Part 1 of the consultation deals with the challenges to the regulatory approach raised by new models of care and further integrated services being developed as part of the Five Year Forward View and Sustainability and Transformation plans. 

The delivery of these plans often involves the restructuring of services delivered by new organisational forms.  Such collaborative working between providers creates challenges for CQC as the regulatory system under the Health and Social Care Act is based upon registering, inspecting, and rating a provider for the services under its control; services provided on a collaborative basis present a challenge to this system and, furthermore, the inspection and rating system tends to attribute concerns (in terms of poor inspection findings and ratings) to the providers of the services where those concerns materialise, even though the cause of those concerns may lie in shortcomings in other parts of the local health system. 

It is therefore encouraging the CQC are looking at how they can adapt their regulatory system to most effectively regulate new models of care and complex providers.  To date, the consultation is a very broad one on the principles CQC will apply in developing its approach to regulating the changing landscape of care provision.  The details will be set out in a further consultation in the Spring.

In terms of the principles, these are, broadly, fairly general statements which one would expect of a responsible regulator.  It is worth highlighting, however, that one of the principles makes it clear that CQC "will not penalise providers that have taken over poor services because they want to improve them".

The consultation also makes a few other points to bear in mind in relation to the development of new models of care as follows:

  • Accountability for quality of care: although it may seem obvious, it is essential that, when developing any new models, and collaborative working practices, providers are clear as to which organisation(s) hold accountability for the quality of the care provision; this is essential for identifying which organisation(s) need to be registered in respect of the services. This will be a key consideration for providers to consider when breaking down traditional barriers between entities and working more collaboratively to deliver care through integrated services, whether through contractual or organisational joint ventures.
  • As part of this, CQC state they encourage any provider who is thinking through a change to consult with them at an early stage so the CQC can offer support.
  • Strengthened focus on leadership: CQC make it clear that assessments of a provider's leadership will be of particular significance to assessment of new and complex models of care, given the importance of leadership for the sustainability, quality and safety of services.  As a result of this, more regard will be given to assessment of an organisation's 'guiding mind', and the quality of board-level leadership, both in the initial registration of services, and their inspection once registered.
  • Inspection: CQC also state they are exploring how to schedule inspection activity in a way that recognises providers are working together in less formal partnerships or as entire local health and care economies.  CQC are aiming to offer a coordinated approach to inspections in a local area and "provide a broader assessment of the quality of care in a place".  This might be helpful to providers who are facing increased pressures due to shortcomings in other parts of the 'system'. 

As mentioned, the consultation at this stage, is very much focused on broad principles and further details of how CQC will regulate new models of care will be forthcoming in a further consultation in the Spring.  In the meantime, if you wish to discuss the implications of the regulatory framework on any developing models of care, please contact: Carlton Sadler or Vincent Buscemi


Continue reading the CQC Consultation briefing
Part 1: "Regulating New Models of Care and Complex Providers"
Part 2: The New Assessment Framework
Part 3: "Registering Services for People with Learning Disabilities" 
Part 4: Next Phase of Regulation – NHS trusts

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