CQC – New Fundamental Standards: Part 1, an Introduction
In recent years adult care scandals appear to have been never-ending. The Mid Staffordshire NHS Foundation Trust problems, reported to have caused 1,200 unnecessary deaths, leading to the Francis Report on NHS patient safety and quality, are the most infamous. However, the independent sector has not been immune. In addition to the drip, drip, drip of information from the CQC regarding individual service failings, the Winterbourne View failures and subsequent scandal highlighted that no-one was immune from investigation and the potential to be found wanting.
The CQC acknowledged that the existing framework for inspection and judgement left Providers confused. The current CQC requirements are listed in a way that does not clearly differentiate between those requirements which are essential and those which are desirable. This lack of clarity has led to confusing inspections and judgements, unnecessary conflict between Providers and the CQC, and the enforcement of good standards of care to be impaired.
The Consultation sets out to focus the CQC on its core purpose: “We make sure health and social care services provide people with safe, effective, compassionate, high quality care and we encourage care services to improve.” (Provider Handbook (Adult Social Care) Consultation, Page 2)
In order to achieve this purpose, they say that their role is now to “..monitor, inspect and regulate services to make sure they meet fundamental standards and safety and we publish what we find, including performance ratings to help people choose care”. (Provider Handbook (Adult Social Care) Consultation, Page 2)
The reaction from Government has been predictable. Something had to be done to reassure the public. The CQC has been shaken around, a new care Act passed, new Parliamentary Regulations proposed, new standards of registration and inspection developed, together with the return of the much derided but much loved quality rating scheme.
At the time of writing, late July 2014, the state of play is that in January 2014 the Department of Health published ‘Introducing Fundamental Standards - Consultation on proposals to change CQC registration regulations’, a document setting out the reasons for reforms, the broad outlines of the proposed reforms to CQC registration and inspection processes. The document also included, as Appendix A, the proposed new regulations for adult social care in the form of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Regulation was stated as coming into force in October 2014. However, the CQC website currently indicates that the implementation date is April 2015, subject to Parliamentary process.
The CQC have published, over an extended period, documents describing their detailed proposals for delivery of the new registration and inspection system based on the Fundamental Standards. The proposals were published as consultations, and the deadline for responses is currently listed on the CQC web site as October 17th 2014.
To confuse matters, a recent statement by a CQC Inspection Team Manager was to the effect that they were expecting to begin implementation in October 2014, had been informed that the Regulations would not be through Parliament by then, but were “going to start implementation anyway”. Given that public statements by CQC staff are scripted and officially sanctioned, the clear implication is that Providers would be best advised to begin implementation of any changes required to meet the Fundamental Standards from, or very soon after, October 2014.
The new regulatory processes
The CQC has published a schematic of their regulatory process under the new arrangements.
(Provider Handbook (Adult Social Care) Consultation, Page 6)
The schematic demonstrates that the CQC regard their overall registration process as having five steps, these being:
- Intelligent monitoring
- Expert inspections
- Judgement and publication
- Followed by action, if indicated by the inspection outcome
The scope of each of these processes is based on the new definitions of quality, these being:
(Provider Handbook (Adult Social Care) Consultation, Page 7)
Flowing out of the eleven Fundamental Standards in the Regulations, the CQC have developed five Key Questions to be asked of the Service, each of which is expanded by the Key Lines of Enquiry, or KLOEs, which will, for as long as they last, be referred to by the female name (K)Cloe(s). The KLOEs will structure the inspection process, and each KLOE is expanded by a series of prompts, or more detailed requirements.
Thus far, the Fundamental Standards look like the usual rearranging of the same requirements into a different structure. However, beneath the bland exterior lie some changes of focus and emphasis which will have significant consequences on how adult social care providers register and manage their organisations and people in future.
Quality Compliance Systems Ltd (QCS) provides legal and quality compliance management systems for adult social care providers in England, Scotland and Wales. Although the changes being outlined only affect England in legal terms, the changes in emphasis brought about by their implementation will ripple out into Scotland and Wales.
QCS is preparing its management systems for the expected implementation of the Fundamental Standards approach in October. In a series of articles each aspect of the new regime will be discussed and the revised QCS approach outlined.
Michael Dempsey - QCS Compliance Director