More inspections for poor performers
The CQC is consulting on changes to its inspection model. The proposals would mean better use of data, more inspections for the worse performing services and greater patient involvement in inspections.
This is part of its ambition to become ‘a more efficient and effective regulator’, one that will remain ‘relevant and sustainable for the future’.
The consultation takes place against a background of budget reduction over the next three years. The new strategy will operate from May this year.
Much has changed in the field of regulation and inspection over recent years. Having been involved on both sides – inspected and inspector – I am interested to see the next stage being developed. Since 2013 the CQC has inspected a range of services to establish they are safe, effective, caring, responsive and well-led. The new proposals retain the key lines of enquiry, but also involve improvements to the CQC’s operating model and focus on six themes (see
Improve the use of data and information
Implement a single view of quality
Target and tailor the inspection activity
Develop a more flexible registration process
Assess how well hospitals use resources
Develop methods to assess quality for populations and across local areas
One facet of this is ensuring quality in the face of financial constraints. This is often uncomfortable, but resources such as staff, equipment and facilities are finite so the fact the CQC may consider how effectively they are used to provide care is relevant.
Analysis of data is already part of the inspection process and given that a great deal is available on healthcare performance the challenge is to use it well. These data cover a range of outcomes including mortality statistics, pressure ulcers, infection, falls and results from national audits such as the sentinel stroke audit. These should be used by nurses and others to identify areas for improvement in their own service.
The CQC is suggesting that improved use of data will help them direct their attention to services where previous ratings or current evidence indicates an organisation is performing less well, and therefore encourage improvement, ie risk-based.
Implementation of this data proposal would mean that some nurses experience inspection of their service more frequently than others. It also suggests that improvements could be made and nurses have a role in effecting this.
A strength of CQC inspections is that feedback from patients is important and open meetings are held for the public to give their perspective. Patients – experts by experience – are already members of inspection teams where they talk to patients, relatives and carers. If the proposals are implemented there will be even more members of the public involved.
The idea of a ‘single view of quality’ is interesting, although it is probably the proposal that will resonate least with individual clinical nurses. However at organisational level, including nurse managers, information and reports are provided to many authorities.
The idea that oversight bodies such as NHS Improvement and professional bodies might collaborate and use a shared framework for measuring quality is excellent. Arguably, successful implementation could lead to greater understanding of the quality of services, remove duplication, reduce bureaucracy and speed up improvements in patient care.
Patients also receive care in many parts of the health and social care systems and a single patient may experience care across a pathway involving several different organisations. The inspection process should adapt to this to ensure high quality care, for example by examining handovers between different services. This is being addressed in the CQC proposals.
Inspection teams are made up of the CQC staff together with experts and specialists in many disciplines and different professions. Nurses are involved from student to director level. Each brings their particular skills, knowledge and attributes to the assessment process.
Teams visit all the places where care is given – whether in the NHS, independent or voluntary sector. This includes general practices, care homes, hospices, ambulance providers, dental services and hospitals where they look at wards, departments, clinics and go into the community.
During an inspection the team observes care, listens to patients’ and relatives’ perspectives, reviews evidence, equipment and the environment. Members of the team engage with the staff – and this is the point where most nurses encounter the CQC.
It is important that rather than waiting for an inspection to highlight potential changes and areas of concern, that everyone working in the service should take responsibility for knowing about the care in their service. Many sources of information can be used. Nurses should listen to patients, families and carers, recognise poor care, remedy immediate problems and make longer-term improvements.
Information, for example infection rates, complaints, and incidents should be available. Scrutiny of equipment, the completeness of mandatory training and revalidation of nurses, audit of care and documentation, and many other sources of information can alert staff to a problem.
Reference to the ‘key lines of enquiry’, which are available on the CQC’s website, may help nurses with this, as will reading the inspection reports about their own organisation as well as others.
Good practice can be recognised and, where deficiencies or harms are identified, changes can be made. Nurses can then talk to colleagues from the CQC with pride and confidence in the work they are doing. They should not rely on inspection to identify problems and act as the spur to improvement.
In making these proposals the CQC wants to build on the positive aspects of the way they work, improve where needed and develop to ensure their operating model is suitable for the future. Every nurse now has the opportunity to review them and submit a response.