.cqc.org.uk/inspectionchanges