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How well-led is your organisation?
The CQC believes the quality of leadership is one of the most important determinants of the quality and safety of services, so one of the five questions CQC now asks of all providers is ‘how well-led is this organisation?’. By ‘well-led’ the CQC means that the leadership, management and governance of the organisation assures the delivery of high-quality care for patients, supports learning and innovation and promotes an open and fair culture.
Monitor and the NHS Trust Development Authority (NHS TDA) have come together with the CQC to develop a framework for making judgements about how well-led NHS providers are. The framework is aimed at helping organisations to improve. It will show expectations and enable organisations benchmark themselves against a common expectation of what 'good' looks like.
The three regulators will work together to test the approach and the intention is to put these plans into action by October 2014.
Why put these plans into action?
Robert Francis’ second report into the failings at Mid Staffordshire NHS Foundation Trust concluded that: “The extent of the failure of the system shown in this report suggests that a fundamental culture change is needed”. The primary focus of his recommendations was therefore on fostering a common culture across the NHS that puts patients first. The report also called for action on many related issues, including compassionate care, leadership, standards, governance and information, and openness, transparency and candour.
The report led to major changes in the CQC’s regulatory regime, and also to Monitor’s and the NHS TDA’s routine oversight of providers and assessment of aspirant foundation trusts. It has also resulted in closer working relationships between the three bodies responsible for regulation and oversight, particularly around the sharing of information and intelligence.
What is the value of an aligned framework?
While there are existing tools to enable the development and assessment of leadership and governance, as the Francis report makes clear, there has previously been an insufficient focus on culture across the NHS. Culture is not something that is easy to measure, but it can, and should be, assessed. One of the driving aims of the work that CQC, Monitor and NHS TDA have been undertaking is to ensure both providers and regulatory bodies have a means of understanding culture more systematically.
Having an aligned framework for the assessment of leadership, management and governance is intended to create coherence and consistency across the activities of regulatory bodies and there will be a focus on information and data sharing between them.
CQC’s well-led framework 5 key lines of enquiry
- Is there a clear vision and a credible strategy to deliver high quality care to patients and are the risks to achieving this understood?
- Do the governance arrangements ensure that responsibilities are clear, quality and performance are regularly considered and problems are detected, understood and addressed?
- How do the leadership and culture within the organisation reflect its vision and values, encourage openness and transparency and promote delivery of high quality care across teams and pathways?
- How does the organisation ensure that patients’ views and experiences are the key driver for how services are provided, and that staff are involved and engaged?
- How does the organisation strive to continuously learn and improve, support safe innovation, and ensure the future sustainability of high quality care?
How are providers supported to develop effective leadership?
Following the Francis report, a range of programmes is underway to support providers in developing healthy cultures, improvement and learning strategies, and effective leadership and governance. The NHS Leadership Academy and NHS Employers Offer particular examples, and there are also many commercial and independent organisations with expertise in this area, including a range of independent organisations available to undertake external governance reviews.
CQC, NHS TDA and Monitor want to be open with these organisations, on an equal basis, as this proposal for alignment is developed and implemented. This proposal for alignment is based on supporting improvement in providers, and thereby benefiting patients. It is recognised that consideration needs to be given to the role of organisations that can help build capability in support of this aim.
CQC is currently consulting on provider handbooks which set out its assessment framework, including key lines of enquiry and ratings descriptors for well-led. The intention is that with consultation, engagement and further piloting, CQC’s assessment framework should be issued formally ready for October 2014. From October 2014, CQC’s ratings will be used rather than the ‘shadow’ ratings of the current development phase.
Between now and October 2014, CQC, Monitor and NHS TDA will develop and test proposals to take forward more detailed alignment of frameworks; to explore metrics and financial governance; and to ensure clear and effective arrangements for special measures. These will be tested primarily through CQC’s inspection schedule and the assessment and authorisation process for foundation trust aspirants, and further development and refinement will continue after October 2014. There will be engagement and openness with providers and other stakeholders, taking account of how providers and other stakeholders indicate that they would like to be involved.
The provider handbook for general practice, which is currently under consultation, is designed to help providers understand how CQC will regulate and inspect GP practices and GP out-of-hours services, from registration and monitoring through to inspection and ratings. The draft GP practice and GP out-of-hours inspection handbook consultation runs until 4th June 2014 so providers need to get their views submitted to CQC by next week.
CQC – Working together to assess leadership
Overview to the provider handbook for general practice (for consultation)
Alison Lowerson – QCS Expert GP Practice Manager Contributor