Joint statement from CQC’s Chief Inspectors, and Deputy Chief Inspector and lead for mental health services

Published: 16 September 2020 Page last updated: 12 May 2022

This statement sets out how we will regulate during the next phase of the coronavirus (COVID-19) pandemic. From 6 October, we will begin to roll out our transitional regulatory approach, starting with adult social care and dental services.

Throughout the pandemic, our regulatory role did not change. Our core purpose of keeping people safe was always driving our decisions. However, as the risks from the pandemic change, we’re evolving our approach in a way that is both sensitive to the changing circumstances of providers, and that also puts people who use services at the centre of what we do.

Our transitional regulatory approach is flexible and builds on what we learned during the height of the pandemic. The key components are:

  • A strengthened approach to monitoring, with clear areas of focus based on existing Key Lines of Enquiry (KLOEs), to enable us to continually monitor risk in a service
  • Use of technology and our local relationships to have better direct contact with people who are using services, their families and staff in services
  • Inspection activity that is more targeted and focused on where we have concerns, without returning to a routine programme of planned inspections.

We will continue to adapt our transitional regulatory approach, and remain responsive as the situation changes. We’ll also be considering longer-term changes to how we regulate, which we’ll explore through engagement on our future strategy.

Developing our monitoring approach

In response to the pandemic, we developed the Emergency Support Framework (ESF) as an additional monitoring tool to support structured and consistent conversations with providers. Combined with other sources of information, the ESF helped us to understand where there were risks of unsafe care, prioritise our support to address this, and share learning from providers that were using innovative ways to manage. The ESF also enabled us to have conversations with NHS trusts specifically about infection prevention and control, to assure us that they had effective plans and processes in place.

Our focus over the last few months has naturally been on the immediate risks from the pandemic. Our transitional approach will build on this work to include looking at more areas where quality needs to improve.

The way we monitor services has been developed through engagement with key stakeholders, providers and the public. Our monitoring will have clear areas of focus, based on our existing KLOEs, specifically targeting safety, people’s access to services, and leadership. We’ll continue to build in other areas of focus.

Using our transitional regulatory approach, our inspectors will monitor and review information from all available sources, collecting further information where necessary. Along with Experts by Experience, they will gather information from people who use services and local groups as part of this, and we’re testing how we can improve this. The experiences of people who use services, their families and carers are central to this approach, and to our future direction as an organisation. To promote this, we’ve launched a year-long campaign with Healthwatch England, voluntary sector partners and others to encourage people to share their experience through our Give Feedback on Care service.

We’ll use a range of information sources to support our monitoring. This includes the work we’re doing as part of our Provider Collaboration Reviews (PCRs), and information gathered through our routine ongoing monitoring. As well as information on individual services, we’ll also use information that we hold about local systems, building on the work as part of the PCRs to understand where there are barriers to good care and to target our activity to help break these down.

This is clear in all our guidance and training for our staff: an inspector’s professional judgement will remain part of how we monitor risk. Our risk model and monitoring activity helps prioritise services where there may be a greater level of risk and helps identify what a proportionate response might be. However, inspection teams will always have the option to act quickly and use their own judgement where other sources of information indicate greater levels of risk elsewhere.

Responding to risk

With the risks relating to COVID-19 still present, we won’t just be returning to business as usual. We’ll draw from the best of our existing methodologies, adapting them to work within the environment we’re in. We are clear that our focus will continue to be on services where we have concerns about care and will continue take appropriate action to protect people if necessary.

The pandemic means that we cannot return to our fixed timetable or frequency rules on inspecting and, given the pressures on providers and the risk of spreading infection, it is unlikely we will return to our published frequency in the near future.

We need to strike a balance between making sure we hear people’s experiences of care and accurately assessing quality while minimising the risk of spread of infection and not adding unnecessary pressure on the health and care system. Where we do carry out on-site inspections, our action will be targeted and driven by the information we hold on a service, focusing on areas where we can’t collect information in other ways, or on services where we need to visit more, for example in secure settings.

On-site inspections are a valuable tool and we will continue to use them proportionately. Where we have information that people are not getting good care, a visit is often the best way to understand what’s really going on.

We are also carrying out pilots in adult social care and general practice. Both will be used to explore new ways of gathering evidence without physically crossing the threshold and be carried out with the explicit consent of the provider. This part of our transitional approach will help us test new ways of working that will inform our future strategy and approach.

Rating providers and reporting on our findings

We know that our ratings and information about our assessments are vital in giving a view of quality in a service.

After a review of the monitoring information and using the streamlined set of KLOEs, we will make a judgement. If we are confident that our review indicates a low level of risk, and there aren’t any risks to people who use the service, then we will take no further action and will let providers know the outcome. Over time our plan is to publish a short statement on the service’s page on our website to let people know. We will also share a summary directly with the provider. Before we do this, we first want to work with people who use services and providers to make sure what we use works for them.

Where the outcome of our monitoring activity leads to us inspecting a service, we’ll use our existing inspection methodologies, and adapt to work with the environment we’re in. This means that across all the health and care sectors we regulate, we can still look at any or all the KLOEs on inspection, to ensure people are receiving safe, high-quality care. However, as our inspections will be more targeted and focused around areas of risk, we may not always cover all aspects of our five key questions and our KLOEs. As a result, our inspections may not always lead to a change in rating for a service.

As well as having limited ability to carry out on-site inspections, our ability to re-rate services is also limited by our published methodologies for rating and reporting on services. Although we’ll be able to re-rate a service in a limited number of cases, this varies in practice between the sectors we regulate. We’ll continue to update you through our Chief Inspectors’ blogs and our updated guidance for providers, so that you know what to expect for your sector.

Finally, we’d like to recognise the dedication and professionalism of everyone working in health and social care. COVID-19 is the biggest challenge to face the health and care system in living memory – and the response from the people who form the backbone of this system has been extraordinary. Thank you.

Kate Terroni, Chief Inspector of Adult Social Care

Ted Baker, Chief Inspector of Hospitals

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

Kevin Cleary, Deputy Chief Inspector and Lead for Mental Health Services

Further information

Rollout for other service types will begin on:

  • All trusts from 12 October
  • GP, independent doctors, slimming clinics, urgent care and out-of-hours on 19 October
  • Further detail on rollout plans for the remaining service types will be released in due course.