What are the implications of our findings?
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.
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
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.
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.
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.
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:
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
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
- 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
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
the range of ways that they can work with CQC staff and processes/tools
to improve services before, during and after inspection
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
and support their staff to engage in open, improvement-focused
discussions with CQC inspection teams and other stakeholders
CQC, other regulators and commissioners to:
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