Care Quality Commission: Memorandum of Understanding Agreements (MoU's) with Health Insurers

The CQC has entered into MoU's with Aviva, AXA, BUPA and Vitality, representing a public commitment from these health insurers to share information with CQC about the quality and safety of independent healthcare services.

The MoU's do not override statutory responsibilities, are not enforceable in law and recognise the independence of the signatories to the MoU's. The MoU's recognise that the development of models of healthcare service delivery requires closer co-operation between the CQC and the insurers. 

The insurers agree, to the extent permitted by law, to be open and transparent when in receipt of information regarding the safety and quality of services regulated by the CQC. In particular, the MoU's recognise that in order to be safe, people are entitled to be protected from a wide range of abuse. It is recognised that abuse can be physical, sexual, mental, psychological, financial or arising from neglect, and can be institutional or discriminatory in nature. 

Insurers' visits to CQC regulated services and claims handling, mean they are well placed to pick up on emerging issues of concern across the CQC regulated healthcare services. Clearly the CQC will want to take advantage of insurer information about good practice and improvements in care, as well as highlighted issues of concern.

The fear of punitive action from the ICO could give rise to a conservative or defensive approach towards information sharing. The ICO has the power under the Data Protection Act 2018 to impose a civil monetary penalty on a data controller of up to £17,000,000 or 4% of global turnover.

The MoU's should however assist the sharing of sensitive information in accordance with the Data Sharing Code of Practice, issue by the Information Commissioner's Office (ICO). The MoU's appear to be consistent with the ICO's stated aims of upholding information rights in the public interest, promoting openness by public bodies and data privacy for individuals.

Forming an effective communication loop is advantageous to the CQC, the health insurers and the service provider policyholders, in that:

• the CQC can regulate services more effectively, thereby reducing the risk of harm to patients, residents, staff and visitors to CQC registered services;
• there are potential benefits to insurers from better regulation, which should lead to fewer claims and lower claims reserves. Insurers should enjoy a better working relationship with the CQC. A commitment to openness and transparency can also generate trust from the wider public;
• healthcare service providers potentially benefit from a reduced risk of regulatory action from CQC and less chance of reputational damage. They may also benefit from more favourable policy terms and conditions from insurers, as well as lower premiums, due to an improved risk profile.

Given the clear potential benefits of the MoU's to the signatory insurers, it will be interesting to see if other insurers soon follow suit.

If you would like to discuss this article, please contact Adrian Neale