A regular update for healthcare professionals
Updates relating to the mental heath sector
We have recently published reports and blogs relating to the mental health sector, including:
Monitoring the Mental Health Act
We've published our annual report on the use of the Mental Health Act 1983 (MHA). It details our interactions and insights from engaging with individuals subject to the MHA, along with our assessment of registered services providing care and treatment to those detained under the MHA in 2022/23. We have seen examples of good practice, with staff doing their best in difficult circumstances to provider people with safe and effective care. However, the report highlights that short staffing and underfunding mean children and young people with mental health needs face long waits for essential treatment, while racial inequalities in care persist.
Special review of mental health services at Nottinghamshire Healthcare NHS Foundation Trust
Following the conviction of Valdo Calocane in January 2024 for the killings of Ian Coates, Grace O'Malley-Kumar and Barnaby Webber, the Secretary of State for Health and Social Care commissioned us to carry out a rapid review of Nottinghamshire Healthcare NHS Foundation Trust (NHFT) under section 48 of the Health and Social Care Act 2008.
We have now published two parts of this review: an assessment of NHFT's patient safety and care quality, and progress at Rampton Hospital since their last inspection. This review reflects insights from onsite visits, feedback from people who use services, and data including surveys and prevention reports. It also considers the past 5 years of our inspections and broader oversight of mental health services.
Patient and Carer Race Equality Framework
In this recent blog, Chris Dzikiti, Director for Mental Health at CQC, talks about NHS England's Patient and Carer Race Equality Framework (PCREF). He explores its objectives to address racial disparities and epistemic injustice encountered by individuals from ethnic minority communities. Read more on this framework from NHS England.
New blog from Ian Trenholm
CQC’s Chief Executive, Ian Trenholm, talks about the feedback we’ve received about the roll out of our new regulatory approach and what we’re doing with it.
Ian reflects on what providers have told us is working well and what needs to be improved and updates on some changes to our approach based on your feedback.
In particular, Ian shares an update on the number of quality statements we'll look at in our assessments. Updating that when carrying out an assessment of a service that is either inadequate or requires improvement all quality statements under the key question that are rated inadequate or requires improvement will be reviewed.
CQC X Healthwatch England Share For Better Care campaign
People are more likely to feedback about commercial services and products than their experiences of health and social care, according to new research we commissioned with Healthwatch England.
We have launched our Share For Better Care campaign which aims to encourage everyone to give feedback on their experiences of care, focusing on people more likely to experience poorer care and inequalities who are less likely to give their feedback.
Through our public awareness campaign we aim to show the public how feedback is used by CQC and HWE to make improvements to the health and social care system.
Together, we can improve health and adult social care, knowing about your experiences of care helps us make a real difference. Join the conversation on X using #ShareForbetterCare.
Help support our campaign using the materials in this stakeholder toolkit here.
Get involved and share your story with us!
Provider information sessions on visiting and accompanying in care homes, hospitals and hospices
In December 2023, the Department for Health and Social Care (DHSC) announced legislation to make visiting and accompanying a fundamental standard of care.
Visiting is crucial to the health and wellbeing of those receiving care as it ensures that people remain connected with loved ones and their community. Also that they have people to support and advocate for them when they are at their most vulnerable.
The new legislation will come into force on 6 April 2024. DHSC is running a series of online information sessions via Teams, with support from CQC colleagues. These will explain what the legislation requires you to do as a provider and you will be able to ask any questions you might have about the guidance.
Sessions take place on:
- Wednesday 3 April for care home providers
- Tuesday 2 April for hospital providers
Use this registration form to sign up for a session. Teams invites will be sent a few days before the session. For any queries, please contact the team on visiting
Other news
- We've published the final blog in our series sharing learning from the Supported Living Improvement Coalition. This time, we talk about the final 2 factors Coalition partners told us affected quality in supported living. Read the blog and share your thoughts on our online participation platform.
- Improving fairness in practitioner performance management. NHS Resolution’s Practitioner Performance Advice service has published focused research and resources aimed specifically at understanding ethnic minority and international medical graduates (IMGs) practitioners’ experience of performance management, and at improving fairness for all practitioners undergoing such management. Discrimination and bullying were themes emerging in the research. Resources include an Insights summary report and case studies. The service is committed to achieving meaningful change and has drawn up an initial action plan and is working with partners across the health system. Employers and health organisations are asked to review and reflect on the research and to use the published resources to support decision making when dealing with performance concerns. Practitioners are signposted to information on the support Practitioner Performance Advice can offer them.
- It is the first anniversary of the AI and Digital Regulations Service (AIDRS) website. The website offers developers and adopters of Artificial Intelligence (AI) and digital technology a single place to find relevant information on AI regulation and evaluation in health and social care, delivered in partnership with the National Institute for Health and Care Excellence (NICE), Health Research Authority (HRA) and the Medicines and Healthcare products Regulatory Agency (MHRA). The first case studies and blogs have just been published - please take a look at the website, the case studies and blogs for more information.
- The INTERFACE project, funded by the National Institute for Health Research, investigates clinical governance between the NHS and independent hospitals, influenced by the Paterson inquiry report. They're conducting a national survey on clinical governance, with emails sent to NHS and independent sector leaders from interface
@manchester.ac.uk . If you receive it (check junk folders!), please click the link to complete the survey. For queries or to participate, contact project coordinator Ellie Gee at Eleanor.gee @manchester.ac.uk -
The Medicines and Healthcare products Regulatory Agency (MHRA) is warning people not to buy counterfeit or unbranded anti-choking devices as they do not comply with device regulations and could cause harm. If you have anti-choking devices available in your service, check that they are genuine. A product comparison with photos highlighting the differences between a genuine and a counterfeit device can be found in MHRA's Device Safety Information alert. Do not use the device if you suspect it is counterfeit. Please submit a Yellow Card report if you have previously used a counterfeit or unbranded device and it failed to work, including details of where you bought the product.
A regular update for providers and professionals working in adult social care
Our new provider portal will be available for everyone soon
Between now and the end of March 2024 we're making changes to the way providers interact with us, including introducing our new provider portal.
Our new portal will offer a better experience when submitting statutory notifications and completing some registration actions.
At the moment, only those who have been invited can join the new portal. But from the start of March 2024 any provider can register on the new portal and set up their account.
If you’ve already responded to one of our invitations and joined the new portal, thank you. If you’ve not yet signed up, you can do so from 11 March 2024.
Here's what to do to get ready for these changes:
- Make sure all the contact details we hold for your organisation are correct (you'll need to sign up to the new portal using an email address we have on record)
- Watch the introduction to our new provider portal
- As soon as you receive an invite, sign up to our new portal
- If you don't receive an invite to the new portal, sign up as soon as you can from the start of March 2024
Find out more about our new provider portal
Share for Better Care – our new campaign is launching soon
In the coming weeks we will be launching our new campaign 'Share for Better Care' alongside Healthwatch England, the Race Equality Foundation, National Dignity Council, and the Royal Association for Deaf People.
The campaign, which aims to increase the range and volume of care experiences that people share with us, builds on the success of our Because We All Care campaign which we ran between 2020 and 2023.
The Share for Better Care campaign centres around research and audience insight and focuses on engaging people whose voices are seldom heard, especially people from
- people from minority ethnic communities
- autistic people and people with a learning disability
- disabled people with physical or sensory impairments
- lower-income groups.
We will provide a campaign toolkit for you to help support the campaign.
If you’d like to get involved by sharing a story about the importance of feedback where you work – please get in touch.
Developing our approach to ‘learning culture’
One of our core ambitions is to ensure that the services we regulates have a stronger safety and learning culture.Through our new quality statements, we're looking to assess both ‘safety through learning’ and ‘learning culture’.To ensure we take the best approach to assessing providers on this topic and to ensure we're able to give providers the best quality information on what good likes in this area we'd like your feedback through this short survey.
Safety through learning survey
DHSC offering provider information sessions on visiting and accompanying in care homes, hospitals and hospices
In December 2023, the Department for Health and Social Care (DHSC) announced legislation to make visiting and accompanying a fundamental standard of care.
Visiting is crucial to the health and wellbeing of those receiving care as it ensures that people remain connected with loved ones and their community. They should also have people to support and advocate for them when they are at their most vulnerable.
The new legislation will come into force on 6 April 2024. DHSC is running a series of online information sessions via Teams, with support from CQC colleagues. These will explain what the legislation requires you to do as a provider and you will be able to ask any questions you might have about the guidance.
Sessions take place on:
- Tuesday 19 March and Wednesday 3 April for care home providers
- Monday 25 March and Tuesday 2 April for hospital providers
- Wednesday 27 March for hospice providers
Use this registration form to sign up for a session. Teams invites will be sent a few days before the session. For any queries, please contact the team on visiting
Energy grant
The Department for Culture, Media and Sport (DCMS) is running a £25.5 million funding package to help voluntary, community, and social enterprise organisations in England improve their energy efficiency.
Eligible organisations can able to apply for 1) an independent energy assessment and 2) capital grants to install energy efficiency measures.
The scheme is open to frontline community organisations across England. Groundwork UK, who are delivering the scheme, are particularly keen to hear from small and medium organisations with significant concerns around energy who are directly supporting individuals and communities with critical needs, especially those related to the rising cost of living.
Examples include:
- Services that address poverty, including by providing food, warmth, emergency supplies or personal grants
- Shelter, accommodation and housing for those most in need
- Advice for people experiencing financial, housing or legal challenges
- Services that address specific physical and mental health issues
- Education, training and employment services that improve employability
- Community hubs or centres, out of which a number of these services operate
Organisations are encouraged to apply as soon as possible.
Skills for Care launch new dashboards to track recruitment and retention
Skills for Care has added two new quarterly tracking dashboards to their workforce intelligence. One gives an estimate of the number of people who have been recruited internationally to start a care-providing role. It shows trends and a breakdown across service types and regions. The other shows filled posts, starter rate, turnover rate and vacancy rate, broken down by integrated care board area.
Inside the Adult Social Care Workforce Data Set (ASC-WDS), there is also a new place to track your individual data. The new look of the benchmarks area allows you to compare your workforce metrics against similar providers in your local area, or specifically those who are ‘Good’ or ‘Outstanding’. You can view data on pay rates for different job roles, vacancy and turnover rates and the percentage of staff still in their role after 12 months. There are lots of other benefits in using ASC-WDS too.
Other news
- We're working with the Point of Care Foundation and National Voices on a project supporting integrated care systems (ICSs) to reduce health inequalities. Over the next 12 months, the project, funded by the Regulators' Pioneer Fund, will be developing a framework for ICSs to self-assess how well they reduce health inequalities. Read more on our website.
- We have reordered the guidance section on our website. The changes that we have made are mainly in response to feedback that we have received from providers. There is no new content as part of this work. The main source of information and guidance for providers, local authorities and integrated care systems is now a new Guidance and regulation landing page. You'll find it in the menu at the top of our site. We have also made it easier to download key sections as PDF files. This is in response to providers telling us they wanted to be able to access information on our new assessments all in one place. This work is part of an ongoing series of improvements to user journeys to make them as clear and simple as we can, and to make it easier for providers to see when guidance has been updated.
- Updated notification on the outcome of a deprivation of liberty application. We have now updated the form that health and social care providers should use to notify us of the outcome of an application to deprive a person of their liberty. Providers must notify CQC as soon as they know the outcome of an application, this includes Deprivation of Liberty Safeguards (DoLS) applications and applications made to the Court of Protection. The updated form now incorporates an additional field prompting providers to specify the date on which the outcome of the application was received or the date of its withdrawal.
- In the latest in our blog series reflecting on the learning from the Supported Living Improvement Coalition, Stefan Kallee, Senior Specialist for People with a learning disability and autistic people, looks at the first of 4 key factors that affect quality in supported living. Read the blog, and share your thoughts on our online participation platform.
- Join us at the Care Show London this April. We'll be hosting the “Meet the Inspector” hub at the Care Show London on 24-25 April 2024. Attendees can book a meeting with the inspectors, discuss their concerns, and receive advice on how to improve their CQC ratings. The conference programme includes the latest sector updates and best practices to help you improve your care service, with a focus on understanding what the upcoming election means for social care and providing insights into hiring and retaining staff. Attendees will be able to attend CPD-accredited sessions delivered by over 100 speakers, meet more than 150 suppliers, and network with colleagues. Complimentary passes are available for care and healthcare professionals, those working for a social care provider, allied healthcare, NHS, and public sector professionals.
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The Infection prevention and control in adult social care: acute respiratory infection guidance has been published and is now live. The new acute respiratory infection guidance consolidates the Infection Prevention and Control advice for the adult social care sector. It aims to support providers, and the wider sector, plan for and manage a range of infectious diseases, including COVID-19. This new ARI Supplement to the Infection Prevention and Control resource for adult social care replaces the COVID-19 supplement. The guidance itself can be found here:
- Final week for registered managers to complete the medicines survey. The survey has been emailed directly asking for feedback on medicines and community pharmacy.
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NMC temporary register closing 31 March. The Nursing and Midwifery Council’s Covid-19 temporary register will close permanently on 31 March 2024. Thousands of people stepped forward to support essential health and care services during the pandemic by returning to nursing and midwifery practice with temporary registration. Their contribution made a vital difference to people’s lives. Professionals will not be able to practise with temporary registration after the end of March 2024. The NMC is encouraging everyone on the temporary register who wishes to continue practising as a nurse or midwife after 31 March to apply to move to the permanent register – the deadline for this is 14 March.
The independent regulator of health and social care in England
CQC is changing
08 February 2024
A regular update for providers and professionals about the changes we're making to how we work
How well do you understand how we are changing?
We're introducing a new regulatory model based on a single assessment framework, which we have started to use across the country. Alongside this work we're also starting to roll out our new provider portal.
In 2023, we launched a communication campaign to ensure all health and social care providers understood these changes, what it means for them and how they can prepare.
To help measure the success of this campaign, we'd like to know how well you understand these changes in 2024. Share your feedback through this short survey.
Feedback on how you would use integrated care system assessment reports
We want to get insight into how health and social care providers will use our integrated care system assessment reports and what we should focus on within them.
To help us do this we'd like your feedback through this short survey.
Our new provider portal will be available for everyone soon
Between now and March 2024 we're making changes to the way providers interact with CQC. We're Introducing a range of new and improved digital services to give providers a faster, easier and streamlined way to share information with us, including a new provider portal.
Our new portal will offer a better experience when submitting statutory notifications and completing some registration actions.
We've started inviting users of our existing portal to join the new portal and will invite all existing users by the end of February 2024. If you've received an invite to join the new portal, sign up now without delay.
At the moment, only those who have been invited can join the new portal. But from the start of March 2024 any provider can register on the new portal and set up their account.
Here's what to do to get ready for these changes:
- Make sure all the contact details we hold for your organisation are correct (you'll need to sign up to the new portal using an email address we have on record)
- Watch the introduction to our new provider portal
- As soon as you receive an invite, sign up to our new portal
- If you don't receive an invite to the new portal, sign up as soon as you can from the start of March 2024
Find out more about our new provider portal
Our existing portal is moving to read-only
At the end of February 2024, our existing provider portal will become read-only. That means you won't be able to use the portal to make changes or send us new information. You will still be able to access and download your saved data until the end of March 2024.
Action required for users of our existing provider portal
Please note that existing accounts on our current portal will not be automatically transferred to the new provider portal. This means action is required on your part:
- Register for our new portal as soon as you are invited
- Check your inbox for invites. Invitations to join the new portal are being sent out and all existing users will be invited by the end of February 2024
- If you have not yet received your invite yet, don't worry, just make sure your contact details are up-to-date to receive your direct invite
- Once you're signed up to our new portal, remember to log in to the existing portal and download your saved data before the end of March 2024
Visit the exisiting provider portal to download your saved data
Top tips for a good experience submitting notifications
Providers must notify us about certain changes, events and incidents that affect their service or the people who use it. Giving us the right information first time means you'll need to spend less time responding to our requests for further information.
Here are some top tips for getting notifications right:
- If you have access to the provider portal (current or new), this is the easiest and quickest way for you to submit a notification.
- If you're using a Word form, always download the latest version from our website rather than using saved versions as we change our forms from time to time.
- Make sure the provider and location IDs and name of provider entered on the form are correct. It is important to remember this will have changed if you have made changes to your legal entity. You will find your provider ID and the location IDs on your latest certificate of registration.
- Make sure all the fields on the notification form are completed.
- Keep up to date with the latest guidance on submitting notifications.
- You should always receive a submission notification and a reference when you have correctly submitted a notification. If you do not receive this CQC may not have received your information.
For the best and fastest way to submit notifications, sign up to our new provider portal as soon as you receive your invite.
Read more about statutory notifications
How we'll manage relationships with providers
Catch up on the latest guidance on how we'll manage relationships with providers as part of our new assessment approach.
The way we engage with the services we assess will evolve as we roll out our new approach.
Our new assessment approach
Our new assessment approach is now live across the whole country
What can providers do to prepare:
- Read provider guidance on our new approach to assessment.
- Make sure your contact details are up to date, and the right people in your organisation are subscribed to our email newsletters to get the latest information.
- Watch our videos and webinar recordings on our new regulatory approach.
- Sign up to attend our webinars when we advertise them.
- Join our digital engagement platform to share feedback on our new approach.
NOTE: Our new approach is not currently being used for services we do not rate. We will be in touch with those providers directly for more information about when the new approach will apply to them.
Read more on how we're rolling out our new assessment approach
Share your feedback on our new assessment approach
We'll be adapting our new assessment approach throughout this year, responding to anything we learn as we roll out across the country.
We want to hear your feedback on preparing for our new approach and any experiences of being assessed using our new approach.
Your feedback will ensure we adapt our approach to meet the needs of people who use services and providers.
Subscribe to our new WhatsApp channel
We now have a WhatsApp channel where we will be sharing the latest updates on our new regulatory approach.
Please note that as WhatsApp Channels may not be available to all users yet we won't be posting content that hasn't already been shared by other means.
Subscribe to our new WhatsApp channel
News from the Care Quality Commission: December 2023
The independent regulator of health and social care in England
Newsletter
Our monthly update for everyone interested in health and social care
New guidance on alcohol in care homes
We have worked with the University of Bedfordshire to produce guidance for members of the public and care home managers on the availability and management of alcohol in care homes.
The guidance is based on a study on alcohol use in care homes which found that residents, families, staff and inspectors felt strongly that people living in care homes should be able to continue drinking alcohol when they move into a home.
Speaking about the research and new guidance, CQC's Amy Hopwood said:
“This important research shines a light on the importance of care homes safely supporting their residents to continue drinking alcohol if they wish to, using their professional expertise to balance the risks alongside the individual’s preferences.
“Just like anything else in life that is a matter of taste and choice, how care homes manage alcohol is a strong indicator of how well they are delivering good, safe, personalised care to their residents.”
The research findings and new guidance can be downloaded from the University of Bedfordshire's Substance Misuse and Ageing Research Team's web pages.
- News story: Guidance on the management of alcohol in care settings
- University of Bedfordshire news story: Keeping the spirits up? Research finds alcohol can be part of having a ‘good life’ in care homes
Join us! Work for CQC
CQC staff have a wide range of skills and work across many disciplines.
Find out about roles within CQC, Healthwatch England and the Office of the National Guardian.
Current vacancies include:
- Senior Information Access Officer
- Director of Corporate Provider and Market Oversight
- Registration Inspector - Registration Operations
- Deputy Director for People with a learning disability and autistic people
- Governance Manager
Benefits include generous leave entitlement, NHS or Nest pension schemes and a wide range of employee discounts.
Most roles offer flexible locations with the choice to be home-based. See the individual job listings for more information.
The rollout of our new assessment framework begins
We have now started our rollout of the new assessment framework in our South region and with 'early adopter' providers that volunteered to take part.
Our new framework focuses on what matters to people who use health and social care services and their families. It will let us provide an up-to-date view of quality.
Over the next few months, we will continue to do this region by region. We will be contacting providers with information as we begin in each one.
These changes will help us to get closer to our ambition to regulate in a smarter way and respond to risk. We will be able to have a better understanding of the quality of care in a local area or healthcare system, and ultimately keep people safe.
New blog: Bringing humanity into action – our revised human rights approach to regulation
Lucy Wilkinson, our interim head of equality, health inequalities and human rights, has written a blog looking at the fundamental link between human rights and delivering safe, good quality care.
The blog discusses our refreshed human rights approach, based on the FREDA principles of fairness, respect, equality, dignity and autonomy, and how this works with our new assessment framework.
Our human rights approach recognises that rights-based care is intrinsically linked with the quality of care.
- Blog: Bringing humanity into action — our revised human rights approach to regulation
- Our updated human rights approach
Do you work in health or social care?
Sign up to our other newsletters and follow us on Twitter to make sure you always get the latest information from us.
- Update your subscription settings to get emails for providers and on specialist topics
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New poster for mental health wards
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CQC have recently updated thier 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.
Update from CQC
30 November 2023
A regular update for providers and professionals working in healthcare services
Starting our new assessment approach
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.
We've published information on our website setting out more detail on the roll out dates of our new regulatory approach up to March 2024.
We've also published guidance to support the roll out of our new regulatory framework. We recognise that this guidance needs to be clear to help you feel ready for our new assessments. Please read all our new guidance on:
- how we will gather evidence
- displaying your ratings
- calculating the first scores
- rolling out our new assessments
- factual accuracy check
- publishing our findings.
At this stage, our new assessment approach won't apply to services that we do not rate (for example, dental providers). Although we will start new assessments by region, trust well-led assessments in all areas will begin from 6 February.
No change to fees scheme for 2024/25
Aerial view of a person working on a laptop. On the table is a calculator, papers, and a cup of coffee. Image by Microsoft 365 on Unsplash.
The CQC fees scheme for providers, which covers our costs of provider regulation, will not change next year – in 2024/25. This means that, for many providers, fees will have remained the same for the last 5 years, unless they have changed their registration – for example, by adding locations or service types. As in previous years, NHS trusts, NHS GPs and community social care providers may also see a change to their fees from April 2024 (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.We are, however, currently consulting until 21 December 2023 on our proposal to charge fees to integrated care boards for our new role in assessing integrated care systems.
Find out more about our fees scheme
New poster for mental health wards
We have recently updated our webpage about how people can make a complaint about the Mental Health Act. This includes care while:
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detained in hospital
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on a guardianship
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under a community treatment order.
This page is designed with members of the public in mind, and includes our new easy read poster, which can be printed out and displayed on wards, patient and visitor areas, to ensure people know about their right to raise a complaint about the use of the Mental Health Act with the Care Quality Commission.
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.
Reducing harm from ligatures in mental health wards and wards for people with a learning disability
A laptop with two hands pointing at the screen.
We recently published guidance which was developed by the Mental Health and Learning Disability Nurse Directors Forum in collaboration with experts by experience and the Care Quality Commission.
This guidance is written for staff with responsibilities for:
- caring for patients on mental health wards, and on wards for people with a learning disability
- assessing and managing risks to patients in the inpatient care environment
- those buying, installing and maintaining fixtures and fittings for mental health wards and wards for people with a learning disability.
As part of the guidance, the ligature point recording template has been designed to support staff in identifying and recording ligature risk points, controls and actions required to mitigate risks associated with the built environment.
IR(ME)R annual report 2022/23
Blue square background with yellow warning symbol in the centre.
We've published our annual report on our work to enforce the Ionising Radiation (Medical Exposure) Regulations in England (IR(ME)R). This report presents the key findings from our inspection and enforcement activity.
The report gives a breakdown of the number and type errors that we were was notified about between 1 April 2022 and 31 March 2023. The report also presents the key findings from our inspection and enforcement activity in that time.
New enforcement policy
A desk with a notebook and pair of reading glasses placed on top.
As we begin to start the new assessment approach, we are releasing a new enforcement policy to align to both old and new methodologies. This will enable us to carry out our regulatory functions during this period of transition.Where a registered person is in breach of a regulation but people using the service are not at immediate risk of harm, we may use our power to request a report from a provider.Under this new policy, this is called an ‘Action Plan Request’ when using our single assessment framework and is called a Requirement Notice when using previous methodology.
Subscribe to our new WhatsApp channel
Digital illustration of four red hands raised towards letters that spell out 'Your say' against a plain cream background
We now have a WhatsApp channel where we will be sharing the latest updates on our new regulatory approach.
Please note that as WhatsApp Channels may not be available to all users yet we won't be posting content that hasn't already been shared by other means.
Subscribe to our WhatsApp channel
Our regulatory policy position on modern slavery and unethical international recruitment
Row of grey figures. The blue figure in the centre is in a magnifying glass.
We have recently published a regulatory policy position on modern slavery and unethical international recruitment. In it we make it clear that such practices are illegal and are incompatible with our values.
Joyce Frederick, Director of Policy and Strategy, and Rebecca Bauers, Director for people with a learning disability and autistic people, have written a joint blog to introduce the policy position.
Other news
- Voluntary guiding principles have been co-developed by Skills for Care with the Department of Health and Social Care and the social care sector, exploring delegated healthcare activities across 4 areas. To help gather sector feedback to make ongoing improvements and inform next steps, you’re invited to undertake this short online survey. The survey will be open until January 2024.
- The AI and Digital Regulations Service is looking for adopters and developers of AI and digital technologies to test new content on its website, such as blogs and case studies. The AI and Digital Regulations Service supports the development and widespread adoption of safe, innovative, value-adding technologies in health and social care. It aims to optimise care and improve outcomes across the system. Register your interest to get involved.
- Safety factors surrounding effective communication throughout the pregnancy journey is a recent blog from Maternity and Newborn Safety Investigations programme. The blog highlights the safety factors surrounding effective communication. Identifying the factors that work well, highlighting where there are barriers to effective communication and recognising the work that is taking place to overcome them.
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.
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 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
Photograph of a desk: an open laptop sits beside an open notebook, atop which sits a pair of glasses and pen
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.
