The CQC answers care providers’ assessment concerns as uncovered by QCS survey

Dementia Care

QCS survey uncovers care providers’ concerns regarding the new CQC assessment framework and invites the CQC to respond.

The Care Quality Commission (CQC) is to change the way it assesses care services in early 2023. The new way of working will alter the relationship between the CQC and providers, as the regulator moves from an inspection-based framework to continual assessment.

A comprehensive survey by Quality Compliance Systems (QCS) asked what care providers understand about the new CQC regulatory framework, their major concerns, and how QCS might help. Considering the results, QCS invited the CQC to respond to care providers’ feedback.

Awareness and preparation

While 83 percent of respondents said they were aware of the new CQC assessment framework, just under half felt they understood it well. Over half (63 percent) of respondents said their organisation had not yet started preparing for the new framework. But 58 percent of providers felt they can learn all about the new framework before its 2023 launch, with 66 percent looking for updates more than once a week, and 26 percent looking every day. 

A key element of preparing for the new framework is knowing when the changes will come into force, and how much notice providers will be given. The CQC told QCS that it still reviewing its timeline and will share a revised schedule soon.

“The dates we expect to rollout our new approach to regulation are changing,” the CQC spokesperson says. “It’s important to make sure we are doing the right things at the right times, and that we adapt our new approach.”

Regarding advanced warning, the CQC is aware that providers need enough time to prepare for the new regulatory approach, and so their “ambition is to give providers 2-3 months’ notice (including sharing full provider guidance) ahead of any change”.

They went on to say that there will be a phased roll-out, as opposed to a ‘big bang’. “We are developing our implementation approach in partnership with providers … of all types who help us test our thinking and judge the lead in times for implementing different elements.

“In advance of sharing full provider guidance we will continue to share information on the new regulatory approach so providers always have as much information as we can provide.”

New remote assessments

61 percent of all survey respondents are highly confident the CQC will be more proactive, seeking the views of the local authority and other stakeholders in their service.  However, written feedback from respondents suggests that some providers are apprehensive that the new remote assessments, with CQC inspectors visiting less, might lead to a drop in the quality of care.  

When QCS asked the CQC if they thought fewer site visits could increase the risk of poor care in settings not being identified, the spokesperson said the new approach will “allow us to assess services more frequently and use a variety of methods to collect evidence.

“Our inspections might look and feel slightly different as a result, moving away from large comprehensive inspections – but this means that we’ll be able to make shorter, more frequent visits to services.”

The spokesperson added that “people’s needs and experiences of care are at the heart of everything we do. Our priority is ensuring that everyone gets safe care. A focus of our new approach will be on what’s important to people and communities when they access, use and move between services.

“As part of this, we will work hard on building trust with people using services and their families, and use what people tell us about their care to help decide whether to look more closely at a service or take action.

Key elements of its new approach are:

  • “We will make much more use of information, including people’s experiences of care services. We’ll gather evidence to support our judgements in a variety of ways and at different times – not just through on-site inspections. This means on-site inspections will support this activity, rather than inspection being our primary way to collect evidence.
  • We will no longer use a service’s rating as the main driver in deciding when we next need to assess. Evidence we collect or information we receive at any time can lead to an assessment.
  • We will make judgements about quality more regularly, instead of only after an inspection as we do today. We’ll use evidence from a variety of sources and look at any number of quality statements to do this. Our assessments will be more structured and transparent, using evidence categories as part of the assessment framework and giving a score for what we find. The way we make our decisions about ratings will be clearer and easier to understand.”

Concluding about the three key differences in its new approach, the QCS spokesperson says it will mean that “we can be more targeted in the time we spend on site, taking longer to talk to people using services and making every minute count.”

Reliance on technology

When it comes to sharing evidence electronically, close to 60 percent of respondents are confident about their ability to do so, although many are concerned about the possibility of more ‘paperwork’.

QCS asked the CQC spokesperson what advice they would give a provider not currently using any digital care solutions and whether the emphasis on the remote, digital collection of data and evidence will put them at a disadvantage.

The spokesperson says that the CQC is committed to supporting the digitisation of adult social care, including working to support providers who face barriers to adopting digital care records.

They went on to say that “we believe that good digital record systems can exceed the capabilities and benefits of paper-based records by:

  • Helping providers minimise the risks to peoples’ safety.
  • Supporting their staff to respond more quickly to people’s needs, sharing information quickly and safely.
  • Enabling the ability to share and compare the data.”

Although the CQC will not be validating systems, the focus is on how digital care systems are safe and can enhance good outcomes for people and how this is assessed and recognized.

“We recognise that over time what we mean by ‘good’ develops and shifts’, says the spokesperson. “Approaches move over time from being new and innovative, through being more widely adopted to being standard.

“As part of our strategic theme ‘Smarter Regulation’, our new approach means an expansion of how we interact digitally with providers. Parts of our assessment activity will be carried out remotely, including when we request access to records. We will also increasingly enable providers to access our processes and provide information digitally.

“The assessment framework was built to be iterative. As digital system adoption and use becomes more common it will be of greater prominence in the assessment framework. This is about evolution of the assessment framework to reflect best and good practice.”

The CQC says it will share a full description of how they will use evidence collected through different methods in its new assessments when they publish full provider guidance.

“Our new assessment approach will make much more use of information, including people’s experiences of care. We’ll gather evidence to support our judgements in a variety of ways and at different times – not just through on-site inspections. This means on-site inspections will support this activity, rather than inspection being our primary way to collect evidence.

“This flexibility in evidence collection method means that in some cases, evidence collected outside of an inspection could change an overall rating. However, in many circumstances this information will be combined with either our own observations of care and the care environment or the direct experiences of people using the service.

In addition, the CQC spokesperson says it is “important to note that in some service types we don’t currently observe care or support, for example in home care services.

“Our site visits are instead to the office and our pilot run in 2019 in these services found that we were able to do much of this activity without crossing the threshold and still award Good and Outstanding ratings.”

In relation to the new Quality Statements, QCS asked the CQC spokesperson when the full rating characteristics will be published.

These plans are still in development, the spokesperson says, and the regulator will develop them “through engagement and in partnership with providers, ensuring we understand what providers need.

“The intention is to map each quality statement to national good practice guidance developed by organisations such as NICE and Skills for Care. Providers will be able to use this information to inform their service provision and help with improvement.”

A major concern for providers is what can they do now to start preparing for the changes. The CQC recommends that providers keep an eye on their website and other channels for further news and announcements. They also suggest speaking to local contacts, signing up for the CQC newsletter and engaging with CQC staff.

“We want to work with providers to inform this process and answer any questions they may have,” the CQC spokesperson says. “We’ll do this through forums such as our implementation steering group to advise us on what providers will need to know, when and how as well as, but also through online channels such as our CitizenLab platform.”

QCS will also continue to share with its subscribers more details about how the new CQC framework will work in practice, while providing the latest updates as they are announced.

About the QCS survey

Of the 1,268 survey respondents, 43 percent were from residential care, 38 per cent from domiciliary care, and the remainder from supported living. The respondents were invited to answer a series of questions as well as provide written feedback.

You can download our survey results here

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