New regulations and responsibilities for CQC

Published: 27 March 2015 Page last updated: 12 May 2022

April will bring significant changes to how we regulate the 49,500 health and adult social care providers and services across the country, which are dedicated to making sure people receive the best care possible at all times.

From next month, health and adult social care providers in England will be required by legislation to follow new regulations called the 'fundamental standards', which are more focused and clearer about the care that people should always expect to receive.

There are also new requirements for providers on being open about mistakes when they happen (called the 'duty of candour') and on making sure directors and their equivalents are 'fit and proper'. We’ve published information on how providers can demonstrate that they are doing this effectively.

As well as this, the regulations include a new requirement for providers that we judge to be Outstanding, Good, Requires Improvement or Inadequate to prominently display their ratings on their websites, as well as at premises, public entrances and waiting areas of care services. The aims of this are to encourage improvement, celebrate what is good, and give people clear information on how their services are performing.

As the quality regulator, we’ll be responsible for making sure providers meet these requirements, and we’ll do this by continuing to carry out our new and better approach to inspections. These are expert-led and based on what matters most to people who use services – are they safe, caring, effective, responsive to people’s needs and well-led. You can read our updated handbooks, which describe how we monitor, inspect and regulate different types of health and adult social care.

While we’ve been inspecting the NHS, adult social care, and primary medical services using our new approach for some time, this April will see the formal roll-out of our new inspections for dental surgeries, ambulances and independent healthcare – following feedback from our consultations, we’ve issued the final versions of our handbooks to describe how we will work.

We’ve also published a draft handbook for consultation on how we propose to inspect the quality and safety of health and social care in prisons and young offender institutions.

The questions that our specialist inspection teams use as prompts on their visits help to establish whether the service is providing the high standard of care expected of them. We know that there is great care and we have already rated 23 NHS trusts, 1,241 adult social care services (including hospices) and 388 primary medical services as either Good or Outstanding as of Friday 20 March 2015.

When we find that people are not receiving – or are at risk of not receiving – the high standard of care that we expect and that they deserve, we will hold providers to account to make the required improvements.

We will do this by using our new enforcement policy – a key part of this gives us the ability to prosecute providers for poor care without having to issue a warning notice first. The new policy will allow us to act quickly in response to the seriousness of the concern.

In addition to this, we will continue to place services – or recommend that services be placed – into special measures. Where care is judged to be inadequate, it is essential that the service improves quickly. We have designed our special measures regime to make sure there is a timely and coordinated response to this.

We’ve already placed a number of general practices into special measures and have made recommendations to Monitor or the NHS Trust Development Authority to do the same for NHS trusts – and similarly, we have made recommendations for NHS trusts to be taken out of special measures to recognise the improvements they have made in response, which have been accepted.

From next month, we’ll roll out our special measures regime to adult social care: this means that if we inspect a care home, home care service or any other type of adult social care service from April and then rate it to be inadequate, we will place it into special measures at the time of its rating. This will set a limited period for the provider to make the necessary improvements or to be prevented from providing the service anymore.

The regime works alongside our enforcement policy and we’ve published guidance that outlines what this looks like in practice across the different types of health and adult social care services we regulate.

As well as continuing to monitor the quality and safety of care services, April will see the introduction of a new responsibility for CQC, which will be to monitor the financial sustainability of care providers that would be ‘difficult to replace’.

Change often happens in the adult social care market, and usually it is managed well at a local level with no or minimal disruption to people receiving the care. However, some care providers have so many services across a region or the country, or provide very specialist services, that if they were to close, it would have a big impact on people using them. No one should go without the care and support they need.

By looking at the finances of these ‘difficult to replace’ providers of adult social care alongside the quality information we already have, we will be able to check whether they are at risk of failing. If we judge that they are and that services will be affected, then we will give an early warning to the local authorities so they can make plans to make sure people continue to receive the care they need. The new scheme is called ‘market oversight’ and we’ve published guidance to explain what it is and how we will exercise this new responsibility.

From April, we’ll also be working to deliver our new business plan, which our Board formally approved in our public meeting on Wednesday. In this, we have set our priorities to deliver our ‘new approach’, build an effective organisation and demonstrate the difference we make. We have also prioritised setting a clear direction as to where we see our regulation of health and adult social care going beyond 2015/16. This includes ensuring we respond effectively to the new models of care that will emerge over the next few years, such as those set out in the Five Year Forward View and in the vanguard projects.

We are clear on our purpose, which is to make sure people receive safe, high-quality, effective and compassionate care and we encourage services to improve.  We believe that our new responsibilities, and the new regulations that we are charged with enforcing, will put us in an even stronger position to do this.