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Health and social care: How to prepare for the Care Quality Commission’s new regulatory approach

By Jason Burt | June 13, 2023

The CQC is changing its regulatory approach for health and care providers this year. This Q&A examines what’s changing, how you can get ready and what this means for your insurance.
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The Care Quality Commission (CQC) says planned changes this year to its regulatory approach and specifically its new assessment framework are being driven by a range of drivers. These include a desire to make things simpler and focus on what the regulator believes really matters to people, to deliver a regulatory approach that better reflects how care is delivered, and to connect registration activity to quality assessments.

While there is some consistency with the current regulatory framework, the CQC’s new regime represents a significant change to shifting to be much more customer-focused and feedback-led.

In this Q&A, we consider what’s changing and when, what’s consistent between the current regime and the updated approach, and what steps health and social care organisations can consider now to prepare for change. We also look at the implications for your insurance programme.

Q: What’s different in the CQC’s new regulatory approach?

A: The CQC has said it intends to ‘regulate in a smarter way, adapting and responding to risk, uncertainty and demand.’ Specifically, CQC is replacing the existing key lines of enquiry (KLOEs) and prompts with new ‘quality statements’. The regulator says quality statements are “the commitments providers, commissioners and system leaders should live up to.” Expressed as ‘we statements’ written from the providers’ perspective, they show what providers need to do to deliver high-quality, person-centred care.

CQC has also developed six categories for the evidence it collects:

  • people’s experiences
  • feedback from staff and leaders
  • observations of care
  • feedback from partners
  • processes
  • outcomes of care.

More broadly, the CQC says to fulfil the ambitions of its strategy, the assessment framework emphasises the need to create cultures that learn and improve. It also sets expectations for how services and providers need to work together, and within systems, to plan and deliver safe, person-centred care.

Q: What will be the same as the existing CQC regulatory approach?

A: Quality ratings and five key questions will stay central to the regulator’s approach to health and social care providers the service inspects, namely:

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people's needs?
  • Are they well-led?

Q: What are the timings on the introduction on CQC’s new regulatory approach?

A: The CQC says it will continue to implement the new approach in phases, with plans to launch its new online provider portal later this year in stages. In the first stage this will allow providers to submit statutory notifications.

Towards the end of 2023, CQC says it will gradually start to carry out assessments in the new way, using the revised assessment framework, supported by the portal.

The CQC has not shared details on the enforcement regime around the new framework but we expect further details to be announced later this year.

Q: What does the CQC new regulatory approach mean for your insurance programme?

A: Insurers already look at CQC assessments when they are rating your risk as a health and social care provider. Given the limited market for risks in this sector, it makes sense to get ahead of the new requirements to ensure the quality of your CQC assessment under the new regime won’t negatively impact insurer appetite and/or the cost of cover.

Preparing for the CQC’s new approach could positively differentiate your risk ahead of the new regime coming into force.

Q: How can health and social care providers prepare for the CQC’s new regulatory approach?

A: Poor feedback could lead to negative assessments under CQC’s new regulatory approach, which could impact the organisation and the availability and/or cost of insurance. To protect your organisation from facing this scenario, there are a range of actions you can consider now, including:

  1. Updating your risk register to reflect what we already know about CQC’s new framework, specifying how you gather feedback and establishing processes and controls that cascade down to operational level
  2. Understanding how your service users, staff and other third parties feel about you now and identifying areas for improvement – well-designed staff and other surveys can help you identify where you currently stand and unlock critical insights into how people feel about your service and workplace culture. These efforts can help you develop a plan putting you on the path to being positively assessed by CQC by the time the regulator implements the new approach.
  3. Considering workplace stress factors – while staff stress is not an element the CQC specifically focuses on under the new regime, staff that are stressed in the workplace and/or suffering workplace stress due to the pressures of an imminent new inspection regime, are unlikely to provide positive feedback. Taking steps now to understand workplace stress may also ready the business to be positively assessed by CQC under the new regime.

For expert support preparing your health and social care organisation for new regulatory requirements, get in touch.

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Practice Leader
Claims Defensibility & Regulatory Practice

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GB Health and Social Care Leader

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