As the independent regulator of Health and Social Care in England the CQC works to ensure services provide safe, effective, compassionate, and high-quality care. Taking steps and encouraging service providers to improve provisions to the highest standards.

Throughout the Covid-19 pandemic the CQC has been monitoring service providers. They have used their findings to inform a new strategy which implements learnings from Covid-19 and hopes to protect against future crises.

The Scope of CQC’s Regulation

The CQC employ a mix of non-clinical and clinical staff with varied backgrounds to support their regulatory activity.

They oversee:

  • 23,556 adult social care services
  • 145 NHS acute hospital trusts
  • 272 independent acute hospitals
  • 10 NHS ambulance trusts
  • 101 Independent ambulance services
  • 201 hospices
  • 54 NHS mental health trusts
  • 239 independent mental health locations
  • 10,873 dental practices
  • 6,676 GP practices
  • 162 Urgent care and out of hours
  • 74 NHS or independent community health providers and locations[1]

Across the above institutions, the CQC monitor, inspect, and regulate services to make they meet the fundamental standards of quality and safety.

The fundamental standards published by the CQC covers the following areas:

  • Person-centred care
  • Dignity and respect
  • Consent
  • Safety
  • Safeguarding and abuse
  • Food and drink
  • Premises and equipment
  • Complaints
  • Good governance
  • Staffing
  • Fit and proper staff
  • Duty of candour
  • Display of ratings[2]

Learning from Covid-19

The CQC found that people’s outcomes in relation to the pandemic were significantly impacted by the way their local system operated.

The manner in which health and social care join up has a large effect on the quality-of-care people receive.

Part of the reason why is because of the importance of information sharing. The CQC highlighted how different parts of the system share information can be the pivotal factor in providing someone with the appropriate care.

Another CQC finding was that it is important to recognise the incredible efforts of the care sector.

Ensuring their massive contribution and the difficulties they faced during the pandemic are acknowledged is valuable to the mental health and wellbeing of the caregivers.

To share their findings, the CQC began publishing monthly Covid-19 Insight Reports.

These reports were drawn directly from feedback given by staff and those receiving care, as well as data collection from services that provide care for people in their own homes.

The insights from the CQC’s regular conversations with care providers and partners also factored into each issue.

Health and care providers from all sectors have shared examples with the CQC showing how they have innovated and adapted working practices to respond to the challenges of dealing with Covid-19.

One example comes from GP Dr Rachel Buckley. She carried out a virtual ward round to two care homes via video call.

Rachel was able to see every patient in both homes registered on the practice list. After speaking with the patient, she then telephoned the next of kin to reassure them that their loved ones were being supported.

Covid-19 forced the CQC to adapt how they work to better support providers allowing them to focus on the state of emergency that was unfolding.

Their approach didn’t change in its entirety, they continued to monitor services and carry out risk-based inspections.

They took extra considerations on the impact of the pandemic and deliberated as to whether the actions they were carrying out were proportionate to the risks and pressures faced by the service.

Throughout the pandemic the CQC continued and expanded efforts to:

  • Gather and analyse information
  • Work with providers and partners
  • Act on what they already knew
  • Develop new monitoring tools
  • Share learning

Strong Leadership is Vital

A recurrent theme in the CQC’s analysis of care providers was that committed leadership, consisting of specialists, was the key to delivering outstanding services.

To aid this, they have begun training for all senior leaders and have shifted to a coaching model to nurture leaders.

They are aiming to encourage experimentation and innovation within care services, with visible and hands-on senior leaders being at the forefront of implementing strategy.

Leaders should:

  • Involve service users and their families in planning
  • Shape the culture of the organisation
  • Value staff and give them a voice
  • Empower colleagues and allow them to help ‘steer the ship’
  • Constantly focus on improvement[3]

There’s a saying that to be a good leader you’ve got to have good followers. No. To be a leader you’ve got to breed more leaders.

Jamie Stubbs, Senior General Manager, Ottley House Nursing Home.

There were systems changes throughout the pandemic to deal with the crisis, which has offered insights into the future of care.

To provide successful care, leaders must understand the needs of the local population, including cultural differences and sensitivities.

The quality of relationships between local providers plays a major role in the coordination and delivery of joined-up health and social care services that meet the needs of the local population.

Ensuring a focus on shared planning and system-wide governance has become a priority in the wake of Covid-19. A range of initiatives have come from the pandemic to ensure the safety and wellbeing of frontline and support staff, these need to be carried out beyond the end of the pandemic.

The move to digital working accelerated change and impacted access to services. More generally digital solutions supported data-sharing and communication between health and social care partners and within health and social care organisations.[3]

The CQC’s New Strategy

The CQC aim to be ambitious in their new strategy. They are changing how they regulate care to improve services for everyone.[3]

Their core purpose and role aren’t changing, but the way they operate will be different, with regulation being more relevant to how care is delivered and offering more flexibility to manage risk and uncertainty.

The key themes of their new five-year strategy are:

  • Regulation driven by people’s needs and experiences
  • Smarter, dynamic, flexible regulation that provides timely and high-quality information
  • Regulating for stronger safety cultures
  • Making support more readily available and easily accessible for heath and care services

Tackling inequality in health and care is also a priority, the CQC will be pushing for equality of access, experiences, and outcomes for minority communities.

[1] CQC.org.uk. 2019. The State of Health Care and Adult Social Care in England 2018/19.

[2] CQC.org.uk. 2017. Fundamental Standards.

[3] Murray, Alison. 2021. Head of Inspection, CQC. A New Strategy for the Changing World of Health and Social Care.

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Covid-19 has shaken up health and social care, possibly forever. The CQC has been analysing healthcare during the impact of pandemic, coming up with a dynamic new strategy in an attempt to future-proof care providers in the event of another crisis.

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