Impact of the Care Quality Commission on provider performance

What are the implications of our findings?

Our
qualitative research shows that there are a range of ways that
regulators have an impact on providers beyond directing them to make
specific changes. These happen before, during and after inspection.

This
may be part of the reason why our qualitative findings contrast with
the findings from our quantitative research, which attempted to compare
performance before and after inspection and found limited evidence of
impact.

Inspection and rating have
dominated the CQC’s regulatory model, consumed most of its available
regulatory resources and may have crowded out other potential regulatory
activities that might have more impact.

Furthermore,
the inspection model we studied was focused on individual providers.
However, as health and social care provision becomes more integrated,
this focus will become less tenable and place- or service-based
regulatory approaches that cross organisational and sectoral boundaries
will become increasingly important.

Now
that CQC has completed its first full cycle of inspecting and rating
health and social care providers, it is implementing a new strategy for
regulation that addresses some of the issues raised in our research. We
welcome the greater emphasis that this strategy places on relationship
management and the development of systemwide approaches to monitoring
quality. We also welcome CQC’s efforts to develop a more insightful
system for prioritisation to replace the IM model discussed above.

As
CQC works to implement its revised strategy with stakeholders across
the health and care system, our research emphasises the need to take a
prospective and deliberative approach to designing, piloting and testing
regulatory interventions in order to measure their impact in practice.
In particular, it emphasises the need for:

CQC to:

  • develop
    and use regulatory interactions other than comprehensive inspection
    that draw on its intelligence and insight to support providers, foster
    improvement and prioritise its use of resources
  • develop
    its model in different ways in each sector, depending on factors such
    as the size and number of organisations being regulated, their capacity
    to respond to its recommendations, and the other resources available to
    support improvement
  • invest in
    recruitment and training to create an inspection workforce with the
    credibility and skills necessary to foster improvement through close
    relationships, while maintaining consistency and objectivity
  • not
    underestimate the difficulty in developing a more insightful system of
    prioritisation that draws together both hard and soft intelligence from a
    wide range of sources, takes into consideration providers’ own ability
    to accurately and honestly self-evaluate and engages patients, users,
    providers and commissioners in its development

​​​​​​Providers to:

  • consider
    the range of ways that they can work with CQC staff and processes/tools
    to improve services before, during and after inspection
  • as
    part of this, to recognise that the impact of CQC’s regulatory
    processes is co-produced by CQC, the provider and other stakeholders and
    that they have a responsibility to engage collaboratively in order to
    maximise impact and improvement
  • encourage
    and support their staff to engage in open, improvement-focused
    discussions with CQC inspection teams and other stakeholders

CQC, other regulators and commissioners to:

  • continue
    to develop place- or service-based regulatory approaches that cross
    organisational and sectoral boundaries; to do this, important work which
    is already under way to align the activities of regulators,
    commissioners and other improvement-focused organisations must gain pace
    and depth.

Impact of the Care Quality Commission on provider performance

Published by Residential Forum

The Residential Forum is to promote the achievement of high standards of care and support for children and adults living in residential care and nursing homes, supported housing, residential schools and colleges, hospices and hostels. It contributes to improving the quality of service to the public. Members of the Forum are people of standing and experience drawn from the public, private and voluntary sectors, as well as some who can speak for service users and carers.

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