UK health regulator CQC has ‘significant work to do’ in improving its systems


The Care Quality Commission (CQC) wants to move to an intelligence driven regulatory approach, but needs new systems to support this.

NHS HealthThe UK’s health regulator, the Care Quality Commission (CQC) – which regulates hospitals, adult social care, and primary medical services – is aiming to move towards a more intelligence driven regulatory approach, but needs to do significant work on its information systems in order to achieve its goals.

This is according to a new report out today by the influential Public Accounts Committee, which states the CQC’s workload may well increase over the coming years, due to the financial pressures placed on the NHS, and as a result, faces challenges in being prepared.

However, this is the third time that the Committee has reported on the Commission since 2012, and it notes that it has “improved significantly” over this period.

It’s also worth noting that Sir David Behan has announced his retirement as chief executive of CQC and the Committee notes that the new chief executive “will have a big task to ensure the Commission is able to tackle the big challenges that are on the horizon”.

Committee Chair, Meg Hillier MP, said:

Sir David Behan is stepping down after six years running the Care Quality Commission. The regulator has improved significantly under his stewardship but there is no room for complacency.

Sir David’s successor will inherit a mixture of persistent weaknesses and looming challenges. These must be tackled amid Commission funding cuts and continued financial pressure across the health and care sectors.

Both are a potential threat to the Commission’s ability to carry out its duties, which would in turn undermine the ability of patients and their families to make timely and informed choices about care.

As it stands, the Commission still does not meet the turnaround targets it sets itself for publication of inspection reports. It must do better, particularly on hospital reports, and we expect it to demonstrate progress.

There is also significant work to be done on information-gathering. It is a simple point, but the Commission cannot hope to fulfil its vision of intelligence-driven regulation until it has in place systems that are up to the job.

Even then, it must ensure the information feeding those systems is adequate to flag the early signs of poor care. That means investing time in building relationships at the frontline with Healthwatch groups, CCGs and others.

New systems

The CQC plays a vital role in ensuring people receive safe, effective, high-quality care. However, with health and care providers under severe financial pressure, the Commission’s workload is likely to increase if services deteriorate, and it needs to be prepared for providing stringent oversight.

One area for improvement that the Committee highlights is improving the timeliness of publishing inspection reports, where the CQC doesn’t meet the targets it sets itself across any of the sectors it regulates. The biggest gap in performance is hospitals, where, for example, in the first quarter of 2017-18 only 25% of reports were published within 50 days compared to the target of 90%.

Delays mean that the public does not have timely information to make informed decisions about their care. And delays are largely put down to “inefficient processes within the Commission”.

The CQC is aiming for a more “intelligence-driven regulatory approach”, including reducing the frequency and depth of its inspections – but the Committee notes that this is “heavily dependent on improving its information systems”.

The report notes:

The Commission’s current information systems require significant work including: improving its registration systems; fully implementing its software for analysing text-based information; updating its systems for collecting information from providers; and continuing to develop its ability to draw together information on a provider from different sources. The Commission is testing its new systems as it progresses and has developed a wider digital strategy which sets out the priorities for moving towards an intelligence-driven regulatory approach.

The Commission set out that much of its registration system remains paper based. At present around 50% of its registration applications are completed on-line. Where applications are undertaken on-line around 70% do not need any further action before being processed compared with only around 40% of application forms sent by email. The Commission explained that it has put in place a registration improvement programme to digitise its processes and is also making changes to its underlying process, for example, extending the time period to undertake Disclosure and Barring Service (DBS) checks when a GP practice partnership changes.

The report highlights that the Commission has purchased an off-the-shelf software package in February 2015 to help it analyse and quantify the text based information it receives from the public through its website. However, the Commission said that the software is “not intuitive” and it needed to train staff to use it.

It added that the processes for collecting information from adult social care providers will become digital in January 2018, with an ambition for GP collections to be digital by April 2018. This should enable providers to submit information in real-time rather than through an annual collection.

In terms of its strategy and support, the report notes:

The Commission is testing its systems as it develops them with support from the Department’s digital assurance teams and the Cabinet Office. The Commission confirmed that it has established a digital strategy to support its ambition for a more intelligence-driven regulatory approach and that it had agreed this strategy with its board.

The Commission explained that its strategy has two key elements: first, to strengthen its digital infrastructure; and second, to ensure it is collecting the right information and using it effectively. To support the implementation of the strategy, the Commission has made two key appointments: a chief digital officer (jointly with NHS Improvement) and a director of intelligence.

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