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

  • Organisations we regulate,
  • Ambulance services,
  • Community services,
  • Hospitals

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 coproduction 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.

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. 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 May. It is good to see that the progress we have made in ensuring a more coordinated approach with other regulators has been recognised by a number of NHS trusts. I was also encouraged to read that the proportion of providers who believe the regulatory framework for the NHS is working well has increased since the last time the survey was run in 2015.

Sixty-eight per cent of respondents reported an increase in demand from regulators. Although this is a smaller proportion than in 2015, it is still relatively high. 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. 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.

Our recent consultation which involved providers, their representative organisations and the wider public sought feedback on proposed changes to the way we regulate NHS trusts. The proposals are an evolution of our current approach to assessing and reporting on the five key questions at core service and provider level. They reflect CQC and NHSI’s plans to work jointly on future reviews of leadership and governance. We will be developing and further piloting our approach to inspecting well-led at trust level in the coming months, in collaboration with trusts and NHS Improvement. As part of this work we are keen to work with NHS providers to better understand the detail of any regulatory burden resulting from CQC and other organisations.

I was interested to read that 74 per cent of respondents to the NHS Providers survey reported that their CQC inspection had not highlighted any areas of concern that their board was not already aware of. Through our programme of comprehensive inspections of all acute hospital trusts 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% 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.

We have already seen how regulation has helped drive improvements with 11 trusts having increased their rating on re-inspection and 18 trusts having exited special measures to date. 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.

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.

Last updated:
29 May 2017


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