CQC chief sets out plans for regulating integrated care

Regulator to adapt to joining up of health and social care by inspecting integrated services and assessing quality of care across localities, says David Behan

CQC chief executive David Behan (Credit: Ken McKay/Rex Features)

It is unlikely the Care Quality Commission (CQC) will require changes to its statutory responsibilities to regulate emerging models of integrated health and social care, chief executive David Behan has said.

This is despite the fact that many of these new services will be set up by commissioners and the watchdog currently has no power to review commissioning arrangements. However, Behan is “not worried” this will be an obstacle going forward.

“There has been a debate over the last 12 to 18 months about whether we should be able to inspect commissioners but that would require a change in the law and the law hasn’t changed,” he said.

“We’re also not sat here thinking ‘oh dear me it needs to change’ – in the same way we probably don’t need legislation for the new models of care to arrive, we don’t need legal changes for us to be able to regulate them.”

Behan was speaking to Community Care following the announcement of NHS England’s 29 ‘vanguard’ sites, which will be tasked with developing new models of care under the health organisation’s five-year forward view strategy.

The areas will overhaul traditional services and mark the next step towards a more integrated health and social care landscape.

“What we’re signalling now is how the CQC needs to change in response to the new models,” he said. “Some changes will occur quickly and others will take longer to work their way through the system, but as they do we’ll change how we are organised to reflect that.”

Regulation

The first step will be to look at how the organisation regulates new models of care. They will work with the vanguard sites to understand how services can be monitored for quality and improvement, and will outline how new care models should be registered.

“An example of this would be acute hospitals that employ general practices,” said Behan. “At the minute we register hospitals and we separately register general practices but in the future we’ll need to flex and change the way we register those services.”

“People will often say regulation is a barrier to innovation and what we are determined to do is not get in the way of that innovation as the new models of care emerge.”

This will “undoubtedly” mean the commission will eventually register services that are being delivered jointly by several providers and the inspection team will also adapt to reflect this.

“When we go to inspect these new models I can see the inspection team having some hospital inspectors, some adult social care inspectors and some primary medical service inspectors,” said Behan. “We’ll be mixing the skills of our inspectors, which we do a little bit already but this will mean doing more of it in the future.”

Care pathways

As services themselves become more integrated, the watchdog will look more closely at the care pathways that join them together – from a care home to hospital and back again. This will include undertaking a number of thematic reviews on urgent care provision in 2015-16.

The organisation plans to look at mental health crisis care, end-of-life care, care for older people and the provision of diabetes care in the community. This includes looking collectively at the provision of A&E, 111, out-of-hours and ambulance services.

“We want to understand how the individual services contribute to outcomes for people and will arrive at a view about how well people are being served by urgent care,” Behan said.

“On any pathway there will be more than one organisation and more than one professional delivering that care so this is really going at it from the perspective of the individual.”

Localities

The CQC will also add a new dimension to its reporting capability in 2015-16 by producing locality reports that give a comprehensive picture of the quality of care in a local place. It will focus on two areas in the coming year and aims to identify issues that need to be addressed at a cross-organisational level, as well as at provider level.

“By the end of this calendar year we will have inspected the majority of health and adult social care services in England,” said Behan. “We will then be able to bring together our findings from across the sectors to describe how well people in those communities are being served by their local health and care system.”

This means if you are a person with a learning disability and you live in Norwich, for example, you will be able to access a report that tells you how well you will be served by your local health and care services.

This new approach will also enable the CQC to reflect the quality of commissioning arrangements, even if it is not able to directly review them, said Behan.

“If we’re producing locality reports on two geographical areas then we’ll be commenting on quality. By saying one is good and one is less good we’ll be saying that is effectively a reflection of the ability of commissioners to commission services in those two areas.”

New Care Models

The 29 ‘vanguard’ sites unveiled by NHS England will take the lead on the development of three new care models: enhanced care homes, multi-speciality community providers and integrated primary and acute care systems.

The enhanced care homes aim to provide better and more joined up support for older people by embedding health and rehabilitation services within a residential environment. Multi-speciality community providers will move specialist care out into the community and the integrated care systems will join up GP, hospital, community and mental health services.

Individual organisations and partnerships applied to become ‘vanguard’ sites in January and the 29 chosen areas will now be supported to develop dedicated support packages. The New Care Models programme will be backed by a £200m transformation fund and all areas will be given a learning package with input from NHS England, Monitor and the NHS Trust Development Authority. The programme will be rolled out later this year.

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