According to its founding legislation, the Health and Social Care Act 2008, CQC's main objective is "to protect and promote the health, safety and welfare of people who use health and social care services" (Part 1, Chapter 1, Section 3(1)).
Trust leaders fully appreciate the value of external regulation and oversight, exercised by an accountable independent body, which holds providers to account for the safety and quality of care they provide. They understand that safety and quality regulation complements, but does not replace, the role of the trust board, which is to provide strong leadership, good governance, and capacity and capability for self-reflection.
Trust leaders value CQC's main purpose in terms of protecting patients and service users, ensuring that the fundamental standards of care (CQC, 2022) are met, and reporting publicly on the level of service provision. They perceive CQC's role as being to 'hold a mirror' up to the trust. While the regulator should not normally be able to tell the organisation something it does not know already, its value lies in triangulating information independently, highlighting areas of concern, and benchmarking providers against others to help them improve.
Improvement
According to the Health and Social Care Act 2008, CQC's general purpose is to encourage 'the improvement of health and social care services', alongside ensuring a focus 'on the needs and experiences of people who use those services', and 'the efficient and effective use of resources' (Part 1, Chapter 1, Section 3(2)).
CQC has to date worked on the basis that improvement action is primarily the responsibility of other agencies to take forward (including NHSE, ICBs and other system partners ), and has normally intervened only when it judges it necessary to protect people who use services from harm and the risk of harm, and to ensure that services are of an appropriate standard. These interventions are made under its enforcement powers (CQC, 2023) to require improvement, and to make sure that has been achieved, via action plan requests and warning notices.
Our work with trust leaders has revealed a strong sense that CQC could be doing more to support and encourage improvement and innovation. Our members believe the regulator should use its national level view of safety and quality and its access to qualitative and quantitative information to engage in improvement-focused conversations with providers. This could include discussing what providers could be doing differently, and even helping them connect and network with their peers. Another potentially valuable way that CQC could help providers deliver good quality care is by sharing sector-specific good practice in reports and case studies, detailing providers’ improvement journeys and the factors that contributed to them.
To date CQC has not done all it could to make supporting improvement a key building block of its approach to regulation. However this has begun to change following the publication of its new strategy (CQC, 2021) and the recent project (CQC, 2023) funded by the Regulators' Pioneer Fund (Department for Business and Trade, 2022).
CQC's latest strategy highlights the contribution of innovative practice and technological change to improvement in health and care, and recognises the regulator's role in creating a culture where innovation and research can flourish. One of the most positive aspects of the strategy is that it aims to encourage and enable "safe innovation that benefits people or results in more effective and efficient services".
CQC's recent project report on capturing innovation to accelerate improvement (CQC, 2023) indicates an appetite to do more to support providers. In particular, it reveals organisations need more information and clarity on CQC's approach to innovation, including safety and risk management implications for providers that make bold decisions or make changes with the aim of delivering better care. The report highlights that innovation depends on an improvement culture in which "people feel supported to try new things and have the space to reflect on progress and setbacks".
Given the legislative underpinning for this role, and the useful academic reflections on the value of balancing the requirements to assure and improve care, CQC could be doing more to harness its regulatory power and national-level insight to support improvement. Without being prescriptive, CQC could actively look for improvement and innovation cultures in trusts, focus more on outcomes for patients and people using services, actively share stories and examples, and signpost to other relevant organisations and peers.
Recommendation 2:
We recommend that: Given its important role in encouraging improvement and innovation, CQC makes the most of its privileged observer position by sharing good practice, engaging in improvement-focused conversations with providers, and working with organisations that have a direct role in improvement.