Newsletter
A regular update for providers and professionals working in healthcare services
Message from Sir Julian Hartley
As the year draws to a close, I want to take the opportunity to firstly say thank you to everyone who has been so welcoming, candid and frank with me during my first month as Chief Executive of CQC. I’m grateful to everyone who I have met with so far and who have shared their thoughts and reflections with me – I look forward to meeting many more of you in the coming months.
There’s no doubt that this year has been incredibly challenging for CQC, as well as the health and care system as a whole, but it has been so encouraging to see how many people are willing to work together to support us to be the regulator we all want us to be – supporting health and social care services to provide people with safe, effective, compassionate, high quality care.
We have already started making changes to do this, such as stopping scoring and reporting at evidence category level for provider assessments started after 2 December. One of the main reasons for this being that we have heard that our scoring model is too complex and hard to understand. This is just one of many changes we need to make to urgently improve.
In the new year I’ll be sharing more information on our priorities for the coming months, but the changes we make will definitely be focused on ensuring the regulation we carry out meets its core purpose – to keep people safe and ensure they receive the care they deserve. I’m absolutely committed to working in partnership with people who use services, health and social care providers and stakeholders to do this.
I want to thank you to you, as health and social care professionals, for everything you do to keep people safe and deliver care, particularly when it isn’t easy. Working in health and social care means you don’t always get a break over the festive period, but I hope you’re able to take some down time and spend time with loved ones. I look forward to writing to you in 2025 with more updates on how we are working to improve.
CQC fees scheme for 2025/26
The CQC fees scheme for providers, which covers our costs of provider regulation, will not change next year – in 2025/26.
This means that, for many providers, your fees will have remained the same for the last 6 years, unless you have changed your registration – for example, by adding locations or service types.
As in previous years, NHS trusts, NHS GPs and community social care providers may see a change to their fees from April 2025 (up or down), as we update the variables (turnover, list size, number of people using the service) used to calculate their fees.
Since there is no change to our fees scheme, we will not be consulting on fees for provider regulation this year.
Find out more about our fees scheme
National Quality Board - Principles for assessing and managing risks across integrated care systems
The National Quality Board (NQB) has published principles for assessing and managing risks across integrated care systems.
The document outlines principles for managing quality risks within integrated care systems, particularly in rapidly changing environments. It supports the delivery of safe, effective, and personalised care while addressing inequalities across health services.
The principles sit alongside previously published NQB guidance.
Read more about the principles for assessing and managing risks across ICSs
The Society of Radiographers Ultrasound Census 2024
The Society of Radiographers (SOR) is calling on sonographer managers across the NHS and independent sectors to participate in the 2024 ultrasound census.
The SoR encourages sonographer managers to share their experiences, highlight challenges, and showcase good practices through the census.
Input from both NHS and independent providers is crucial for fulfilling Professional Standards Authority (PSA) requirements and shaping the future of sonographer practice.
The survey will be open until Tuesday 17 January 2025.
Other news
- In April 2024, the Department of Health and Social Care (DHSC) published a consultation, seeking views on removing making changes to some of CQC’s regulations. Specifically to 1) remove the expiry date of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and replace it with a 5-yearly review 2) making changes to CQC regulations relating to ‘treatment (not first aid) in a sports ground or gymnasium’ and ‘temporary arrangements to deliver medical care (not first aid) at sporting or cultural events’ 3) introducing a new requirement to notify CQC of the use of restraint, segregation and seclusion in mental health units. On 18 December, DHSC published their response to that consultation.
- We are aware of a scam where a company that claims to be CQC is emailing registered providers selling in-house training for staff on our inspections and how to get a rating of outstanding. The email includes information copied from our website and a fake CQC logo. We never charge a fee for any guidance, webinars and other face-to-face engagement events and we do not offer training for staff. If you are considering investing in training for your staff, you should make sure the training provider is advertised as independent from CQC and let us know of any examples of training companies that claim otherwise.
- Get ready to make a difference from 24 February 2025 as we launch Share for Better Care Week, a national week of action about helping more people have a stronger voice in their care. Mark your calendars and sign up for our Share for Better Care briefing call on 21 January to find out how you can support our campaign! Let's come together and ask our communities, "Will you share for better care?".
- National Voices have recently published a joint blog with Chris Dzikiti about our Share for Better Care campaign, reflecting on the importance of sharing experiences of care, especially for people experiencing health inequalities.
- Keep up to date with the latest on how we're improving how we work on our website.
- The Government have announced an update on the extension to the banning order on puberty blockers. The full details can be found on the GOV.UK website.
- GP mythbuster 41: Smartcards, and GP mythbuster 91: Patient safety alerts have been updated on our website.
- Cold weather can significantly impact people’s health and well-being. The UK Health Security Agency (UKHSA) has guidance on reducing risks for people living in care homes or receiving care at home over winter.
- The Digital Care Hub is raising awareness across the care sector of how to avoid falling victim to a scam. Check our their informative videos across X and LinkedIn.
Newsletter
A regular update for providers and professionals working in healthcare services
Improving how we work
From 2 December, we will be making some urgent interim changes to our approach to provider assessments.
We will stop scoring and reporting at evidence category level for provider assessments. This will mean that we will only produce scores at quality statement level.
This change will mean we will be able to deliver more assessments, at a faster pace, that better reflect the quality in a service.
We will update our guidance to reflect this change.
Find out more about what this change means for you
Maternity survey 2024
This survey looked at the experiences of pregnant women and new mothers who used NHS maternity services in 2024.
Women who gave birth between February 1 and February 29, 2024 (and in January for trusts with fewer than 300 eligible births in February), were invited to take part. The fieldwork was conducted from May to August 2024, with 18,951 responses received, resulting in a 41% response rate.
Overall, the results highlight areas of improvement over the past year, especially in access to mental health support during pregnancy. However, it also reveals ongoing challenges in maternity care, with reports of poorer experiences in certain aspects. These include communication during labour and birth, the information provided during hospital care after birth, and involvement in postnatal care - areas where feedback suggests a longer-term decline in positive feedback.
In September we published our maternity improvement resource, informed by findings from our National Maternity Inspection Programme. This shares practical examples of where providers can drive improvement in triage, incident management, leadership and culture, and health equity.
Maternity improvement resource
Share For Better Care - empowering people to improve health and social care through feedback
We recently we held a webinar with Healthwatch England, hosted by one of our campaign partners the Patients Association.
Attended by 180 people, a mixture of the public, health and social care staff and other stakeholders – it was a really engaging event with challenging but fair questions.
Peoples’ experiences can provide vital lessons for the health and care sector, helping it understand what is working and what needs improvement.
Watch the webinar and:
- hear about their campaign, which aims to support more people to have their say on health and care services
- understand the barriers that exist to giving feedback and potential solutions
- listen to patients explain first-hand their experience of providing feedback and how this improved their care
- discuss the current ways people provide feedback and what more can be done to ensure peoples' voices are heard.
Please look out for our joint blog with National Voices coming out in the next few weeks.
National Patient Safety Alert
Profiling, adjustable or medical beds (beds) are used extensively in hospitals, care homes and people’s own homes. It is essential that these beds and associated equipment are used correctly and safely to minimize the risk of injury or death to bed occupants.
The Medicines and Healthcare products Regulatory Agency (MHRA) continue to receive reports of adverse incidents involving beds and equipment, the most serious leading to injury and death.
The following guidance, published by the MHRA sets out good practice, aimed at anyone with responsibility for the provision, prescription, use, maintenance, and fitting of beds and associated equipment. This includes the importance of appropriate staff training, correctly following manufacturers' instructions and adequate service and maintenance of beds and equipment.
Useful links:
- MHRA NPSA (relating to beds and equipment)
- MHRA bedrails guidance
- MHRA medical device guidance
- MHRA medical device checklist
It may not be immediately obvious to consider a bed as a medical device and it is worth noting although the medical device guidance doesn’t list profiling/adjustable beds as a medical device, the accompanying checklist does.
New online immigration status (eVisa)
We are advising you of a change to some immigration documents. Biometric residence permits (BRP) and biometric residence cards (BRC), are being replaced with digital proof of immigration, called an eVisa.
From 31 October, new visa applicants are being issued with eVisas, and existing visa holders who currently prove their rights with a BRP, BRC or a passport containing a visa vignette or ink stamp, will need to create a UKVI account to access their eVisa. This needs to be completed by 31st December 2024.
Some helpful guidance on how to create an eVisa account:
- Information on what people need to do and by when, including for those who hold a physical immigration document, and a list of grant funded organisations offering support
- Guidance videos explaining how to access and use eVisa
- Download the eVisa Partner Pack - this includes factsheets and guides for organisations, helpful materials to inform your colleagues/organisations you may collaborate with of the transition to eVisa, including a suggested email to send and drag and drop copy for intranets.
Download the eVisa Partner Pack
Urgent and emergency care survey 2024
A recent survey of over 45,500 people who used NHS urgent and emergency care (UEC) services in 2024 revealed generally positive interactions with staff. However, significant challenges were reported, including long waits for assessment and insufficient support for managing pain or controlling symptoms. This comprehensive survey examined the experiences of patients accessing Type 1 and Type 3 UEC services.
The survey used two tailored questionnaires to capture feedback for each service type. Results were analysed at both the trust level and the overall England level, providing a detailed view of patient experiences across the country. Type 1 services encompass A&E departments, often referred to as casualty or emergency departments, while Type 3 services include urgent treatment centres, commonly known as minor injury units. Importantly, the survey only considered services directly managed by acute NHS trusts.
Newsletter
A regular update for providers and professionals working in adult social care.
Feedback on ratings characteristics
Following the reviews into our regulatory approach led by Dr Penny Dash and Professor Sir Mike Richards we want to work with you to make improvements to how we regulate.
Over the next few months, we'll be offering opportunities to work with us to co-design elements of our regulatory approach, through sessions, surveys like this and more.
We’ve heard that you’d like more information on what we consider to be good and outstanding care.
To support this, we’re starting a period of engagement to help develop new ratings characteristics that will describe what we would expect to see at different ratings levels.
We're sharing a draft set of ratings characteristics. We want to know if you think these give enough information / which areas need more detail.
Watch the recording of our recent session on ratings characteristics.
Your Voice Matters: Join Our "Share For Better Care" Webinar - Empowering patients to improve health and social care through feedback
Patients' experiences can provide vital lessons for health and care services, helping them understand what is working and what needs improvement. However, not everyone knows how to speak up about their care, and health and care services could be better at telling people how they can provide feedback and why this matters.
The Patients Association is hosting a webinar on Wednesday 6 November 10-11 a.m. to discuss this issue.
Join the CQC, Healthwatch England, and the Patients Association to:
- Hear about their campaign, which aims to support more people to have their say on health and care services
- Understand the barriers that exist to giving feedback and potential solutions
- Listen to patients explain first-hand their experience of providing feedback and how this improved their care
- Discuss the current ways people provide feedback and what more can be done to ensure patients' voices are heard.
With the NHS currently consulting on its 10-year plan to reform, it's never been a better time to discuss how we can ensure patients have a stronger voice today and in the future.
Change NHS consultation
The NHS has been there for us for over 76 years. But to make sure the NHS is here for the next 76 years, doing all it can to support the health of everyone, they need your help.
They want to have the biggest ever conversation about the future of the NHS.
It doesn’t matter whether you have a lot or a little to say. Your views, experiences and ideas will shape a new 10 Year Health Plan for England.
This is open to everyone. If you are a member of the public or someone who works in health and care in England, go to start here, to tell us how the NHS needs to change.
If you are contributing as a representative of an organisation, complete the organisation questionnaire. This is an early opportunity to share your insights as we begin an extensive programme of engagement to develop the 10 Year Health Plan.
If you register your email address, NHS will stay in touch to seek your views as the 10 Year Health Plan develops.
Research reveals how older adults can thrive in a care home
‘Thriving in Residential Care’ is groundbreaking new research from My Home Life England, part of City St George’s, University of London, which reveals the diverse experiences of older people living in care homes across the UK.
One of the largest ever qualitative research studies on older people’s experiences of living in residential care, the research identifies some challenges, but reveals proportionally many more benefits of living in a care home.
The insights, heard directly from older people, care teams and families, shine a light on six key ways that older people can thrive in a care home, if the conditions are right.
Find out what supports older people to live well and thrive in residential care.
New trends in the adult social care workforce
Skills for Care’s new report highlights key workforce trends, including recruitment, retention, pay, and demographics and workforce projections. The report also explores factors impacting CQC ratings.
Key findings include:
- 1.705 million filled posts and 131,000 vacancies, bringing the total to 1.84 million—the highest on record.
- Turnover rates for care workers (29.9%) and registered managers (19.4%) were at their lowest since 2017/18.
- The proportion of male workers increased to 21%, up from 18% historically.
- The local authority and independent sectors workforce’s average age, which had been rising, dropped to 43.7 years in 2023/24
- These changes have been influenced by an increase in international recruitment. Internationally recruited workers were more likely to be male (29%) and an average age of 34.1.
These findings rely on data from the Adult Social Care Workforce Data Set, which helps providers access training funding and manage records.
Calling all health and adult social care professionals working in England!
The Institute for Employment Studies are researching workforce inequalities in health and social care and want to hear from you! They want to understand how employees with certain characteristics are unequally treated while at work, including discrimination, bullying or harassment, not being fairly considered for promotion, or not being able to get issues like these recognised or resolved when they arise.
The survey takes 20 minutes to complete and will provide evidence of how workforce inequalities are experienced and observed in the health and social care sector. The survey can be accessed here. The survey will close on 10 November. If you have any questions, please contact workforce-inequalities
Keeping information safe: Data protection and cyber security in social care
Care providers need to store and share information securely, on paper and digitally. It's essential to delivering person-centred care, based on good information. And it’s a legal and regulatory requirement.
Digital Care Hub are working with the Care Provider Alliance and their Better Security, Better Care team to understand the data protection and cyber security challenges you face. They will work with them to deliver free support on the key issues. To help them with this, please complete this short survey
You may be aware but a reminder of Digital Care Hub's new resources below:
- To tie in with cyber awareness month we have released new advice on how to deal with a cyber attack.
- Digital Care Hub welcomes the recommendations in the BCS Chartered Institute for IT’s landscape review of digitisation in social care.
- Transforming adult social care through digitalisation - a landscape review
- New case study on why Roses Homecare went digital
- Finally, new free training and support that new care services need to do around Data Security and Protection Toolkit.
Other news
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What approaches are being taken by regulators to tackle inequalities - and what actually works? CQC commissioned SQW, supported by The King’s Fund Library Service and Dr Tammy Boyce, to deliver a rapid evidence review and series of interviews to explore how regulators can tackle inequalities experienced by those using or needing services. The latest episode of SQW’s Insight for Impact podcast explores key learnings from this research. CQC’s Lucy Wilkinson joins guest speakers from the Equality and Human Rights Commission, the Institute of Regulation and SQW, to discuss the findings from the research, key themes and interesting takeaways. The podcast considers implications for CQC and for regulators in all sectors. Listen to the podcast.
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Registration fee invoices: Invoices are currently being sent by post to a provider’s registered address. If you are expecting an invoice and have not received it, please email NCSC
.Finance to request a copy. Please include your contact details and provider ID. We will email a copy invoice out as soon as possible. We are managing a large number of enquiries at present.@cqc.org.uk - In a recent guest blog, Robyn Chappell, Lived Experience Advisor, reflects on her experience as part of the Expert Advisory Group for a project with CQC and the Point of Care Foundation, funded by the Regulators’ Pioneer Fund, which is developing an engagement and health inequalities improvement framework for integrated care systems. We also share an update on how the project is progressing on our website.
- Moritz Flockenhaus, one of our Regulatory Policy Managers has published a blog with the AI and Digital Regulations Service for Health and Social Care on 'reflections on building the AI and Digital Regulations Service' - you can read the blog here.
- Subscribe to our WhatsApp channel, where we share the latest updates on our new regulatory approach.
Newsletter
A regular update for providers and professionals working in healthcare services
Re-building a trusted approach to our regulation
We have set out how we will drive the improvements needed to re-build trust in our regulation.
This involves making immediate changes to support our response to the recommendations in the interim report from Dr Penny Dash and to improve our ways of working ahead of the publication of the final report. These changes will help us to deliver:
- a clear and transparent programme of assessment and ratings
- quicker and more effective registration and assessments of providers
- simpler and clearer reports.
Visit our website to read a summary of the immediate changes we are making. We will share more details soon of what is happening and when. This will include further information on the frequency of assessment and when we expect to carry out more assessments.
New resource aimed at encouraging improvement in NHS maternity services
We have published a series of online resources to support NHS hospital maternity services, sharing good practices and encouraging improvement. Developed with input from providers, maternity staff, and stakeholders, these resources are designed for staff at all levels to enhance the quality of care and drive positive change.
The resources, which complement our recent national maternity inspection report, focus on four key themes:
- leadership and culture
- safety incidents
- triage processes
- healthcare equity.
Each theme offers guidance on what good practice looks like, what we assess during inspections, and examples of excellence. We invite feedback through our pop-up survey on our website to help us refine and expand this online resource.
Ionising Radiation (Medical Exposure) Regulations annual report 2023/24
The Ionising Radiation (Medical Exposure) Regulations (IR(ME)R) protect individuals from accidental or unintentional exposure to ionising radiation in healthcare settings. Healthcare providers must notify us of incidents that meet reporting thresholds. Our annual report outlines the number and types of errors reported between 1 April 2023 and 31 March 2024, along with key findings from our inspections and enforcement activities during that period.
In 2023/24, we received a total of 819 notifications across all modalities. These incidents represent a small proportion of over 30 million diagnostic imaging exams and 116,000 radiotherapy treatments conducted. Common issues included errors resulting from inadequate identity checks and staffing shortages. The report identifies recurring concerns and offers practical actions for employers to improve safety and compliance with regulations.
Note to providers: With effect from 1 October 2024, IR(ME)R 17 will be amended to the Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024 - or 'IR(ME)R Amendments 2024’.
Statutory Instrument and Explanatory memorandum: The Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024 (legislation.gov.uk) and The Ionising Radiation (Medical Exposure) (Amendment) Regulations 2024 (legislation.gov.uk).
The accompanying IR(ME)R guidance has also been updated to support interpretation of the new provisions: Ionising Radiation (Medical Exposure) Regulations 2017: guidance - GOV.UK (www.gov.uk).
Notifications
There are a range of statutory notifications that every provider must report to CQC. The legislation allows NHS trusts to submit some statutory notifications via the national system commissioned by NHS England. This used to be the National Reporting and Learning System (NRLS) and is now Learn from Patient Safety Events (LfPSE). This is set out in notifications guidance for providers.It is important to note that independent providers must still make direct notifications to CQC. This is because of the way the legislation is written. This means that, even if an independent provider is able to report the incident via the national system set up by NHS England, they must also make a direct notification to CQC.The August edition of our provider bulletin did not make this distinction, but we hope this is now clear.
Notifications guidance for providers
Workforce inequalities in health and social care survey
The Institute for Employment Studies are researching workforce inequalities in health and social care and want to hear from you.
They want to understand how employees with certain characteristics are unequally treated while at work, including discrimination, bullying or harassment, not being fairly considered for promotion, or not being able to get issues like these recognised or resolved when they arise.
The survey takes 20 minutes to complete and will provide evidence of how workforce inequalities are experienced and observed in the health and social care sector, providing a better understanding of the frequency and types of workforce inequalities. If you have any questions, please email workforce-inequalities
Other news
- Subscribe to our WhatsApp channel, where we share the latest updates on our new regulatory approach.
- Moritz Flockenhaus, Regulatory Policy Manager at CQC, has published a blog with the AI and Digital Regulations Service for Health and Social Care on 'reflections on building the AI and Digital Regulations Service'.
- Adult Community Mental Health Trusts – Requests for information - We’d like to thank colleagues at Adult Community Mental Health Trusts (ACMHT) who responded to our recent requests for information to support our understanding of ACMHT individual services and teams, and to understand what actions have been taken following the special review of mental health services at Nottinghamshire NHS Foundation Trust. We are also holding 3 provider engagement events in early November for ACMHT to support with our planning of ACMHT thematic reviews. The nominated individual from your trust will have received the invite to these events and asked to nominate 2 individuals to attend. We look forward to seeing you there.
- In a new guest blog, Robyn Chappell, Lived Experience Advisor, reflects on her experience as part of the Expert Advisory Group for a project with CQC and the Point of Care Foundation, funded by the Regulators’ Pioneer Fund, which is developing an engagement and health inequalities improvement framework for integrated care systems. We also share an update on how the project is progressing on our website.
As part of the CQC teams’ regular updates and engagement sessions, please see the latest slide deck for information. If you have any questions, or need further support, please email CQCTeam
Newsletter
Our monthly update for everyone interested in health and social care
Final part of our special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust published
Following the conviction of Valdo Calocane in January 2024 for the killings of Ian Coates, Grace O’Malley-Kumar and Barnaby Webber, Rt Hon Victoria Atkins MP, former Secretary of State for Health and Social Care, commissioned us to carry out a rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT).
We were asked to look at 3 specific areas:
- A rapid review of the available evidence related to the care of Valdo Calocane
- An assessment of patient safety and quality of care provided by NHFT
- An assessment of progress made at Rampton Hospital since the most recent CQC inspection activity
We looked at areas 2 and 3 in a report published earlier this year.
Our review looking at area 1 has now also been published.
This review finds that there appear to have been a series of errors, omissions, and misjudgements in Valdo Calocane's care. Key among these were:
- Inconsistent approaches to risk assessment.
- Poor care planning and engagement.
- The decision to discharge Valdo Calocane back to his GP in September 2022
The review also found that if the decision had been made to treat Valdo Calocane under section 3 of the Mental Health Act (MHA) 1983 on his fourth admission to hospital further options would have been available for his care and treatment in the community.
- Press release: CQC publishes final part of special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust
- Special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust: Part 2
Adult inpatient survey: Find the results for your local trust
We asked over 63,500 people who stayed in hospital for at least one night in late 2023 about their care.
The survey asked people to give their opinions on the care they received, including quality of information and communication with staff, whether they were given enough privacy, the amount of support given to help them eat and drink, and on their discharge arrangements.
Nationally, results covering waiting times have continued to decline.
People’s experience of being discharged from hospital also remained poor. Only 33% of respondents said they were involved ‘a great deal’ in decisions about their discharge.
However, the majority of respondents were still positive about their interactions with doctors and nurses - as has been the case in previous years.
- Adult inpatient survey 2023
- Find the results for your local trust
- Press release: More people report poor discharge experiences and deterioration in health while waiting for treatment but interactions with staff are largely positive
- Other NHS patient experience surveys
Six local authority assessments published
We have published 6 new reports under our new responsibilities to assess how local authorities are meeting their responsibilities to make sure people have access to adult social care and support.
The six new reports look at:
- Bracknell Forest Council, rated good
- London Borough of Brent, rated requires improvement
- County Durham, rated good
- Derby City Council, rated requires improvement
- Derbyshire County Council, rated good
- Hertfordshire County Council, rated good
The reports look at 9 areas spread across 4 themes to check how well the authority is meeting their responsibilities. Each area is given a score out of 1 to 4. A score of 1 is given when evidence shows significant shortfalls for this area, and 4 when evidence shows an exceptional standard is being met.
- Local authority assessment reports
- Bracknell Forest Council: local authority assessment
- London Borough of Brent: local authority assessment
- County Durham: local authority assessment
- Derby City Council: local authority assessment
- Derbyshire County Council: local authority assessment
- Hertfordshire County Council: local authority assessment
Looking at the support adult social care services receive on the safe management of medicines
We commissioned research company Ipsos to look at what support adult social care providers receive to make sure medicines are managed safely. We also asked them to look at how the support impacts the quality of care providers are able to deliver.
The research found that adult social care services have access to a wide range of different types of medicines support from a variety of sources, but that not all care providers receive support from community pharmacy or other healthcare professionals.
Providers also told the researchers that further support would be welcomed in the form of training, consistent advice and guidance and easier contact with pharmacies and healthcare professionals.
This work was carried out as part of our research and evaluation programme. The programme helps us:
- understand what makes a good service and how we can help providers improve
- become a smarter and more flexible regulator
- check and understand our impact
We share what we find. This is to help drive improvement in health and care and make sure all parts of the system are using the same evidence base.
- Provider survey: Medicines support in adult social care
- About our research and evaluation programme
- External reports and research
Annual report and accounts published
Our Annual report and accounts (ARA) look at our progress and performance during 2022 to 2023.
The first part of the report looks at the work that we've done, progress towards our objectives and targets, and our impact as a regulator.
The report also gives an overview of the funding we receive, where our expenditure is incurred and how we aim to demonstrate value for money.
Newsletter from CQC
Our monthly update for everyone interested in health and social care
Our response to the interim findings of the Dash review into our operational effectiveness
Dr Penelope Dash has published the interim findings of her review of our operational effectiveness.
This interim report gives a high-level summary of Dr Dash's early findings. It has been published to help shape the changes needed to start the process of improving CQC.
In response, Kate Terroni, our interim chief executive, said:
"We accept in full the findings and recommendations in this interim review, which identifies clear areas where improvement is urgently needed. Many of these align with areas we have prioritised as part of our work to restore trust with the public and providers by listening better, working together more collaboratively and being honest about what we’ve got wrong.
"We are working at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve."
Professor Sir Mike Richards has been appointed to conduct a targeted review of how the single assessment framework is currently working for NHS trusts and where we can make improvements.
Kate was appointed interim Chief Executive at the start of the month, after Ian Trenholm's departure. Following her appointment, Kate set out 3 urgent and immediate areas of action:
- Improve how we’re using our regulatory approach
- Fix and improve the portal that providers use to share information with us
- Rethink our ways of working
We'll be updating our website with more information about our change programme in the coming weeks.
- News: Response to the interim findings of the Dash review into CQC's operational effectiveness
- GOV.UK: Review into the operational effectiveness of the Care Quality Commission: interim report
- Update: Responding to concerns about changes to our regulation
- Change at CQC
Helping integrated care systems reduce health inequalities
Four integrated care systems (ICS) will be testing a new framework looking at how they speak with people and communities. The framework helps ICSs check how effective this work is at reducing health inequalities.
The framework has been developed by CQC, National Voices and the Point of Care Foundation.
National Voices and the Point of Care Foundation led the recruitment of ICSs through an open applications process. They received expressions of interest from 11 ICSs and selected 4 for testing:
- Black Country ICS
- Gloucestershire ICS
- Hampshire and Isle of Wight ICS
- Nottingham and Nottinghamshire ICS
The successful ICSs were chosen to make sure there was a mix of demographics, geography, level of deprivation and experience in addressing health inequalities. The testing phase will take place during the autumn.
This project is supported by a grant from the Regulators' Pioneers Fund, and work began in February 2024.
Our update on the safer management of controlled drugs
Earlier this month we published our annual update on the safer management and use of controlled drugs.
The report shares important insight on the use of controlled drugs in health care and adult social care services.
The annual update draws on prescribing data, feedback from controlled drug local intelligence networks, and our wider inspection and regulatory work. The report will help people working with controlled drugs to strengthen the arrangements for their safe management and use.
- News story: Controlled drugs annual update report for 2023
- Report: The safer management of controlled drugs: Annual update 2023
- Controlled drugs annual updates from previous years
- Guidance for providers: Controlled drugs
Our annual report looking at the quality of care in Defence Medical Services
We've published our latest annual report looking at our independent inspections of Defence Medical Services (DMS).
The Defence Medical Services provide medical care for members of HM Armed Forces. We inspect defence medical treatment facilities to ensure that armed forces personnel and their families have access to the same high-quality care as the rest of society. Our annual reports highlight the key findings from inspections.
In 2023/24, we carried out first inspections and follow-up inspections of services including: medical centres, dental centres, community mental health services, a regional rehabilitation unit, and the Pre-Hospital Emergency Care (PHEC) service for British Forces Cyprus.
- Report: CQC's inspection programme of Defence Medical Services: Annual report for 2023/24 (Year 7)
- Defence medical services annual reports from previous years
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Following on from the CQC Inspection in 2023, the trust received 12 Must Do and 30 Should Do actions.
The actions have been progressed through the CQC action plan via Divisional oversight with reporting into the Trustwide CQC Action Plan Assurance Group.
We are now seeing continuing progress for CQC actions with many closed down or in the close down process.
In preparation for discussion at the next Trustwide CQC Action Plan Assurance Group meeting scheduled for Tuesday 13th August 10.30 - 11.30am, divisions are asked to consider the following questions to feedback on:
- Could the same CQC issue be picked up in other service areas within or across divisions?
- As a division have you rolled out the improvements across relevant service lines or services where the CQC issues could occur?
- What do we need to do to make this happen?
Newsletter
Our monthly update for everyone interested in health and social care
Ian Trenholm to step down
Ian Trenholm, our Chief Executive, has announced his intention to step down from his role of Chief Executive and as a Board member at the end of the month.
Reflecting on his decision, Ian said:
"During my six years leading CQC, we have made important changes to the way we work in order to help improve care and keep people safe. We are now in the final stages of delivering an ambitious transformation programme - this month saw the delivery of the last big milestone in a complex and challenging programme of work.
"While there will always be more work to do, the conclusion of this stage of the transformation feels like a good time to move on. It has been a privilege to work with such a passionate, committed and talented group of colleagues.
"I am incredibly proud of what we have achieved together, and I am confident that the organisation will continue to evolve to help support the health and care system to provide good, safe care for people."
Kate Terroni, CQC's Deputy Chief Executive will be appointed as Interim Chief Executive. A permanent appointment will be made in due course.
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Catch up with the latest blog posts from CQC
Take a look at our latest blog posts:
Exploring our community mental health survey results
In this blog from last month, Chris Dzikiti, our interim Chief Inspector of Health Care, explores the results of the latest community mental health survey, focusing on new insights on child and adolescent mental health services.
Progressing the Patient and Carer Race Equality Framework
Chris Dzikiti and Dr Jacqui Dyer, Mental Health Equalities Advisor at NHS England, talk about the work our two organisations are doing to implement the Patient and Carer Race Equality Framework (PCREF).
See our other blog posts
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Please see the below link to our CQC notifications guide, there will be no changes in here to what you are already doing as a division in terms of notifications to CQC but this slide deck will ensure that you have the current information and links all in one place. Guidance and forms can change regularly but the links on the page will always take you to the most recent updates and forms to be used.
Location code is something we are asked for quite frequently and so we have added these in (slides 11/12/13).
We hope this is helpful but if you do have any questions at all please let us know and we will be happy to talk you through any element of this.
Updated presentation - Managers Guidance to a CQC Inspection for 2024.
The QRV report is subject to ongoing review and consultation but we will be linking this review to the published reports that CQC make available following their initial inspections using the new Single Assessment Framework (SAF). We anticipate that the SAF will have a real focus on Safe and Well Led areas therefore we’re currently prioritising reviews of the following –
- S1. Learning culture (Safe) – went live 1 June 2024 replacing S1. Incident reporting, including Serious Incidents
- S3. Safeguarding (Safe)
- S7. Infection prevention and control (Safe)
- S8. Medicines optimisation (Safe)
- W7. Learning, improvement and innovation (Well Led)
- W8. Environmental sustainability – sustainable development (Well Led)
As part of the CQC teams’ regular updates and engagement sessions, please see the latest slide deck for information. If you have any questions, or need further support, please email CQCTeam
Guidance on visiting in care homes, hospitals and hospices
On 6 April, new regulations came into effect covering visiting and accompanying in care homes hospitals and hospices and will be part of Care Quality Commission (CQC) inspections going forward.
CQC has published provider guidance to explain how providers can meet the new standard. In addition, the Department of Health and Social Care recently held a series of webinars to help providers understand what is required under the new standard and how it will be enforced by CQC. The recordings of the webinars have been linked in the frequently asked questions document.
If you have any questions, please contact: visiting
Retaining our overall Good CQC rating and Outstanding for well led and caring - 14 April 2023
Mersey Care has again been awarded an overall ‘Good’ rating from the Care Quality Commission (CQC), following an in-depth inspection carried out between November 2022 to January 2023. The Trust continues to be recognised as ‘Outstanding’ for the ‘Well Led’ domain and has now also been recognised as ‘Outstanding’ for the ‘Caring’ domain.
We had two announced and four unannounced inspections at six of our mental health and community health services, as well as one unannounced inspection of Wavertree Bungalow. Across the Trust, 41 inpatient wards/teams were inspected in total. As a requirement of the external re authorisation process, Ashworth Hospital was also visited.
Receiving an overall ‘Good’ rating and improving on the number of overall ‘Outstanding’ domains is a real achievement and a testament to all the hard work and innovation to which every one of you has contributed. This outcome is good, given that the inspection was so soon after the pandemic and just a year after the acquisition of the former North West Boroughs NHS Foundation Trust (NWB) and Southport and Formby community services (SFCS).
Three of the mental health services inspected were rated ‘Good’ and one was rated ‘Requires Improvement’. Two of our community health services were also rated ‘Good’. Wavertree Bungalow was rated ‘Requires Improvement’.
The inspection was not only an opportunity to showcase our work but also to look at our organisation through a different lens. The report describes our organisation as well-managed, and highlights areas of ‘outstanding practice’ in: using data to generate new patient/service insights, allowing staff time to focus on continuous learning and innovation, listening to patients, embedding our reducing restrictive practice work, heading up the first NHS led Global Centre for Research on Mental Health Inequalities and introducing quality improvement initiatives into community inpatient services.
We have recommendations to address, such as improvements to our estate, role specific autism training, and - consistent with other NHS trusts - how we respond to recruitment and staffing challenges, and the impact these pressures have on our patients, service users and staff.
The former Liverpool Community Health NHS Trust inspection and ratings from 2018 have been incorporated into our new ratings, without an inspection of these services, which impacted on the safe and effective domain ratings. We look forward to a re-review of these services so that the great improvements that we know have happened are accurately reflected in our overall rating.
It is worth saying again that this is also our first CQC inspection since the COVID-19 pandemic and the acquisition of NWB and SFCS. We fully recognise it takes time to assimilate teams, services and align cultures. However, this inspection describes very well how we have managed to carry out this change whilst keeping a strong sense of continuous improvement in place.
The Board of Directors hugely appreciate your tremendous efforts to make sure our patients, service users, carers and families receive the treatment, care and support they need. Your dedication, kindness, professionalism and compassion shine through the report and we should all be rightly proud of our collective achievements and the difference we make to the communities we serve.
CQC will continue to monitor our Trust and check improvements have been made, where required.
A huge thank you for all you do, each and every day, and well done.
The Wavertree Bungalow and Well Led Reports are available on our website. New certificates will be distributed in due course.
Information Request System Development - 11 September 2023
As part of continuous improvement, in collaboration with IT colleagues, we are developing a new SharePoint based system to aid and streamline the CQC information request process.
The key objectives of this system development are –
- to standardise and automate Trust wide processes for responding to both ad hoc and inspection CQC information requests wherever possible whilst ensuring strict timeframes set by the CQC are met; and
- to streamline the divisional and corporate sign off process to improve transparency and efficiency.
The key outcomes of this system development are –
- that processing CQC information requests in a standardised and automated Trust wide process will become business as usual for all staff to avoid multiple processes being used. This will reduce confusion around processes, and improve clarity around timescales for responses to be provided and signed off; and
- that streamlined divisional and corporate sign off processes updated on the system at each stage of the information request will provide transparency for all staff involved with the information request as to its progress at any given time. This will significantly reduce email traffic and confusion around the progress of information requests and will provide clarity around accountability for the information provided.
This work is ongoing and we will keep you updated as progress is made. In the meantime, all CQC information requests continue to be disseminated by our team via email.
CQC Preparedness Sessions - 12 September 2023
The next CQC Preparedness Session, led by Sandra O'Hear, Deputy Director of Nursing and Quality, will be held on 24th October 2023. These sessions are to ensure that all managers and senior leads are informed of the latest developments from CQC and also receive key messages from corporate leads such as Estates and Patient Safety. If you would like more information or have any queries regarding this, please contact the CQC Team at CQCTeam@merseycare.nhs.uk.
Quality Review Visit (QRV) changes - 17 October 2023
Following the Care Quality Commission (CQC) inspection, we introduced changes to our QRV process to make sure QRVs continue to fully assist us to improve the quality of care we provide to our patients, service users and their carers. These changes also aim to help us prepare better for future inspections.
The additional three new Safe domain standards relate to patient harm, waiting times and caseloads and are subject to ongoing discussion. Whilst these new standards remain important and valid, we recognise that there is a need for greater understanding and clarity on what the gold standard looks like for rating and evidencing.
We want our leaders to feel better equipped to respond well to QRV standards and to engage in future changes to QRVs. Therefore, it’s been agreed that these new standards will be reviewed and redefined by senior Trust and divisional leads.
Although QRV leads will continue to ask teams to supply evidence and respond to questions in relation to the three new standards, this will be for the purpose of refining and defining exactly what’s required. Therefore, ratings for these standards will be paused and temporarily disabled (by rating them as N/A) until 1 January 2024.
Already published QRV reports which include the new Safe domain standards will be retrospectively re-rated over the coming weeks. As such, some team’s Safe domain and overall ratings may change - team leaders will be kept informed.
Alongside these changes, a record will be maintained of how the three new Safe domain standards have been rated. This will be a manual data set available for any required data analysis but it will not be accessible Trust wide.
Trust and divisional leads will be contacted to take part in these valuable ongoing discussions to make sure the clarified ratings and evidence requirements are confirmed and ready for the go live date on 1 January 2024.
Update - Since 1st January 2024, the new Safe domain standards relating to waiting times and caseloads were reintroduced. There are ongoing discussions regarding the new Safe domain standard relating to patient harm which is expected to be reintroduced later in 2024 as part of the new Learning Culture area of enquiry.
CQC Preparedness Session - October 2023
As part of the CQC teams’ regular updates and engagement sessions, please see the latest slide deck for information. If you have any questions, or need further support, please email CQCTeam
CQC's New Regulatory Approach - roll out January/February 2024
From 23 January 2024, CQC will start using the new regulatory approach with a small number of providers in the North and Midlands regions. From 6 February 2024 CQC will start using the new regulatory approach with all providers in the North and Midlands regions and will include NHS well-led assessments.
New poster for mental health wards - 11 December 2023
New poster for mental health wards
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CQC have recently updated their webpage about how people can make a complaint about the Mental Health Act. This includes care while:
- detained in hospital
- on a guardianship
- under a community treatment order.
The Trust has arranged for the posters to be professionally printed and will be sent out to team team in the coming days.
It is a requirement that anyone detained under the Mental Health Act must be helped to understand how to make a complaint if they wish to.
MHA patient information leaflet
CQC have shared some information for any patients detained under the Mental Health Act. The booklet aims to help our patients to understand their rights to meet one of our Mental Health Act Commissioners when CQC are visiting a hospital ward, and what they can expect from CQC.
The information also explains patient rights about taking medication and how to complain if they need to.