A ‘bold ambition’: Care Quality Commission’s new strategic plan now out for consultation

A focus on regulation driven by people’s experiences, expectations and needs from health and care services. The ambition is to change how people engage and share experiences of care with CQC – building trust with the public and motivation to share their experiences.

CQC commit to taking a number of actions:

• Enabling feedback to be given in different ways – whether giving information to inspectors, Experts by Experience, Mental Health Act reviewers, Local Healthwatch or using digital channels.
• Developing skills and tools to enable all people to share experiences but with a focus on the most disadvantaged of society.
• Improving capacity and capability to get the most out of feedback so that it can be used to identify changes in quality of care.
• Providing a clearer definition of what ‘good’ and ‘outstanding’ care looks like, based on what people say matters to them. It will be these definitions that CQC will use as the basis for assessing services and the information that they collect as evidence.
• When assessing services, they’ll look at how they work with each other, and in partnership with communities to make improvements, including how effectively they involved people in designing and improving services.
• Services will be assessed on how well they work together as a local system in an area with systems falling short being held to account for the quality of care in their area.

CQC plan to regulate services in a more targeted and flexible way so providing a more consistent, up-to-date and accurate picture of quality across services using the best information. This will include better use of resources, focusing on risk and where care is poor to ensure they are an effective, proportionate and an efficient regulator.

Key commitments include:

• Moving away from relying on a set schedule of inspections to a more flexible, targeted approach. While site visits are a key part of performance assessments, the intent is to use all regulatory tools, methods and techniques to assess quality continuously, rather than relying only on scheduled all-inclusive on-site inspection visits. Local CQC teams are to play a key part in this process.
• Inspection of sites will follow where CQC need to respond to risk, observe care and when specific information is required and when sampling to check view of quality is reliable.
• Keeping service ratings about quality up-to-date, rather than rely on the outcome of periodic all-inclusive inspections to change them, using the best information available. This will based on insight from CQC’s relationships with providers and providers’ own self-assurance and accreditation.
• Using regulatory powers in a smarter, more proportionate way based on technology enabled data analysis, using data science techniques to support robust and proportionate decision-making.
• Increasing focus on people’s experience of care with stronger emphasis on gathering the public’s feedback as part of CQC’s insights into the quality of care, as part of the rating and published information.
• Improving data collections and reducing duplication and workload as part of improving the CQC’s digital interface.

An expanded definition of what CQC consider to be a provider of care and what it means to carry on a regulated activity. This will ensure that all parts of an organisation that are responsible for directing or controlling care are registered and held accountable.

A key tenet of the strategy is embedding a stronger safety and learning culture where “risks aren’t overlooked, ignored, or hidden” – and staff can report concerns openly and honestly, confident that they won’t be blamed. CQC want this approach to be universal with leaders, staff and people using services. Safety it explains must be a top priority for all. It also points to the lack of national agreement on what we mean by safety in different heath and care sectors and services. CQC will work to agree a definition that explains what is meant by safe care and how this could apply in different services.

Key actions:

• Future assessments will focus on checking for open and honest cultures, with learning and improvement at their core.
• Inspections will focus on the type and levels of patient safety expertise in services, including how providers assure themselves that they are improving safety, training and support. CQC also commit to increase their own safety expertise to ensure their approach is in line with the latest safety thinking.
• CQC will look for processes to show that leaders and staff are committed to involving people in their own safety throughout their health and care journey, including checking that people have the information they need to help them be equal partners in their care and playing a part in their own safety.
• With new ways of delivering care, CQC will change how they regulate safety in all services with a focus on the types of care setting where there’s a greater risk of a poor culture going undetected and people are often unable to speak up for themselves. They will review the monitoring of safety from registration through to enforcement.

This theme covers the CQC taking on a “much more active leadership role” in driving improvement by targeting priority areas that need the support most. CQC want to see improvement within individual services and the way they work together as a system to make sure people get the care they need.

It aims to do this by:

• Establishing and facilitating national sector-wide improvement coalitions with a range of partners within both health and care.
• Committing to strengthen their relationships at a local level to promote collaboration on improvement across local systems, including addressing health inequalities.
• Being clearer on standards, setting a higher bar for what is expected of services rated as good.
• Developing a coordinated and effective approach to regulating new innovations an technology, encouraging technology-enabled services.