Update: CQC on its regulatory approach from April 2021

As Covid-19 pressures in the health and care system start to ease, the CQC has announced that it will be expanding its inspection programme from next month.

In March 2020 CQC paused its routine inspections with activity focused on where there was a risk to people’s safety. In January 2021 the CQC continued to only undertake inspection activity where there were serious risks to people’s safety or where it supported the health and care system’s response to the pandemic. This leaner approach enabled health and care organisations to work together, delivering care in new and innovative ways according to a report published on 17 March 2021 by NHS Providers.

In its statement, CQC explain that they will “continue to undertake inspection activity that either responds to Covid-19 or that responds to risk of harm to the public” but from April 2021, CQC will also be undertaking the following additional activity:

Adult social care services

• Undertake infection, prevention and control (IPC) inspections in care homes to ensure people are receiving safe care
• Adapt their care home IPC method to use in community settings such as supported living and extra care
• Rapidly inspect potential designated sites so that people who have COVID-19 can be discharged from hospital in a timely way, freeing up capacity in acute care
• Inspect and re-rate services where appropriate and where it may create additional capacity in the system (including those services that are registered and not yet rated), supporting local authorities to commission care where needed

Hospital services (including independent health and mental health services)

CQC will continue with their current risk-based approach to regulation, undertaking inspection activity where there is a clear risk to safety.

In addition, they will also:

• return to inspect and rate NHS trusts and independent healthcare services that are rated as inadequate or requires improvement, or where new risks have come to light, and develop plans to review ratings for all hospital providers to make sure they are still appropriate based upon our latest assessment of risk;
• carry out some core service with well-led inspections of mental health trusts and independent mental health providers;
• prioritise high risk independent healthcare services for inspection, for example, cosmetic surgery services, independent ambulance services, and those where closed cultures may exist;
• closely monitor how hospitals are ensuring robust infection prevention and control and carry out focused IPC inspections where we have concerns about a provider’s oversight of infection risk;
• conduct Mental Health Act (MHA) monitoring visits to ensure the rights of vulnerable people are protected;
• carry out focused inspection activity in emergency departments where our data monitoring and local intelligence indicates that increased pressure is having a direct impact on the quality and safety of care; and
• roll out a programme of focused inspections of safety in NHS maternity services where data and local intelligence identifies concerns about the quality of care; these inspections will look closely at issues such as team working and culture, and experiences of staff and patients.

Primary medical services

Additional CQC activity will include:

• working jointly with Ofsted to deliver multi-agency inspections of children’s services and review approaches;
• working jointly with HM Inspectorate of Prisons (HMIP) and other inspectorates to inspect health and social care in secure settings;
• resuming inspections of independent primary care providers, focusing on high/medium risk providers that have never been inspected or that were inspected but not rated;
• resuming inspections of GP, out-of-hours and NHS 111 services where we have identified breaches of regulations, including those rated as inadequate, requires improvement and good, along with services rated as requires improvement where there are no breaches of regulations. These will be focused inspections looking at three key questions (safe, effective and well-led), as well as any other key questions rated as requires improvement/inadequate, and any other areas identified as a concern from previous inspection;
• inspecting services that are newly-registered and have not been inspected during the 12 months since registration, or during the three months since registration for online services;
• commencing a programme of focused inspections for oral health providers exploring an increased use of technology; and
• continuing to develop the transitional monitoring approach.

All services

Across all services, the regulator will continue to monitor and assess where there is a risk of a closed culture developing, which includes monitoring and acting on information of concern about blanket bans on visiting. They will also review their approach to inspections of services for people with a learning disability and autistic people.

Registration applications

Here the focus will be on prioritising registration applications that are critical to the Covid-19 response and on improving their registration service.

Comment

We expect that CQC’s latest announcement will be met cautiously by the sector.

CQC is currently developing its new strategy following its recent consultation which is expected to launch from spring 2021 with many welcoming its intention to take a system wide approach to regulation, in order to support collaboration. However NHS Providers echo concerns that changes to regulating systems should not be made “too hastily” before the full impact of the legislative proposals made in the health and care White Paper to put ICSs on a statutory footing are seen.