Regulations Here, the CQC sets out all many


laudable ambitions but gives no detail about how it will achieve change. The CQC does not explain how it will foster a better working relationship with providers based on trust. In addition, the CQC does not


explain how it will manage to reduce the paperwork and reporting that providers, managers and care staff have to carry out. Furthermore, it does not give any detail about how it will ‘use…regulatory powers in a smarter, more proportionate way’ so as to ensure it takes ‘the right action at the right time’. Moreover the consultation fails


to explain how the CQC will use the technology, ‘innovative analysis’ and ‘data science techniques’ to attain more ‘robust and proportionate decision-making’.


More questions than answers Without some detail, these ambitions are little more than words. This is, of course, a broad consultation designed to garner feedback from all parts of society. From the perspective of those who work in the sector, it is the breadth of the consultation that lets it down. Care providers responding to this


consultation, will want to know the following. l How often will inspections be carried out?


l How often and on what basis will ratings be changed?


l What right of reply will care providers have to a proposed change in the CQC’s reporting or rating about a service?


l What methodologies will be in place to assure the quality of judgements made by the CQC inspectors?


l What are the ‘regulatory methods, tools, and techniques’ the CQC is going to use to ‘assess quality continuously, rather than relying only on scheduled all-inclusive on-site inspection visits’?


l If further reliance is going to be placed on digital feedback from the public, what assurances can the CQC give that they will look into the validity of that feedback, for example to


discount vexatious complaints? What information will providers and managers be given about the source of such feedback?


The first consultation provides more ambition than action and raises more questions than answers. Thankfully, some progress is made in the CQC’s second consultation.


Consultation on changes for flexible regulation The second consultation is more focused on how CQC will inspect, assess quality, rate services and decide whether to take enforcement action. This comes in two parts: part 1, where the CQC describes how it will change its inspection, assessment and ratings practices, and part 2, where it describes its proposed changes to consulting with providers about future changes to the way the CQC works. Part 1 explains changes the CQC is


proposing in relation to the regulation of health and social care. There are two elements that will concern care providers. First, the CQC wants to move away from using comprehensive inspections as the main way of assessing quality and awarding ratings. It wants to use other sources of information to provide the basis for assessments and changes to ratings.


When the CQC says it wants to work in a ‘more targeted and proportionate way’, it is not clear what sort of proportionately they are talking about


24


This appears to mean that a rating


could change without the CQC crossing the threshold. The CQC will continue to inspect where it receives information that poses significant risks to people’s safety, it says. The CQC also states it will work in a more targeted and proportionate way. Second, the CQC wants to update ratings and assessments of services more frequently and will not return to the usual inspection frequencies. Changes in ratings and assessments


may instead be based on people’s feedback and experiences of care, a combination of targeted inspections, national and local data and insight from other organisations and partners, and from CQC’s relationships with care services and their own self-assurance and accreditation.


Concerns about the proposals The CQC has said that these proposals will sit alongside further changes in how they assess quality and that further information will be provided later this year. We have some concerns about what CQC is proposing to do. When the CQC says it wants to work in a


‘more targeted and proportionate way’, it is not clear what sort of proportionately they are talking about. The implication seems to be that its judgements will be more proportionate - a good thing for providers - but it is equally possible that it means they will do less work before changing a rating - a good thing for the CQC. Exactly what information is the


CQC proposing to rely on as the basis for changing a rating? Inspections and enforcement action already rely on what


www.thecarehomeenvironment.com • April 2021


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