Transforming regulation in a new era for social care

Kate Terroni, Chief Inspector of Adult Social Care, Care Quality Commission

Nobody could have predicted the year and journey we’ve all been on through the COVID-19 pandemic. We always knew we had an incredible sector and workforce, but you have done more than we could ever have imagined. COVID-19 has accelerated change across health and social care and in this new world we’ve also had to transform.

At the beginning of the pandemic we acted early, decisively and quickly to respond to the challenge. We launched our Emergency Support Framework (ESF). This provided a structured framework for the regular supportive conversations that inspectors were having with providers. It also captured information which we shared to help support the wider health and social care system to respond to issues and keep people safe. We completed over 18,100 ESF assessments and heard some fantastic feedback from you about how valuable these conversations were. Listening to your feedback we developed our transitional monitoring approach which helps us target our regulatory activity most effectively – it’s the way we’ll work going forward.

I’m proud of the achievements we’ve made with Healthwatch England and other partners  on our year- long joint campaign called Because we all care. The ambitions of the campaign are to support and encourage more people in England to feedback on health or social care services. We’re asking people to first raise concerns with the provider, but if they are unhappy about the matter not being resolved, then they should let us know.

We made significant improvements to our online form for people to share their care experiences. Last year just over 37,000 people shared their experiences of care with CQC through our Give Feedback on Care online form, a 29% increase on 2019. Feedback through Give feedback on care really does make a difference. 54% of risk-based inspections have been triggered by information from the public.

Infection prevention and control (IPC) has always been important but the COVID-19 pandemic put it in the spotlight. We introduced IPC inspections to share good practice, uphold high quality care and ensure services are safe. We’ve seen some fantastic IPC practice out there and published our findings last year to share best practice.

Since the beginning of the pandemic we have completed over 3900 risk-based inspections of Adult Social Care locations and over 1300 Infection, Prevention and Control (IPC) inspections. This includes approved designate locations, which are part of a scheme to allow people with a COVID-positive test result to be discharged safely from hospitals. These inspections are measured against our ‘eight ticks’ of IPC assurance.

There are 159 designated settings assured so far. We’ll continue to work with the Department of Health and Social Care (DHSC), local authorities and individual care providers to provide assurance of safe and high-quality care in these settings. Several weeks after we’ve assured a designated setting, we’ll be giving those providers a supportive phone call. The Care Provider Alliance have also brought together a working group to share best practice and advice.

We’ll continue to look at IPC on risk-based care home inspections, including where there are rising numbers of people with COVID-19 and in response to whistle-blowing or information of concern. This year we’re beginning to explore developing our care home IPC methodology to community settings such as support living and extra care.

We recently published a news story on the importance of visiting. We’re aware that in some places blanket decisions are continuing to be made against government guidance. Where decisions are being made, whether that is for visiting, people not being allowed to see visiting professionals, testing or vaccinations, the focus must always be on the individual needs and rights of the person. If you’re making a blanket decision, we’re asking you to review these and talk to the people in your service, their relatives, loved ones and your local inspector.

COVID-19 has accelerated change across health and social care and in this new world we must also transform. We need to make changes to the way we regulate so that we can effectively regulate through the eyes of people who use services, be flexible and proportionate in our regulation and drive improvement. We’ve learned a lot from our response to the pandemic, and we’re using this to put us in a better place for the future and support services to keep people safe. Thank you to everyone who took part in our strategy consultation. There’s still time to contribute to our consultation on changes for flexible regulation. We’ll be engaging around implementation of our strategy from May, so that we can make our strategy work for everyone.


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