Building capacity, responding to risk: CQC’s approach to regulating the NHS

Chief Inspector of Hospitals, Ted Baker, updates on how the Care Quality Commission is regulating NHS services during the pandemic

The health and social care system is dealing with ever-increasing pressure as it continues to respond to the pandemic. The dedication and resilience of both frontline staff and leaders has been extraordinary, and I want to thank you for everything you have done and continue to do.

Throughout the pandemic, our regulatory role has not changed. Our core purpose to keep people safe drives our decisions. We have worked flexibly and continue to adapt as the pressures evolve.

Recognising the tremendous pressure you are under, we are keeping our approach under constant review so that we can support you, while ensuring that people receive safe care. We recently published an update on our general regulatory approach, and I wanted to share more detail on what that means for NHS providers.

We know there are serious capacity issues across the NHS. And we acknowledge that the pandemic has affected — and continues to affect — quality of care. My immediate priority therefore is to use our position to help build capacity and to respond to risk, including to staff and people who use services.

Building capacity

In adult social care services, we continue to undertake infection, prevention and control (IPC) inspections to ensure people are receiving safe care. We are rapidly inspecting potential designated sites so that people who have COVID-19 can be discharged from hospital in a timely way, freeing up capacity in the system.

We will also inspect adult social care services where there is an ability to award a new rating. This will support local authorities to commission care where needed.

Our registration team has been running a COVID-19 priority registration process since the start of the pandemic, and this will continue for the foreseeable future. This applies to providers planning to deliver services which provide additional health and social care provision in an area or contribute to the control of the outbreak of coronavirus or the treatment of people who have contracted the illness. To ensure we do not cause any delay, we can assess applications at the same time as new services are being set up to deal with urgent capacity needs.

Responding to risk

We understand the enormous pressure NHS services are under and the impact this has on both staff and patients. We recognise that usual expectations can’t always be maintained under current circumstances and providers will need to mitigate risk as far as they can within the resources available to them, in line with national guidance. It is important therefore that we all maintain honesty and transparency about the risks that services are facing.

Since March last year, our inspections have been driven by the need to investigate whether people are or could be at risk of harm. In November 2020 we saw a 60% increase in the number of whistleblowing enquiries relating to hospitals compared to the same period last year. With no planned return to routine inspections for the time being, it remains important that staff continue to raise concerns and feel safe to do so. By sharing concerns you help us to measure and understand the impact of the pandemic on staff, on services, and on patient care.

We continue to work closely with other parts of the system, such as NHS England and Improvement at regional and national level. Many concerns are being resolved and risks addressed without the need for us to inspect services. Where inspections are necessary, we use the evidence we gather to escalate issues on behalf of providers and demand a national response where concerns can’t be resolved at local level. We’ve had feedback from some providers that our inspections have been a valuable catalyst for accessing additional support — during this pandemic, I want this to be the experience for all providers we inspect.

As well as hearing concerns through our inspection teams and Give feedback on care service, we’re also regularly speaking to clinicians working in emergency departments through our National Emergency Medicine Speciality Advisor Forum. They have been a valuable link to the frontline and have been integral to helping us understand the reality of the pressures that are being faced and how we can best respond and offer support. Patient FIRST is a good example of how we have worked together to quickly develop a resource to support providers in their response to the pandemic.

I know that staff are doing their utmost to deliver the best quality of care they can, but the challenges they face are enormous and the burden they are carrying is heavy.

We will continue to work flexibly, adapt our approach and remain responsive as the situation changes, reflecting our commitment to supporting providers and keep people safe in this incredibly challenging time.

The Care Quality Commission is currently consulting on its new strategy, and we want to hear what you think. Find out more on our website.