Developing our new regulatory model

In her latest blog, Joyce Frederick, Director of Policy and Strategy updates on work we are doing to develop a new regulatory model

In my first week back at CQC, as the new Director of Policy and Strategy, I wanted to update you on where we are with the work to develop our new regulatory model.

The last 18 months have been one of the most challenging periods for health and social care. I have been consistently impressed by all the hard work across the care system to deal with the pressures of the pandemic, continue delivering essential care, coordinate a successful vaccination programme, and now start to lead the system’s recovery.

The pandemic has accelerated existing changes in health and social care and we know we need to change how we work as well.

Building on engagement so far

Our new strategy sets out an ambition to focus on people and communities, improve safety through learning and accelerate improvement. We also set out our aim to be a smarter regulator, one that is more dynamic and flexible in how it regulates and provides up-to-date and high-quality information and ratings. The work on our new regulatory model is all about making that a reality.

This will take a while to develop, with different iterations to get it right. I therefore wanted to take this opportunity to share our latest thinking for how we will regulate in the future.

In developing our strategy, we engaged with a huge number of people who use services, as well as providers, our partners and own colleagues. We have built on that strong base to continue having conversations about some of the underpinning principles and concepts that will provide the framework for our new regulatory model.

Some of our model will feel familiar, some of it will feel very new, but all of it will be the product of engagement with our stakeholders.

Developing a new assessment framework

Our ratings and our five key questions will stay central to our approach. But we are introducing an updated framework for making our judgements about the quality of care. This will be based on a set of ‘quality statements’, pitched at the level of ‘good’ and clearly linked to the regulations. They will replace our current Key Lines of Enquiry (KLOEs) and prompts, helping to make things clearer for providers and reduce the duplication that currently exists across our KLOEs.

Importantly, we will use these statements to set out what good and outstanding person-centred care looks like and what people should expect from providers, commissioners and system leaders. The need to be clear about this is something we have consistently heard during our engagement with people who use services, as well as providers.

We will use this set of statements in our assessments of all sectors and service types and at all levels, from registration through to our new work looking at local authorities and integrated care systems. This will be the basis for our single assessment framework.

Providing an up-to-date view of quality

In order to give the more up-to-date view of quality, we intend for the information we receive, collect and analyse to assess providers to be reviewed more frequently, without being tied to a date in the calendar or the requirement to carry out an on-site inspection. At the forefront of our minds when designing this new approach is how to better obtain people’s experiences of care and develop better relationships with providers, reducing any unnecessary workload.

We know from conversations with providers that they would benefit from knowing how often our assessments take place. This work, along with developing the ‘trigger points’ for an assessment, will be a priority for further engagement with all our stakeholders.

Providers often challenge us about consistency and transparency in our judgements. To address this, we are developing a method to categorise evidence and introduce a method to score the assessments. We are proposing to have six evidence categories, covering everything from people’s experiences of care right through to processes (e.g. policies in place at a service). In many ways this will all be data already familiar to providers and to our inspectors, but by bringing in the six categories alongside a way of scoring we are able to bring a more structured and consistent framework for assessing quality.

To enable us to be clearer with providers and the public about how we use the information we have about care in a service or local area we will set out what evidence will be required for each service type and at each level. We know this is a detailed and important piece of work that we want to be one of the main areas of focus over the next few months.

We will use scoring to gain a more granular understanding of where a provider sits within a rating assessment — we know that providers are supportive of this to help drive improvement. We want to do more work to develop the detail that sits under this ambition, including the language we use to talk about it and how it works.

Many of you will have got involved in our recent consultation on more flexible and responsive regulation, which gave us the freedom to use a range of methods to assess quality, combining work off site with visits to a service or provider. Site visits will remain a hugely important part of our work. However, the difference is that we will already have the evidence and data we need ahead of a site visit to a service so that we can have a laser-like focus on people’s experiences when we are on site.

What’s next

Currently, much of the work is about developing this framework. We will then develop the detail that sits beneath and want to start testing with providers how this might work in practice. The scope and nature of the testing will change over the next 12 months from small scale conversations directly with small groups of providers, through to live environment testing and implementation just prior to rollout.

We will keep sharing regular updates with you about how the work is developing, but in what has been the hardest 18 months for health and social care in a generation I cannot thank you enough for the work you do, and for taking the time to engage with us on our new approach. Keep looking out for more blogs and podcasts from me and other colleagues about this work, including over the next few weeks about how we will be developing our approach to using data and insight better, as well as changes we are making to regulate integrated care systems and local authorities as the amendments to the Health and Social Care Bill progress through Parliament.