The King’s Fund has worked with the Care Quality Commission (CQC) to identify five key challenges the regulator faces, which could be helped by evidence, as it rebuilds its approach. The findings are set out in a new report: ‘Evidence on what works in regulating health and social care’.
CQC asked King’s Fund to undertake this work, to help ensure its new approach is based on the best evidence and learning. The report shares findings from the first scoping phase of this evaluation, which involved reviewing evidence, interviewing experts and engaging with CQC staff to understand what good regulation looks like.
The results aim to give CQC information it can use to help rebuild its regulatory model.
Five challenges
• Setting regulatory expectations. Organisations that are regulated by CQC have complained that they are not clear what standards they are expected to meet or how their performance will be assessed. The review of evidence found that CQC needs to clearly communicate its expectations for what good-quality care looks like and how this will be assessed, aligning regulatory models with the regulator’s mission and purpose, and using a range of methods to achieve the regulator’s purpose (not just inspection) that are tailored to the different organisations it regulates. Standards should be co-designed with regulated providers and set high to promote improvement. ‘Enforced self-regulation’ may have a place, but must be accompanied by a facilitative and supportive approach from the regulator.
• Ensuring expertise in the regulatory workforce. Recent reviews have found that CQC inspectors sometimes lacked knowledge of the sectors they were inspecting, which affects their credibility with providers. In addition, they did not have enough training and support. Investing in effective training and development for inspectors is therefore vital, with three key skill sets singled out as sector expertise, regulatory expertise and relational skills.
• Adopting risk-based regulation. CQC’s latest regulation strategy adopted a risk-based approach to regulation, however, evidence across different sectors shows how difficult this is to enact, which is reflected in the challenges CQC has experienced. Risk-based approaches always involve a process of learning and require ongoing evaluation and development. Recognising that data is not perfect, inspectors need the right tools and time to use the data properly, and they still need to talk to people and understand what is really going on.
• Developing relationships and trust. The problems with CQC’s current regulatory model have severely damaged its relationships with providers and other stakeholders, which must be restored. Regulators need to be flexible in the way they work with providers and be able to use different styles of engagement when appropriate.
• Changing the regulatory model. The literature highlights the importance of piloting new approaches and investing in training to support the rollout or new models. New approaches should be evaluated to establish if they are achieving their intended impact, and ongoing work needs to embed a culture of learning and evaluation. Piloting and testing should not be confused with a phased rollout in stages, which does not allow time for staff to implement learning between one phase and the next.
Next steps
The King’s Fund will now work with CQC over the next two years to share learning and evidence to support its ongoing development of a new approach to regulation.
