Professor Sir Mike Richards: reflecting on the impact of quality regulation

Professor Sir Mike Richards profile picture

23 June 2017

Professor Sir Mike Richards
Chief inspector of hospitals
Care Quality Commission


As an organisation we are committed to listening to the views of the providers that we regulate. As well as listening to the feedback our inspectors receive from individual provider organisations, we also seek to understand what providers think about how CQC regulates them via our external co production groups, views gathered before, during and post inspection and via our own annual survey of all registered hospital providers. NHS Providers’ annual survey on regulation is another useful measure and I noted the results from this year’s survey with interest.

 

Progress made 

I was pleased to see an increase in respondents who said they thought that that CQC and NHS Improvement have become more closely aligned in the past 18 months. It is good to know that the progress we have made in ensuring a more coordinated approach with other regulators has been recognised by a number of NHS trusts.

Working more closely with partners to agree a shared view of quality and avoid duplication is a priority for us, as set out in our five year strategy published last year and reflected in the changes we are making to the way we monitor, inspect and rate NHS trusts as part of the next phase of regulation.

Working more closely with partners to agree a shared view of quality and avoid duplication is a priority for us

Professor Sir Mike Richards    chief inspector of hospitals

The changes to our approach for NHS trusts are being introduced following an eight week consultation and mark a move away from large comprehensive inspections towards more targeted, intelligence driven assessments, focused on individual core services and trust leadership. Earlier this week we published a number of documents, including our new assessment frameworks for health and adult social care, and guidance for trusts on our new inspection approach for hospitals.

 

Next phase of regulation 

Key changes include the introduction of a new regular provider information return (PIR) which is focussed on requesting data that is not available from other sources. This will reduce the reporting requirements on trusts and ease administrative burden. The first new provider information requests have been sent to NHS trusts this week starting with those where our intelligence indicates greatest risk or those that have not been inspected in the past 12 months. We expect to have sent PIRs to around a third of trusts by the end of the year. Our new approach inspections will start from September.

In time we plan to move to a single online collection mechanism that providers will use to submit and update information needed for both CQC monitoring and inspection and to help NHS Improvement identify support needs under its Single Oversight Framework. We have also been working closely with NHSI to further align our approach by developing a shared well led assessment framework and a new use of resources assessment and rating for NHS acute hospitals. We continue to pilot this work in the coming months, in collaboration with trusts and NHS Improvement.  In doing so we are keen to work with NHS providers to better understand the detail of any regulatory burden resulting from CQC and other organisations.

CQC Insight has been designed to help us identify potential changes to quality since the previous inspection and allows us to have a rolling picture of what quality looks like, based on a number of data sources.

Professor Sir Mike Richards    chief inspector of hospitals

Our revised approach also involves CQC Insight - a new monitoring tool that brings together all the quantitative information we hold about a provider into one place. It has been designed to help us identify potential changes to quality since the previous inspection and allows us to have a rolling picture of what quality looks like, based on a number of data sources.  We will combine this with our inspection findings and ongoing engagement with trusts. The design and metrics of Insight for acute trusts are subject to ongoing development and we will be sharing the data with providers and seeking their feedback in the coming weeks. In the future we will share Mental Health, Community Health and Ambulance Insight tools too.

We are in a position to introduce these changes now that we have completed our programme of comprehensive inspections of all hospital trusts and as a result have a far greater understanding of the quality of hospital care than ever before. In carrying out those inspections I have received much first-hand feedback that our inspection reports have provided information that has helped trusts take action to improve quality of care, even when those issues were ones they were already aware of.  Of the hospitals that responded to our post-inspection survey, 92 per cent told us that the inspection visit had made them think about how they deliver care, and the same percentage mentioned the report had helped them take action to improve their service.

 

Driving improvement

We have already seen how regulation has helped drive improvements with 22 acute hospitals having increased their rating on re-inspection and 18 trusts having exited special measures to date. In addition, our recently published case study report on eight acute trusts that have made significant improvements highlights that trust staff believe regulation and inspection has had a positive impact. As a result, patients across England are receiving better and safer healthcare and providers are running higher quality services which, ultimately, is the key shared objective for trusts and regulators alike. 

But, as we highlighted clearly in our State of Acute Hospitals report, the scale of the challenge that hospitals are now facing is now unprecedented – rising demand coupled with economic pressures are creating difficult-to-manage situations. As we roll out the changes in our approach, we will continue to use our voice as the quality regulator for the whole of the health and adult social care system to highlight where gaps in that system are impacting on the quality of care in NHS trusts, a message we previously emphasised in our State of Care report 2016.

The scale of the challenge that hospitals are now facing is now unprecedented – rising demand coupled with economic pressures are creating difficult-to-manage situations.

Professor Sir Mike Richards    chief inspector of hospitals

CQC’s purpose is to make sure that health and social care services provide people with safe, effective, compassionate, high-quality care, and to encourage care services to improve. Our evidence shows that the quality of care that people are receiving is improving with CQC’s involvement, but understanding more about our impact and how we can continue to support improvements in service delivery remains a priority.

 

Read our Impact of regulation in a shifting environment report

Read a blog by Policy advisor - regulation, Cristina Sarb on the findings of our regulation survey

About the author

Professor Sir Mike Richards profile picture

Professor Sir Mike Richards
Chief inspector of hospitals

Sir Mike became Chief Inspector of Hospitals in July 2013. Read more

Article tags:

We use cookies to ensure you have the best possible experience on our website. By continuing we’ll assume that you are happy to receive them. Close