Following a consultation earlier this year, the CQC updated its guidance for independent healthcare providers in England and the resulting changes started to come into effect on 2nd July.
The guidance sets out how the CQC will begin rating independent healthcare services that were previously unrated, such as independent ambulance services, independent substance misuse services and cosmetic surgery services.
Following inspection, ratings will be awarded for whether these services are safe, effective, responsive, caring and well-led at overall service and location level, using the same ratings principles used for all other services.
The guidance also confirmed that as part of the changes the CQC will:
- Introduce ‘CQC Insight’– a data monitoring tool currently in use for NHS hospital trusts and primary care providers – for independent healthcare services, starting with mental health and acute services.
- Adopt a more intelligence-driven model of regulation informed by ongoing monitoring of the quality and safety of care.
- Increase the number of unannounced inspections, moving towards maximum re-inspection intervals based on service ratings.
- Develop a digital routine provider information request (requesting information between inspections) to further improve their ability to monitor services.
- Develop proposals for registering parent companies/groups.
- Assess and rate ‘outpatients’ and ‘diagnostic imaging’ services separately to better reflect the way these services are organised and managed at many independent hospitals.
What This Means in Practice
The CQC is prioritising routine inspections as follows:
- Services not previously inspected but which the CQC now have the powers to rate
- Services that the CQC has inspected but not yet rated
- Services that pose a higher risk
- Newly-registered providers
The CQC will not normally announce the day it intends to inspect services, although, in the case of routine inspections, it is usually within three months of information relating to the inspection being submitted to the CQC.
The inspection will be carried out for a minimum of one day, although this may be longer depending on the type and size of service being inspected. Inspections that last longer than one day may not necessarily take place on consecutive days.
All inspections will follow the new health assessment framework, with a significant focus on ‘well-led’.
They aim to complete the first round of inspections, awarding all services a rating, by 2021.
Once inspected services should expect their next inspection, provided no causes for concern are raised, within the following timescales:
- Services rated as outstanding – within five years
- Services rated as good – within three and a half years
- Services rated as requires improvement – within two years
- Services rated as inadequate – within one year
Where concerns have been raised either by an inspector or those monitoring services for the CQC, additional, focused inspections will be carried out. These focused inspections may look at one aspect of care or a reduced number key questions. After a focused inspection, the overall rating for a location can change – up or down, helping providers who have made significant improvements in their service communicate this to patients, their families and carers. Focused inspections will normally be unannounced and do not include a provider information request.
Services which have not been subject to the ratings regime until now will be rated for the first time after their next comprehensive inspection. They will be rated against each of the CQC’s standard 5 questions, with an aggregated, overall rating, also being awarded.
Monitoring of Services
- Each service provider will be awarded a Relationship Owner who will develop close links with service. They will meet service providers at least once a year, although this may not be face to face.
- The CQC Insight tool, used to plan inspection timetables, taking into account all the information held on a service, is being rolled out across the healthcare system starting in September. The first wave of the roll out includes independent acute and mental health hospitals.
- Over the summer the CQC consulted on plans to make corporate/group providers more accountable for the quality and safety of services delivered. Proposals included revising registration criteria to cover organisations that can exercise ‘direction and control’ over the quality and safety of services, as well as those directly involved in the delivery of care. Whilst we are sometime away from new guidance being issued and changes being made to the registration system, a report summarising the findings of the consultation is due for publication in the autumn.
- Work is being done with NHS Trusts looking at making changes to the format of inspection reports, with additional information being provided in appendices. If pilots are successful these changes will be rolled out across all inspection reports.
- The CQC is developing plans for information returns to be made between inspections. Proposals for this requirement have not yet been published and so a date for implementation is some time off.
What Independent Healthcare Service Providers Should be Doing Now
- Ensure that policies, procedures and quality assurance systems are upto date, taking account of the new requirements and the CQC’s focus on ‘well-led’.
- Ensure that staff across the organisation understand their duties and responsibilities and that they have had all appropriate training.
- Ensure that staff understand the inspection process, and their role is assisting inspectors should they arrive whilst they are at work.
How We Can Help…
Words Worth Reading Ltd offers a comprehensive range of documentation and consultancy services to the healthcare industry. These include Care Quality Commission (CQC) Registration and compliance, Information Governance and even mandatory nurse training. We are familiar with the detailed requirements of healthcare monitoring authorities in all four of the countries of the United Kingdom. Find out more about how we can help you by: