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.
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Update from CQC
2 November 2023
A regular update for providers and professionals working in healthcare services
New assessments starting from 21 November in our South region
Two healthcare professionals sat at a table, smiling. The picture is greyed out, with an orange and green border, with the words 'the world of health and social care is changing. So are we.' written across the bottom of the picture.
From 21 November we will start using our new single assessment framework in our South region.
Between 21 November and 4 December we will undertake a small number of planned assessments with 14 early adopter providers, whilst continuing to respond to risk. We will then expand our new assessment approach to all providers based on a risk-informed schedule.
We are sharing more information with providers in the south separately and will be in touch with providers in other areas of the country to confirm when we'll start using our new approach with them shortly.
Read more on how we're implementing
NOTE: At this stage our new assessment approach will not apply to services we do not rate or NHS trust well-led assessments. We'll be in contact with those providers with the detail of how we'll roll out our new approach with them.
The South region includes services registered in these counties: Berkshire, Buckinghamshire, Cornwall, Devon, Dorset, Gloucestershire, Hampshire, Kent, Oxfordshire, Somerset, Surrey, Sussex and Wiltshire.
Combination of cost-of-living crisis and workforce pressures risks ‘unfair care’ – longer waits, reduced access and poorer outcomes for some
Our annual assessment of the state of health and adult social care in England looks at the quality of care over the past year.
This year has been a turbulent one for health and social care. In addition to the ongoing problem of ‘gridlocked’ care highlighted in last year’s State of Care, the cost-of-living crisis is biting harder for the public, staff, and providers – and workforce pressures have escalated. This combination risks leading to unfair care – where those who can afford to pay for treatment do so and those who can’t face longer waits and reduced access.
Read the full report on our website.
Share your feedback on our latest guidance
We've recently published some new provider guidance that describes the evidence we'll use to assess individual quality statements for different types of providers.
We want to make sure this guidance gives you the information you need to understand this part of our new approach.
To help us understand that we'd like your feedback on the guidance.
Planning for winter pressures
Winter is always a challenging time for health and social care. Our recent blog discussed these challenges and our role in encouraging system working and maintaining standards of quality.
In this update we explain our approach over the coming winter, including how we will support providers to manage risk, continue to prioritise our visits to providers, and act on concerns from the public and stakeholders.
Our focus remains on making sure people who use health and social care receive the quality of care they need and deserve.
Launch of the Patient and Carer Race Equality Framework
On Friday 3 November NHS England will launch the Patient and Carer Race Equality Framework (PCREF), which aims to support mental health trusts to tackle and improve racial health inequalities.
NHSE are holding a webinar on Friday 3 November at 10.30am which is free to attend and will cover:
- An overview of the PCREF from a national perspective
- Hearing from people with lived experience of mental health care
- How pilot trusts have implemented the PCREF locally
- The work of voluntary sector organisations in embedding the framework in partnership with pilot trusts
- Q&A session with all speakers
Register for this event and view the full agenda.
The PCREF is relevant to mental health trusts and mental health providers, i.e. all providers who are in receipt of public sector funding supporting patients/carers/communities in the access of, and experience and outcomes of, mental health services.
CQC teams will start to make enquiries about providers’ awareness of the framework and plans to embed it from the 3 November. They understand it will take time to embed and will take a supportive and proportionate approach to assessing compliance.
If you have queries relating to our assessment of the implementation of the framework, please get in touch.
Consultation: regulatory fees for integrated care system assessments
This consultation sets out our proposed approach to recovering our regulatory costs for assessing integrated care systems by charging integrated care boards an annual regulatory fee.
We have a new duty to carry out an independent review and performance assessment of integrated care systems. This enables us to provide additional assurance to the public of the quality of care in their area.
The consultation closes at 12 noon on Thursday 21 December 2023.
Other news
- New guidance on caring for people with heart failure on virtual wards available. NHS England’s new guidance on caring for people with heart failure on virtual wards is a key resource for teams looking to set up heart failure virtual wards and other clinical teams looking to support people with heart failure in their existing virtual ward(s). Read the guidance and the blog.
- In the second of our 'CQC is changing' webinar series, you can hear from Amanda Hutchinson, Head of Policy, Regulatory Change and Dave James, Head of Adult Social Care Policy. Amanda and Dave introduce quality statements and evidence categories, and the role they play in our new regulatory approach. We talked through where these two elements fit in the wider new regulatory approach and what guidance is available to help you understand them. Sharing example quality statements to explore how we’ll use evidence categories to identify specific sources of evidence to use in our assessments.
- During the summer, we’ve heard from providers that they need more guidance before they feel ready to adopt new ways of working. We’re still developing our guidance and we’ll continue to involve providers in that development through Citizenlab, our webinar series, and more. You still have time to contribute to our Citizenlab survey on provider guidance, which will remain open until 1 November 2023.
- The CQC Medicines Optimisation Team has secured funding to conduct research into how we can accelerate change to ensure the sustainable use of medicines and decrease the environmental impact of medicines use. Please take part in our short survey and support this research. Even if you are not actively working on this just now, we are keen to hear your views. The survey is open until 30 November 2023.
- The NHS Clinical Entrepreneur Programme (CEP) InSites Pilot Programme aims to enable real world testing and evaluation to help spread innovation across the NHS. It is inviting new organisations to join the year 2 of the pilot programme. This is open to integrated care systems and NHS trusts across acute, specialist, children's, mental health, community and ambulance sectors. Applications close on 3 November. Find out more.
- As of 1 October 2023, the Maternity and Newborn Safety Investigations (MNSI) programme is now hosted by CQC. This move will enable high-quality, independent, family focused maternity investigations to continue. There will be no change to operations or workforce and there will be no interruption to ongoing investigations
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
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.
CQC update for healthcare professionals
The independent regulator of health and social care in England
Update from CQC
28 September 2023
A regular update for providers and professionals working in healthcare services
New guidance: Evidence categories
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The first piece of guidance we have shared is about the types of evidence we'll look for as part of assessing each quality statement. We want to share this now, so you have time to read and understand it, as well as sharing your feedback on whether it works for you.
We have grouped different types of evidence under 6 evidence categories. Each category sets out the types of evidence we look at to understand:
- the quality of care being delivered
- the performance against each quality statement.
This is to make our judgements more transparent and consistent.
We will make clear what we look at in our assessments, by setting out the evidence categories that we’ll focus on for each quality statement.
We would appreciate your feedback on whether the guidance works for you. Log into CitizenLab to take the survey.
If you're not already a member of CitizenLab, you can register today.
Explore our guidance on evidence categories
Adult inpatient survey 2022: results
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The 2022 adult inpatient survey captures the views and experiences of more than 63,000 people who stayed in one of 133 acute and specialist NHS trusts in England for at least one night during November last year. It's been carried out annually since 2002.
Most people who completed our 2022 survey said they had a positive experience in their interactions with doctors and nurses, being included in conversations and having confidence and trust. This has stayed roughly the same since 2021.
Overall, this is consistent with other aspects of the survey, however hospital waiting times, staffing levels, patient discharge and overall experience in particular, appeared to decline.
Review the survey results, including open data, supporting information and further breakdowns for individual NHS England trusts, below.
Protocols for use of intramuscular (IM) Clozapine for inpatients
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It has come to our attention that many local protocol documents advise incorrectly that Mental Health Act (MHA) Second Opinion Appointed Doctor (SOAD) approval must be sought in order to prescribe IM Clozapine.
MHA SOADs are only required in the circumstances described in section 58 of the MHA. There is no additional specific requirement under the MHA to certify IM Clozapine treatment in any other circumstance. Local IM Clozapine protocols should be reviewed to ensure this reflects this position.
Planning for the coming winter
Photograph of a hospital road sign that reads from the top: Accident & Emergency (below) Out of Hours Service
“We want to help organisations understand where they need to focus. We’re not doing this to be punitive or catch people out. We’re doing it so organisations can have a better appreciation of areas they may need to focus on so that people get good quality, safe care. We want to be able to help providers to pinpoint the key issues – some of which aren’t always immediately obvious — so they can direct efforts to where they are needed most” — Dr Sean O'Kelly
We know winter is one of the most difficult times of year for the health and care system.
We speak to Dr Sean O’Kelly, Chief Inspector of Healthcare, and Dr Prem Premachandran, Emergency Medicine Consultant, Frimley Health NHS Foundation Trust and CQC National Professional Advisor – Urgent and Emergency Care, about some of the challenges and the role of the regulator in encouraging system working and maintaining standards of quality.
Patient FIRST updates
Photograph of an ambulance in motion - the background is blurred to suggest it's moving quickly
We recently made updates to our Patient FIRST resource.
Since we first published it, and since the height of the COVID-19 pandemic, references to infection control procedures have changed.
Help shape CQC: have your say
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We're always keen to hear from you to help us to shape how we work. Sign up to our online participation platform CitizenLab today, to share your ideas and feed back on live projects.Currently, we'd love to hear from you about:
- Our guidance on evidence categories: does the information we've provided meet your needs?
- Medicine sustainability: our research aims to drive innovation and accelerate improvement in medicine sustainability – and the views and experiences of all colleagues in health and social care providers will help support this.
Other news
- The next webinar in our transformation series will introduce our quality statements and evidence categories, and the role they play in our new regulatory approach. Join Dave James, Head of Policy – Adult Social Care and Amanda Hutchinson, Head of Regulatory Change, on Thursday 12 October, from 3.30 to 4.30pm. (Please register before 12pm on Thursday 12 October. The webinar will also be available on YouTube – we’ll let you know when it’s available).
- We've started the assessment process on our 2 pilot integrated care systems (ICSs). Each pilot system has received a request for information from us. Discover more about what the process involves, and its next steps.
- The Department of Health and Social Care (DHSC) has launched a consultation to understand if the guidance for training on learning disability and autism is good enough. If you haven't already, please review the easy-read Oliver McGowan draft code of practice and respond before the consultation closes at 11.59pm on 16 October 2023.
- The Medicines and Healthcare products Regulatory Agency (MHRA) has recently shared updated guidance in response to reports of deaths and serious injuries from entrapment or falls relating to medical beds, bed rails, trolleys, bariatric beds, lateral turning devices and bed grab handles. Where relevant, please take action as soon as possible and complete by 1 March 2024
Follow us on Twitter!
Follow @CQCProf on Twitter to get regular updates about the work we are doing with professionals and provider organisations in England.
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.
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 update for healthcare professionals
The independent regulator of health and social care in England
Update from CQC
31 August 2023
A regular update for providers and professionals working in healthcare services
Our new cross-sector policy position on restrictive practice
Photographs of Chris Dzikiti and Rebecca Bauers. Pull-quote on the left-hand side reads: Reducing restrictive practice is everyone's responsibility. (...) We all can and must do better to eliminate the inappropriate use of restrictive practice in health and social care.
We know that the use of restrictive practices, including restraint, seclusion and segregation, can have a devastating impact on people and cause them trauma.
Earlier this year, members of our expert advisory group for autistic people and people with a learning disability told us we needed to address the issue head on and develop a clearer and stronger position on the use of restrictive practice.Rebecca Bauers, our Interim Director of People with a Learning Disability and Autistic People, and Chris Dzikiti our Director of Mental Health, discuss our new cross-sector policy position on restrictive practice and how this translates to providers and people who use services.
Webinar now available: New regulatory approach and provider portal roll out
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The first webinar in our transformation series, this episode focuses on how we'll roll out our new regulatory approach and provider portal to all health and social care providers.
We also let you know when we expect to start using our new regulatory approach and the steps we’ll take to get there.
This one-hour webinar is led by Chris Day, our Director of Engagement, and Amanda Hutchinson, our Head of Policy, Regulatory Change. It’s an opportunity to hear the latest updates about our new regulatory approach.
There were some technical issues during this webinar and unfortunately, some of the presentation slides were cut off. Access the full slide deck.
Avoiding harm and breaches to fundamental standards: case study
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In September 2021, a service user was able to access and exit out of a first-floor window at an acute hospital. The service user fell from the window and received multiple spinal fractures. The investigation we completed concluded that there was a breach by the Registered Provider of Regulation 12(1) and 22(2)(a) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, resulting in avoidable harm to the service user. There was no window restrictor fitted, allowing unrestricted access as well as ineffective governance systems in that there was no planned preventative maintenance programme (PPM) in place. A Fixed Penalty Notice in the sum of £4,000 was issued to the Registered Provider.
We view breaches of the fundamental standards very seriously. The decision to issue a fixed penalty notice as an alternative to prosecution was based on the circumstances of this case and was not a decision taken lightly. Given the serious nature of this incident however, if an incident of this type were to happen again, we would have no hesitation in prosecuting accordingly.
Since the incident occurred, the hospital has taken steps to ensure it does not happen again. This included conducting a site-wide inspection of windows to ensure windows are adequately restricted. They have also implemented a 3-monthly PPM schedule for windows maintenance to be fully documented and audited. Further, twice annual reviews of windows by Estates Management has been introduced with PPM compliance and window restrictor governance reports completed.
Notice: Expiry of Form T3
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Historically, the Mental Health Act Commission took the view that Form 39 – now Form T3 – should not be over 2 years.
Our position is that there is no time limit for a Form T3, unless one is stated on the form by the Second Opinion Appointed Doctor (SOAD), or a change in circumstances renders the form ineffective. Paragraph 25.83 of the Code of Practice provides guidance on those circumstances.Approved Clinicians (ACs) and staff responsible for administering treatments should continue to ensure that this is covered by a statutory certificate where this is required. ACs must also submit reports under Section 61 when required.
Help shape CQC: have your say
Digital illustration of four red hands raised towards letters that spell out 'Your say' against a plain cream background
We're always keen to hear from you to help us to shape how we work. Sign up to our online participation platform CitizenLab today, to share your ideas and feed back on live projects.Currently, we'd love to hear from you about:
- Improving CitizenLabWe'd love to know how we can improve the projects we share on CitizenLab, to make sure we hear people's views and experience of health and social care.
Other news
- Give your views by 19 September 2023: learning disability and autism training for health and social care workers. The Oliver McGowan draft code of practice sets out how providers of health and social care can make sure their staff receive training in autism and learning disabilities suitable for their role. What you tell the Department of Health and Social Care (DHSC) about the code of practice will help shape the final version of the code. The code of practice is named after Oliver McGowan, whose tragic death in 2016 highlighted failures in care that could have been prevented. We believe that it is essential that autistic people and people with a learning disability have access to safe, high-quality care. We have worked with DHSC to shape this code of practice.
- Look out for an email about our Annual Provider Survey, which is due to go live next week and will close on 29 September 2023. This survey is your chance to share your feedback about CQC – a real opportunity to tell us what you think about our strategy and ambitions for the future. The more survey responses we receive, the better informed we are, and the better able we are to fulfil our purpose.
- NHS Confederation has published practical guidance to support the adoption and scaling of proven innovations in healthcare. It identifies learning from case studies that have successfully adopted and scaled innovation and highlights key issues to consider to help ensure success.
- Learning from safety incidents: new resource on protecting people using wheelchairs available. People who use health and social care services should be protected from injuries when using wheelchairs. Explore what happened, how we and the provider involved have responded, and the steps you can take to avoid it in your service.
Follow us on Twitter!
Follow @CQCProf on Twitter to get regular updates about the work we are doing with professionals and provider organisations in England.
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.
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.
CQC are continuing to engage to develop their new regulatory model further and are starting to test it with others. Please take some time out to read and digest our latest CQC update here which covers information from Estates and Facilities and Patient Safety too.
In response to the above changes with the way CQC regulate services, we are changing our Quality Review Visit (QRV) Report to reflect this. Below are the steps we are taking to ensure the new framework is aligned.
