CQC proposed inspection approach for independent acute healthcare

CQC last week launched its long awaited consultation on its approach to regulating independent acute healthcare. 

The consultation runs until 23 January 2015. The document sets out a reasonable level of detail on the main features of CQC's approach to regulation of the sector.  However, on other important points (namely the use of special measures, and rating of providers at a corporate level), the consultation is a 'blank canvas' simply inviting suggestions as to how the approach should be developed.  Providers are therefore strongly encouraged to review the consultation and participate as fully as possible in shaping the direction of regulation.

Classification of services

CQC stress that, in developing its model, it aims to treat providers equally when they deliver similar types of services, whilst tailoring its approach where there are differences that need to be taken into account.  To do this, CQC is proposing divide the sector into the following groups:

• Hospitals
• Single specialty services
• Non-hospital acute services

The question of which group a particular service falls within is not altogether straight forward:  for instance, the 'Hospitals' group will include all facilities providing cosmetic surgery, and independent sector providers of maternity services, even if those are the only services carried on at those facilities.

'Single specialty services' are those independent providers which have a main or sole activity of:

• Termination of pregnancy procedures
• Haemodialysis or peritoneal dialysis
• Hyperbaric therapy
• Diagnostic imaging and endoscopy
• Diagnostic laboratory services
• Refractive eye surgery
• Fertility services
• Hair transplantation services
• Specialist inpatient services for long-term conditions

'Non-hospital acute services' are, in broad terms, non-surgical services not falling within the 'Single specialty services'  category.

Approach to regulation and inspection

For 'Hospitals' and 'Single specialty services', the approach to regulation and inspection is broadly equivalent to that being undertaken for NHS acute providers.  However, there will be a few differences:

• Although CQC will use Intelligent Monitoring (gathering information from various sources) to decide when, where and what to inspect, the lack of national data sets for independent acute healthcare means more emphasis will be put on the provider supplying information via a Provider Information Request.  However, CQC points out that it is continuing to work with the Private Health Information Network (PHIN) to explore ways of developing nationally comparative data sets for the independent sector.
• The size and composition of inspection teams will be significantly smaller than for NHS acute providers (which have experienced teams of up to 80 inspectors).
• Although CQC will use a combination of unannounced and announced visits, it does not plan to run listening events before inspections, as there is often no specific catchment area for independent healthcare services.
• Following the inspection, unlike for NHS acute providers, quality summits will not be a standard feature although they may happen in some cases.

CQC intends to begin publishing ratings of 'Hospital' services from April 2015 (with all acute hospital locations to be rated by April 2016), with ratings of 'Single specialty services' commencing in October 2015.

However, 'Non-hospital acute services' will be subject to a different approach and, although inspected against CQC's five key questions, will not receive a quality rating.

Special measures in the independent healthcare sector

CQC also discuss the possible introduction of a 'special measures' regime for the independent healthcare sector.  However, whilst for NHS trusts and foundation trusts 'special measures' involves the exercise of certain powers by the NHS TDA or Monitor, in the context of independent sector, CQC state this term means "levers for improvement" which might be used alongside traditional powers of enforcement.  Effectively, special measures are "one last chance to improve" under which CQC would take action to get a service to improve, rather than close the service using its enforcement powers. 

However, the consultation is silent as to the nature of those 'special measures' in the independent sector or when they may be applied;  in considering the latter question, the consultation invites views on whether the use of a special measures regime should be wholly or partly based on the extent to which people depend on a service, or have a choice of alternative providers and asks how CQC should "ensure a fair playing field with the NHS for 'one last chance to improve'".  These are important questions and, given the special measures regime in place in for NHS bodies, it is important that independent sector providers input as to how such a regime could apply in their sector.

Corporate ratings?

CQC's proposed inspection system will result in ratings of individual locations for 'Hospitals' and 'Single specialty services'.  However, CQC is also considering how they might aggregate ratings at a provider level in the independent healthcare sector (as is done for NHS providers).  CQC is therefore seeking views as to how it might "take account of provider level quality governance, leadership and overall performance in the independent sector, and whether that should be in the form of an overall provider rating".

Conclusion

We would encourage all independent sector providers to fully engage in the CQC consultation.