Summary

Major CQC changes are afoot for independent healthcare providers this year.

At a glance:

  • Parent companies/groups to be CQC registered for the first time - 'live testing' 2018/19;
  • New assessment framework for independent healthcare inspections from April 2018;
  • Strong focus on 'well-led' - including at provider level - with new KLOEs and inspections always covering this;
  • Proposals for closer monitoring between inspections, core service changes and rating some types of provider for the first time, starting from June/July 2018.

Is your organisation ready?

What changes are being proposed?

The CQC's third (and final) 'Our next phase of regulation' consultation sets out the changes in store for independent healthcare services, including further details about changes already in the pipeline and some new proposals around monitoring, inspection and rating.

Registration

The change likely to have the biggest impact on independent sector providers is the CQC's plan for holding the overall leadership of corporate/group providers to account for the quality and safety of services delivered further down the organisational chain.

The CQC proposes to do this by revising its registration criteria to adjust how it defines a service provider so this encompasses any organisation that can exercise 'direction and control' over the quality and safety of services, rather than just those which are directly delivering services as currently.

We will have to wait a while longer (expected to be in the Spring) to find out what the new registration criteria will be, although the CQC has previously suggested the revised criteria will not require organisations with a financial interest alone to be registered with the CQC.

What about the practical impact of this for providers?

  • Parent companies/groups which have previously been beyond the regulation of the CQC will have to be registered with the CQC, unless they can demonstrate a 'financial interest' only;
  • Many services could end up with multiple registered providers, each with associated registration fees;
  • The Fit & Proper Persons Test would extend to directors at all levels within a corporate structure/group;
  • In the event of an alleged breach, the CQC could bring enforcement action against both the parent company and the local provider. Given that levels of fine for CQC prosecutions are determined partly by size of company/turnover, this would mean we start seeing much bigger fines for prosecutions brought by the CQC.

The plan is for the first registrations of this type to happen during the coming financial year and providers need to ensure there is Board-level awareness of this proposed change and its potential impact throughout corporate/group structures.

Inspection

The CQC is proposing a more targeted and tailored approach, and independent healthcare providers can expect a number of important changes to inspections.

The most immediate change relates to the assessment framework used to inspect and rate independent healthcare providers. From April 2018, the new CQC health assessment framework will replace the existing 'Provider Handbooks' for all independent healthcare inspections, including inspections after April 2018 to follow up previous concerns. The new framework retains the same 5 key questions - i.e. are services safe, effective, caring, responsive and well-led - but includes some new and revised Key Lines of Enquiry and Prompts for CQC inspectors to base their assessments on, plus revised ratings characteristics.

There will be a greater focus on particular core services where risk is the greatest and a focus on 'well led' in all inspections.

The CQC will also produce more succinct 'user friendly' inspection reports.

What is the impact of these proposals?

If you have not already done so, independent healthcare providers will need to:

  • Review the new/revised KLOEs, benchmark your organisation against them and update your quality assurance systems and policies/procedures accordingly;
  • Ensure clinical and corporate governance processes are sufficiently robust to meet the new emphasis on 'well-led';
  • Provide staff training to ensure awareness of the new requirements at all levels of the organisation;
  • Be prepared for unannounced or short notice inspections and targeted inspections based on intelligence held by the CQC;
  • If issues are found at location level, under the proposals, the CQC will assess quality at provider level and so independent healthcare providers would need to prepare for inspections at Head Office. This approach will be tested in 2018/2019.

Monitoring the quality of services

Independent healthcare providers also need to prepare themselves for greater CQC monitoring between inspections. The latest consultation proposals include:

  • CQC Insight - The CQC has developed a new data monitoring tool to help identify changes to quality (whether good or bad) which, in turn, will help inform decisions about which services to inspect and when. Roll-out would start with independent acute hospitals and mental health service providers from early 2018/19. The CQC intends to work more collaboratively with partners and providers to develop robust data collections to enable effective monitoring.
  • Relationship Management - the plan is for the CQC to maintain regular contact throughout the year with independent healthcare providers at each location and also with some providers at a corporate level. Complex providers delivering different types of services will get a single CQC relationship-holder.
  • Regular provider information collections - As for other sectors, the plan is to introduce regular provider information collection (as opposed to just requesting information before inspections), to support monitoring between inspections, although this is not likely to be until 2019/20.

In practice, this will mean organisations making sure they routinely generate high quality governance information about how they measure up to CQC standards, including being able to detect and rectify any compliance gaps as and when they emerge.

Rating

Although some types of independent healthcare providers are already rated by the CQC (including independent acute hospitals), many are not. This is going to change, with the CQC starting to be able to rate most types of independent sector provider from 2018/19 (possibly from June/July this year).

This will mean independent sector services such as cosmetic surgery acute hospitals, termination of pregnancy, refractive eye surgery, diagnostic imaging and independent doctors/clinics providing primary care services (including online) being rated 'outstanding', 'good', 'requires improvement' or 'inadequate' for the first time.

What happens next?

The consultation closes at 3pm on 23 March 2018.

We can expect more detail on timings and how these proposals will work in practice when the CQC publishes the outcome of this consultation, which is expected to be in June/July time.