Our proposals for more flexible and responsive regulation

Ian Trenholm, Chief Executive of CQC, blogs about the specific changes being proposed that will move us towards our ambition to be a more dynamic, proportionate and flexible regulator.

Ian Trenholm, Chief Executive

In recent years, health and social care has changed significantly — not least in response to the COVID-19 pandemic. We also need to change so we can continue to make sure we meet the needs of the people who use services and the providers we regulate.

We’ve learned a lot from our response to the pandemic so far, and we’re using this to put us in a better place for the future and support services to keep people safe.

Your views and feedback have also been invaluable as we’ve developed our strategy. Following on from our current strategy consultation, we’re also proposing some specific changes. These will enable us to deal with ongoing challenges from the pandemic and move us towards our ambition to be a more dynamic, proportionate and flexible regulator.

Assessing and rating quality

Our inspection reports and ratings give a view of quality that’s vital for the public, service providers and stakeholders. We want to introduce changes to allow us to assess and rate services more flexibly, so we can update our ratings more often and make ratings easier to understand for everyone.

We want to assess quality and rate services by using a wider range of regulatory approaches — not solely on-site or comprehensive inspections. This means we’ll make more use of the information that we hold to update ratings, and it won’t always be necessary to carry out a site visit if we want to update a rating. Rather than following a fixed schedule of inspections, we propose to move to a more flexible, risk-based approach for how often we assess and rate providers.

We’re also proposing changes to how we rate GP services and NHS trusts — to make ratings simpler and more relevant for people who use services. We are not proposing any changes to how we aggregate ratings in adult social care as part of this consultation.

Changes for GP practices

As well as inspecting and rating GP practices for our five key questions, we also currently assess people’s experiences of care in six population groups and rate each group against the effective and responsive key questions. Feedback from GP practices, the public, national stakeholders, and our own inspectors showed that our current approach is too complex. We’re committed to considering our regulatory impact and keeping our approach as simple as possible, so we want to make ratings easier to understand and give a better reflection of the quality of care for local people. Ratings for the different population groups rarely show any variation, and they tend to reflect the quality of care for all people using the GP practice. As well as this, providing care to specific population groups is often influenced by wider local health systems; we want to reflect this in developing our approach to primary care networks and the wider health and care system.

For these reasons, we’re proposing to stop giving ratings for individual population groups. But it’s important to know that we’ll still look closely at how practices provide personalised care to their local populations and how they consider different people’s needs when they receive primary medical care.

Changes for NHS trusts

We want to simplify the system of aggregating ratings for NHS trusts. So, rather than having multiple levels of complex aggregated ratings, we want to provide a single rating at Trust level based on a development of our current trust-level assessment of the well-led key question. Again, we’ve listened to feedback from stakeholders, the public, trusts and our inspectors, which tells us that the current approach is too complex, and the aggregation of ratings can conceal variation in the quality of services and doesn’t always reflect the way people experience services and care.

We want to focus on the culture and leadership of an organisation, as well as the specific services where people receive care. We also plan to work with providers and NHS England/Improvement to further evolve our approach to rating the quality of NHS trusts.

How we’ll engage with you in the future

The way we currently consult and engage on any changes to our methods is a long process and means we can’t implement changes and tell our stakeholders about them quickly enough. We want to change this.

In future, we’ll hear people’s views constantly through a range of ways, making it easier for us to design solutions together with all our stakeholders in real time as we develop our future ways of regulating.

This means you’ll see fewer large-scale formal consultations, but more ongoing opportunities to contribute as we’ll engage in different ways that suit specific groups of people and types of provider.

We want to hear your views

We’d like to hear what you think of our proposals for more flexible and responsive regulation so we can make sure that the changes work for everyone.

I’d encourage you to read the full consultation document on our website and respond using our online form. This consultation is open for responses until 5pm on 23 March 2021.

You can also tell us what you think using our online Citizenlab platform, where you will find other opportunities to engage in CQC’s work.

I want to finish by saying thank you again to all those working in health and social care for your incredible contributions over the last year.