Update from our Chief Inspectors on our regulatory approach: 10 December 2021

Page last updated: 12 May 2022
Organisations we regulate

CQC continues to deliver a risk-based approach to inspection, while taking action to increase system capacity.

Services are under exceptional pressure as we head into winter, and this is compounded by new variants of COVID-19. This is inevitably putting the safety and quality of services at risk. Here we update on how we plan to regulate over the next few months.

Our focus will always be on supporting services to ensure people receive safe care. But we also recognise we need to respond to the severe pressures under which many parts of the health and social care system are working.

We want to ensure that our approach remains appropriate and proportionate. We will continue to focus inspections where there is evidence that people are at risk of harm, where we can support increasing capacity across the system and identifying good practice that we can share to drive improvement.

We recognise that the priority for all providers is to deliver safe, good quality care to people who use their services. We will support providers that are taking balanced, risk-based decisions in partnership with people who use health and social care to maintain access to services and keep them as safe as possible in response to system pressures.

We do not currently plan to return to routine frequency-based inspections.

We are also aware that in some circumstances re-rating services can support providers to deliver more capacity across the system and address wider pressures they’re facing. We will use our ongoing monitoring to identify services that may have improved and where appropriate inspect to identify improvements and re-rate.

Alongside our risk-based inspection activity we will continue our ongoing monitoring of services. We’ll use this to identify risk and signal where we may need to take further action to ensure that people are receiving safe care and offer support for providers. Most of our inspection activity throughout the pandemic has been driven by feedback from people who use services and concerns shared by people who work in health and social care. So it remains as important as ever to share any concerns or examples of good practice you have about services you work in and encourage people who access your service to share feedback with us.

Many of the challenges that health and social care providers face need a response from the whole system. So we are continuing to work with organisations that represent the public, care providers, and our partners to identify concerns across individual sectors and systems so we can provide support and guidance. For example, issues about workforce capacity, access to services, and rising demand.

We’ll keep our approach under review and respond as the situation across the health and social care system changes.

What this means for providers

Across all services we will:

  • Continue ongoing monitoring of services, including a monthly review of the information we hold about a service to identify any risk to quality and safety.
  • Use our independent voice to amplify the urgency for immediate support for services under pressure and for the development of new models of care. Making the case for services designed around local need so that people get the right service in the right place at the right time. Delivered by a workforce who are valued and supported.
  • Prioritise registration activity where we can support the creation of extra capacity in the system.
  • Use information to determine where registration activity needs to be focused.
  • Deliver a more co-ordinated approach to inspecting urgent and emergency care pathways this winter. Where we identify risk we will look at how services across a system are working together. To identify improvements that could benefit people using services and staff delivering care.
  • Monitor and assess where there is a risk of a closed culture developing. This includes monitoring and acting on information of concern about blanket bans on visiting. Our monitoring will also show us where we need to look at services we've had limited or no contact or information from over a period of time.

Primary medical and dental services

We will:

  • Pause our monitoring calls with GP providers where there is the lowest level of risk.
  • Inspect only where there is a clear risk to safety, including access to GP, out of hours and urgent care services. A risk-based inspection that focuses on access will not lead to a change in rating but if additional risks are identified, we will expand our focus which could lead to a change in rating.
  • Continue to develop our approach to reviewing GP records through digital access.
  • Follow up inspections to those GP services currently rated as inadequate.
  • Use our monitoring and inspection activity to understand where different approaches to system working could reduce pressure on primary care.
  • Work with Ofsted to deliver multi-agency inspections of children’s services and review our approach.
  • Work with HM Inspectorate of Prisons (HMIP) and other inspectorates to inspect health and social care in secure settings.

Hospital services

These include independent health and mental health services. We will:

  • Inspect services in NHS Trusts and independent health providers where there is a clear risk to safety.
  • Conduct Mental Health Act (MHA) monitoring visits to ensure the rights of people are protected.
  • Prioritise high risk independent healthcare services for inspection. For example, cosmetic surgery services, independent ambulance services, and those where closed cultures may exist.

Adult social care services

We will:

  • Inspect where there is a clear risk to safety. Using appropriate focused and targeted inspection methodologies.
  • Monitor to identify services currently rated as Requires Improvement who may have improved.
  • And from January, begin a programme of activity to inspect providers currently rated as Requires Improvement. To identify where improvement has taken place and where possible re-rate. Supporting the creation of additional capacity in the system.
  • Activity to support the system over winter. Including supporting the establishment of new designated settings and delivering infection, prevention and control inspections. Helping to ensure people can be supported to be discharged from hospital when they are medically fit to leave.

Developing our future regulatory approach

We also recognise that the health and social system has and continues to change. And we need to change as well. In May we launched our new strategy which set out our ambitions for the future of regulation.

Since then, we have been working in collaboration with people who use services, health and social care providers and professionals and other partners to develop our future regulatory approach.

This includes work on:

  • a new assessment framework.
  • approaches to how we use people’s experiences of care.
  • developing our assessments of quality in systems and our assurance of how local authorities deliver their duties under the Care Act.
  • how our teams interact with providers and other stakeholders.

We want to thank the tens of thousands of people who have been involved in this work to date. Your feedback has supported the development of a regulatory model fit for the future of health and social care. And will support us to assure people receive safe, effective high-quality care and drive improvement.

We will continue to engage widely as we co-produce our future approaches. If you would like to be involved or for more information, sign up to our digital engagement platform. Also look out for our regular email bulletins,podcasts, blogs and videos

We are committed to continuing to address unsafe and poor-quality care, work in partnership with people who receive care and all parts of the system to drive improvement and use our independent voice to highlight issues of concern. Our regulatory approach enables us to do this.

Finally, we want to end this message with a thank you to everyone who works across health and social care. Your hard work and commitment during the pandemic has meant that people are still receiving good quality health and social care under the most demanding of circumstances.

Kate Terroni, Chief Inspector of Adult Social Care

Professor Ted Baker, Chief Inspector of Hospitals

Dr Rosie Benneyworth, Chief Inspector of Primary Medical Services and Integrated Care