The new system of regulation - what it means in practice

October’ss Care Conversation event heard from the Care Quality Commission’s chief executive, Cynthia Bower, on the new regulatory system

The Care Quality Commission’s (CQC) function was to make sure organisations met the standards set out in the Health and Social Care Act 2008, Cynthia Bower told delegates. ‘But what we chose very early on was to express things in terms of outcomes for patients and people who use services – a focus on outcomes rather than processes.’

It was up to providers to decide how they met these outcomes, she stressed, with a single system of regulation and a generic set of standards across the different sectors regulated by the CQC – adult social care, the NHS and independent healthcare. ‘We put people who use services, their families and their carers at the centre of everything we do.’

A key priority was acting swiftly to eliminate poor quality care, she said, and the organisation also championed joined-up care, making sure it was focused on people’s needs. ‘We’re trying to make our judgements real-time judgements and give people real-time information,’ compared to the annual feedback that had been a feature of the CQC’s predecessor, the Healthcare Commission.

‘We also had a determination that we would work within the system, not stand outside and comment from the sidelines,’ she told delegates. ‘We’ve shifted the mindset of regulation – the public wants a regulator that actually gets in there and works to improve the system.’ NHS trusts were registered, with the adult social care system coming on board earlier this month – a process involving 10,000 separate organisations across more than 24,000 locations – while primary dental care and primary medical services would come on board in 2011 and 2012 respectively.

CQC involved service users in its compliance monitoring reviews as far as possible, she said, using a wide range of evidence sources. The organisation uses targeted and responsive measures, she stressed, taking rapid action to follow up concerns. A new tool called the Quality and Risk Profile (QRP) gathered information from foundation trust regulator Monitor, alongside other regulators, HES, NHS Choices, patient and staff surveys, LINks, whistle blower concerns and complaints, and the aim was to make all of the information available to the public within the next 18 months.

‘We’re trying to move into an era where we can be as open as possible with both providers and the public,’ she said. The tool focused on six key areas, giving each a red, amber or green rating to prompt activity from inspectors. ‘It shows both our judgement and how it was made, and it will be user-friendly and updated as soon as we get the information through – a live, web-based tool.’

It was the duty of organisations to ensure compliance at all times, and the CQC had both civil and criminal powers to enforce this. ‘I don’t imagine we’d ever get to a point where we’d close an entire hospital, but we can use restrictive conditions that say they can no longer provide a particular service – we have powers to stop you providing a service if we don’t think it’s safe, including at a very granular level.’

The organisation is looking into a replacement for the recently abolished star ratings system for adult social care, she told delegates, as it provided useful information for the public and was a ‘huge drive for improvement’ for the sector. However there was a question as to whether the state was best placed to deliver this.

Overall, the landscape was changing, she told the seminar, although the CQC had five years to embed its approach and will also develop an organisation called HealthWatch that would be the consumer champion for healthcare. We’ve got a huge transition to go through. Monitor would itself evolve but remain a partner and there would be close working with the NHS Commissioning Board, she said.

‘We absolutely believe that the only reason to get up and come to work is to ensure that standards improve if they’re not good enough, and we passionately believe that we can only do this effectively in partnership with other organisations.’