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Plans to change the way health and social care is regulated have been published by the Care Quality Commission (CQC).

CQC is inviting people to give their views on its plan to ensure health and social care providers give people safe, effective, compassionate and high quality care.

These plans follow from the recommendations made in the Government’s response to Robert Francis’ report into failings at Mid Staffordshire NHS Foundation Trust Patients First and Foremost, alongside comments from service users, the public and other reviews.

This consultation focuses on hospital care with a further consultation on adult social care and general practice going out later this year.  

The principles that will guide CQC’s work are set out in five questions that will be

asked when inspecting services; are they safe, are they effective, are they caring, are they well-led and are they responsive to people’s needs?

These questions will help judge the quality and safety of services.

Proposals in the consultation include:

• expert inspection teams led by the chief inspector Sir Mike Richards
• a single rating for each hospital
• a programme for failing hospitals
• action where providers fail to meet fundamental standards of care
• a clearer, more effective test to hold named directors to account for their legal commitments to deliver safe, effective, compassionate, high-quality care.

This consultation follows the publication of CQC’s strategy Raising standards, putting people first in April and is open for eight weeks.

The consultation will enable CQC to finalise methods for longer, more thorough inspections of NHS and independent acute hospitals, which will start in October this year. The approach will be extended to mental health and learning disability services after it is established in acute care.

The changes CQC is proposing will make sure it is a strong, independent inspectorate that recognises responsibility for delivering quality care lies with care professionals, clinical staff, providers and those who arrange and fund local services.

Generalist inspectors will no longer exist as CQC moves towards specialist inspection teams, led by a chief inspector of hospitals, social care or general practice.

CQC chief executive, David Behan, said: ‘This consultation is a critical step towards making root and branch changes to regulation.

‘These proposals put CQC firmly on the side of people who use services. We have listened to what people have said is important to them about services and used this to form these proposals, but there is a huge amount of detail to decide on before we can move to the next step.

‘We are determined to make the right changes to help us make sure health and social care services provide people with safe, effective, compassionate and high quality care.’

CQC Chair, David Prior, said: ‘These changes mark a break from the past for the CQC. We have not been looking at the right things when we have inspected hospitals and we have not had the right level of clinical expertise to get under the skin of organisations.

‘These proposals firmly put patients at the heart of what we do. It should mean that when someone goes into hospital they have confidence that the hospital is getting the basic aspects of care right – the kind of care we all have a right to expect. These standards were not met at Stafford hospital.

‘Our inspectors will focus on things that are meaningful to people, not on bureaucratic processes. They will not tick boxes but miss the point.’

Professor Terence Stephenson, Chairman of Academy of Medical Royal Colleges said:

‘Following the Francis Report it is essential that the way standards of care are set, rated and monitored is made both more transparent and more robust.

‘For these processes really to deliver results for patients, clinicians need to have confidence in and a sense of ownership of the arrangements.

‘It is good to see that CQC wants to engage clinicians with this consultation. I am sure that the Academy, Medical Royal Colleges and other professional clinical organisations will want to participate in this process. We are committed to work with CQC to develop and deliver a system that will help ensure the highest possible standards of care for patients.’

Details of the consultation proposals

NHS and independent acute hospital inspections

The frequency and length of inspection will depend on the risk the service presents.  Most inspections will be longer and more thorough than the existing approach. CQC will focus less on the numbers of inspections it carries out and more on the number of days spent inspecting. Inspections could last 20 days or longer and most will remain unannounced.  

CQC proposes to review an ‘outstanding’ hospital’s rating every three to five-years, ‘good’ hospitals every two-to-three years and hospitals ‘that require improvement’ at least once-a-year. Those rated ‘inadequate’ would be inspected as often as required.

One of the future themes of inspection will include peer review. CQC is in dialogue with the royal colleges about recognising and using their findings. However, CQC will also continue to inspect with its own inspection teams, which include specialists and people who use services, ‘experts by experience’. Inspectors will prioritise speaking to people who use services and front-line staff, as well as senior managers and board members.

Information from people who use services, including whistle-blowers, will become one of the most important sources of information when deciding where to inspect. CQC’s surveillance will use fewer indicators to assess risk and these will be split into three sets. The first set will be the centre-piece of its new model and will include mortality rates, never events and results from staff and patient surveys, as well as information from the public. This set of indicators trigger action by inspectors. The second set of indicators contains a wider range of data that supports and provides explanations for information in the first set. This includes nationally comparable information such as results from clinical audits and information from accreditation schemes.

CQC looked at the most significant quality and safety issues for NHS hospitals and the data that exists to measure them, to design these indicators. It is looking for views on how these could be developed further. 

Action

The proposals will strengthen CQC’s powers to address quality failures.  Under the new plans it will be easier for CQC to prosecute providers who breach fundamental standards, without the need for a formal warning. 

Where CQC finds that the quality of care at NHS hospitals requires significant improvement it will set a timescale for recovery and refer trusts to Monitor or the Trust Development Authority (TDA) to take enforcement action as appropriate. Ultimately, this could include the appointment of an administrator who would replace the board of directors and consider the options for reconfiguration.

Standards

We will simplify our standards to reflect the five questions we will ask about the quality and safety of services.

The consultation proposes standards that identify three levels of quality; ‘fundamental’, ‘expected’ and ‘high’.

The fundamentals of care focus on basics, no provider can ever fall below these without facing serious consequences. Expected standards will be set to prevent mediocre care and are set at a higher bar than ‘fundamental’ standards.

Providers will be legally required to meet these standards to remain registered. Organisations such as NICE and NHS England will lead on developing the definition of high quality care to support inspectors in identifying providers which perform at this level.

Ratings

Ratings will be dynamic and published as a result of inspections. CQC will also publish the information the rating is based on. Ratings will exist on a one to four point scale: inadequate, requires improvement, good and outstanding.

An NHS acute hospital trust will receive an overall rating, plus service level ratings, it is proposed. Each of a trust’s hospitals will also have an overall rating.

These ratings will seek to be the definitive statement of quality of care that is useful for people who use services. To achieve this CQC proposes that the rating comprises of the inspection judgement, indicators and the findings of other organisations, such as the royal colleges. 

For media enquiries call the CQC press office on 0207 448 9401 during office hours or out of hours on 07917 232 143. For general enquiries call 03000 616161.

Notes to editors

About the Care Quality Commission

The Care Quality Commission (CQC) is the independent regulator of health and social care in England.

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

We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find to help people choose care.