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Regulating for Complexity

23 October 2017

Earlier this year, the CQC launched the second phase of their consultation into how they work in an ever changing landscape of both health and social care. This phase has some particular resonance for the social care sector because it was looking at how regulation encapsulated the complexity of some provider structures, and at provider level assessment and ratings. The consultation phase was open over the summer period, and NCF worked with members to submit a response and our full response can be found here 
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The thrust of the change is to ensure both greater visibility and accountability to those organisations who currently ‘sit above’ CQC registered providers, based on the premise that they have an impact on the quality of care delivered, and were not currently held to account, and all entities who meet their revised criteria will be required to register with CQC. This will enable CQC to make ownership relationships and inks between providers clear to the public on their register. There are a number of caveats to moving this forward that are outlined in the response. 

The first of these is that they are not in a position to regulate parts of an organisation that sit overseas, and that raised concerns about whether that might push some parts of organisational structure outside of the CQC jurisdiction. In addition, they recognise that this is likely to have a resource implication – and that there will need to be an impact assessment prior to this moving forward – and any additional resource implications will need to be met. There is no indicator of how or when all this will come to force, but in an organisation that has been tasked with full cost recovery, the suggestion that additional resources might be required is likely to send a shiver down the spine of complex providers – and I suspect require a trigger for a further targeted consultation around impact and fees before this gets bedded in.  

As ever, with any such change, the devil will be in the detail and there is more detail to emerge in the Spring about exactly what the criteria are that establish how to determine whether more ‘arm’s length components of a broader structure have ‘direct control and care’. 
Early suggestions include their interest will focus in on complex organisations where decisions are made centrally or in a part of the hierarchy detached from immediate care provision that relate to quality assurance, policy development and the right to influence employment decisions.

It is important to remember that the CQC have already published, in relation to their first phase of consultation this year, their thinking around how they will regulate new models of care, found here
Of course, the ultimate move forward in this approach is that at some point you can point to a ‘provider –level’ assessment and rating. This is intended to provide greater accountability at the parent company level. However, there were lots of concerns highlighted within consultation responses that focused on the risks around aggregated care ratings and how they might detract from the current position of ‘easy to compare, easy to understand’ service level ratings. The way forward for this is much more ‘softly softly’ and the CQC describe a more organic approach, piloting this with providers where they are finding location level issues which they believe will be improved by intervening at a higher level. I believe this is one to watch, but may prove to be in the ‘too difficult’ pile because of fears that aggregated ratings may paint an unfair picture – favourable or otherwise – for larger provider groups. Ultimately, CQC will need to demonstrate that any of these changes will have a direct impact on their ability to regulate and thus encourage improvement in the quality of care.

The area based assessments that they are currently involved in are sighted as a good opportunity to learn about how peoples experiences and outcomes are affected by the way care services work together. There is a bit of a ‘wait and see’ feel to much of this consultation response, and whilst some things will change in the Spring, the overall implementation is likely to be less of a ‘cliff edge’ than other regulatory changes. 

The full document can be accessed here

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