Care Quality Commission Chief Executive, Ian Trenholm, discusses the immediate priorities for CQC, what’s coming next with our Transitional Regulatory Approach, and further ahead to our future strategy.

Image of Ian Trenholm, Chief Executive of CQC
Image of Ian Trenholm, Chief Executive of CQC
Ian Trenholm, Chief Executive, CQC

I’d like to start by acknowledging the great efforts of everyone working in health and social care over the last few months in response to the global pandemic. CQC is one part of an interconnected health and care system and I know we have all worked incredibly hard together. Coronavirus is still with us though, and that means new ways of working for us all.

With that in mind, I’d like to update you on what we are doing now, and share our thinking on what we could do next and in the future to contribute to regulating health and social care services as we develop our new strategy.

Now

While routine inspections were paused, we kept regulating. We continued to inspect in response to risk and concerns; we regularly engaged with providers; and continued our monitoring activity.

Innovation and inspiration

Like you, we’ve learned a lot over the last few months. We’ve seen a lot of innovative practice during the pandemic that has undoubtedly saved lives. These fantastic examples from the frontline showcase some of the ways that providers have responded and senior emergency department clinicians have told us how COVID-19 has been a catalyst for change in emergency care

For me, these examples demonstrate a determination to think differently to meet the needs of people who use services and keep people safe in a time of crisis. Resilience, imagination and a desire to drive improvement all spring to mind. These examples are not a prescription for change or a complete picture, but we hope they will act as a helpful catalyst for improvement as we all plan for the coming winter and potential COVID-19 spikes.

New monitoring tools

Thanks to significant work on our digital capabilities, we were able to rapidly respond during the crisis in a number of ways. We developed the Emergency Support Framework (ESF) — a structured framework for our regular conversations with providers, allowing us to adapt to the specific needs of each sector. As referenced by the Secretary of State for Health and Social Care in his recent speech on the future of healthcare, the ESF represented an adaptation of our usual regulatory approach to the new reality. We used data and feedback to identify problems in real time, worked with providers to have honest conversations and offered ongoing advice and support. We also introduced a new home care tracker, designed to work alongside the NHS Tracker for adult social care to help us monitor risks to the quality of care.

At the request of the Government, we were able to support the testing of staff and residents in adult social care services. While this meant stepping outside of our usual regulatory role, it was the right thing to do to support the national response to the pandemic.

Provider collaboration reviews

The speed and scale of the response required by the pandemic has highlighted the importance of collaboration and partnership across the health and care system. Responses to the pandemic have offered opportunities for partnership working, ensuring shared efforts to avoid fragmentation and drive best experiences and outcomes for those accessing care within a system.

Building on this work, we’ve started a series of rapid reviews focusing on 11 Integrated Care System (ICS) and Sustainability and Transformation Partnership (STP) areas. These Provider Collaboration Reviews (PCRs) will share examples of where collaboration has worked well across the system, helping to drive improvements and prepare for future pressures on local care systems. We’ll be publishing the findings from these in our September COVID-19 insight report, and in this year’s State of Care report. These PCRs build on the Local System Reviews (LSRs) we were commissioned by the Government to carry out in 2017/18 and the resulting recommendations we made on system working. We continue to encourage the Government to commission further such LSRs given the positive impact providers told us they had.

Next

As services start to resume to some degree of normality, providers are looking at how they balance the importance of effective infection prevention and control measures with the needs of people using their services, and it’s no different for us. However, we won’t just be returning to business as usual.

From September we’ll be introducing a Transitional Regulatory Approach. This will be a flexible, iterative, approach that brings together the best of our existing methodologies with learning from our COVID-19 response, in a way that enables us to better deliver our purpose. Importantly this will include us visiting providers.

Our focus over the last three months has naturally been on the immediate risks presented by the pandemic. We know that this needs to evolve.

From September we will develop our monitoring approach to capture a much broader range of topics as part of the monitoring process and use all the information available to us to present a clearer view of risk and quality.

This means we will evolve the approach we developed through the ESF to look at more of the issues that matter to people. We will develop clear areas of focus for our monitoring, based on existing Key Lines of Enquiry (KLOE) specifically targeting safety, access and leadership. We want to continue to iterate our areas of focus throughout the autumn and place greater emphasis on other areas, such as improvement cultures.

As the risk of coronavirus recedes and we are able to increase on-site activity, we’ll be widening our scope to include services where we have evidence that care needs to be improved as well as those services where we have evidence people may be at risk.

We’ll strike a balance between making sure we hear people’s experiences of care and making an accurate assessment of quality with minimising infection control risks and not adding unnecessary pressure on the health and care system.

We know that responding to coronavirus has presented an unprecedented challenge for providers across health and social care. But it remains that everyone deserves to get good, safe care. We will support and encourage those providers who are trying to improve and provide the best care for people using their services, but we will take action where necessary.

Future

How health and social care is organised has changed over the last few years and continues to evolve rapidly. We’re seeing new ways of working in partnership across health and care, and our LSRs and PCRs show us that quality of care is not just about provider assessments. It is also about how people experience care as part of a health and care system.

We know that to stay relevant, our assessments of quality need to better reflect how people experience health and social care — not just now, but in the future. Our approach to regulation needs to draw on intelligence and data, minimise disruption to providers, and be effective for the public and people who use services.

As part of our future strategy we want to explore how we might take a more system-led approach to how we regulate.

The coronavirus pandemic has also underlined the health inequalities in our society and amplified the collective challenge we all have to keep people safe and protect the most vulnerable. My colleague Kate Terroni was in Parliament discussing this a few weeks ago. As a regulator, we know that we need to work in new ways and ensure that we are facing these challenges head on.

We’re developing a new strategy to launch in May 2021 that will set out how we do this. We’ve been discussing what is most important to members of the public, providers and our stakeholders. There are four main themes emerging:

  • Meeting people’s needs

We know care is better when it’s developed through the eyes of people who use services and delivered in partnership with them. We think the same of regulation. We’d like to transform how we collect and understand people’s individual experiences and those of local communities, focused on people who face inequalities, to make sure services meet their needs. We want to help people make decisions about their care and empower them to drive change by providing the information they need in the right way.

  • Promoting safe care for people

We want to lead the establishment of a universal safety culture across health and care. This would include setting an expectation that providers will actively and visibly promote ‘speaking up’ at all levels; identifying priority areas where safety risks are present and setting demanding standards for improvement together with our partners.

  • Smarter regulation

We want to gather information differently and develop how we work with others so we’re only collecting it once. We also want to use information differently. From the point of registration we think it’s important to build open, ongoing relationships with providers, to provide a more immediate picture of care, and to respond to risk so we’re making the right intervention at the right time.

  • Driving and supporting improvement

We can do more with what we know to drive improvements in the quality of care, using our unique baseline understanding as set out in our annual State of Care report.

Have your say

There will be a full public consultation on our strategy in January 2021, but ahead of that we want to hear as many views as possible to help shape it. We’ve already started some work on this through a series of webinars and activity on our digital participation platform, and there will be lots more opportunities over the coming months. Sign up to our bulletins to make sure you hear about these.

So, to summarise, now we’re continuing to focus on higher risk services; next we’ll launch a Transitional Regulatory Approach, and we’ll be consulting on our next strategy to help us prepare for the future.

We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve.

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