Help Health and Care Clients Manage Changes Around Inspections

Ruth Reaney, head of Health & Care at Travelers Europe, explains how due diligence and risk management can help clients manage recent changes from the Care Quality Commission (CQC).

Following the introduction of the Single Assessment Framework (SAF) in November 2023, the Care Quality Commission has changed the way Health & Care clients navigate inspections and share information. Specifically, there are new quality statements regarding their services, a new portal, and a new scoring system (though specific ratings have not changed). The changes aim to streamline the evaluation process across different kinds of care services to help ensure consistency and clarity, as well as highlight quality of care from the perspective of service users.

In the meantime, some concerns have surfaced about the framework—and about the CQC itself.¹ An independent review of the CQC in May 2024 by Dr Penelope Dash found that although the new framework was intended to make the assessment process simpler and allow for more frequent inspections, people have voiced concerns that the system is not working as it should. Further, the review found a number of failings within the CQC. For example, it indicated that some inspectors who visited hospitals said they had never been in a hospital before, and some who visited care homes mentioned they had never met anyone with dementia before.²

Understanding the changes

Keeping those concerns in mind, Travelers has been working with Delphi Care Solutions, our partner in providing care consulting services to clients, to study how the new framework affects the assessment of risk for Health & Care services. For one, brokers reviewing quality statements about a care service will now need to dig a bit deeper to find the details that led to a decision. In the new structure, quality statements have been condensed, so it’s possible for an overall rating of “outstanding” or “good” to pertain to limited areas of evaluation. To see the bigger picture of a client’s strengths and weaknesses, brokers should ask if the client has had an inspection under the new methodology, then enquire about the specific evidence categories reviewed and how they were scored within that assessment. This can help uncover situations where there were one or two quality statements rated as “requires improvement” even though their overall rating was “good”—or areas where a care provider hasn’t had a comprehensive inspection in five years’ time.

The CQC’s push toward digitisation via their new portal should make any information about a care provider easier to share, collect, and compare in real time. Once providers have a handle on any new data collection requirements they must meet and training needed to support them, they should be able to send evidence continuously, allowing the CQC to review it more efficiently. This should lead to more consistency in evaluations, a greater focus on providers where safety concerns have been raised, and perhaps fewer cases where providers have been given the benefit of the doubt when information is inaccurate or missing. Of course, this may also lead to faster response times from the CQC when safeguarding risks are flagged. (In the past year, there has been a clear increase in the number of inspections conducted out of hours. Under the new methodology, the CQC has said that any quality statement stated as less than “good” will receive a comprehensive site visit.)

The benefits of proactive preparation

Any change can make people feel unsteady, and with the full operational effectiveness review due out in Autumn 2024, we expect to see further changes to the system. In the meantime, it’s important to note that Health & Care providers aren’t being asked to do anything all that differently from before. Still, it’s beneficial for them to know how information about their services is now being used and shared.

For example, as a result of the changes outlined above, providers may be able to make a stronger case to their workers that safety is the responsibility of everyone on staff, thereby securing a shared sense of purpose. Through the portal, they also have the tools to share data more quickly and readily, which is likely to result in inspections that are less frequent or necessary for those who remain compliant. Easier access to information about care providers can make areas of risk rise to the surface so they get the attention they need—both from inspectors and from the care facilities themselves.

To generate those benefits, preparation is key. Care providers will do well when their staff knows where to find required information, is fully aware of the evidence available to meet various requests, and has a sense of ownership when it comes to delivering a high quality of care. If they do, the unexpected out-of-hours inspection is less likely to rattle them and they will be that much more confident and ready to help when one happens. When everyone on staff is involved in supporting a provider’s quality of care, everyone wins—and insurers and brokers can help spread the message.

To learn more about the changes summarised above, view a recent webinar from Travelers and Delphi Care Solutions.

Sources
¹ https://www.bbc.com/news/articles/cjk3p4jnnl6o
² https://www.gov.uk/government/publications/review-into-the-operational-effectiveness-of-the-care-quality-commission/review-into-the-operational-effectiveness-of-the-care-quality-commission-interim-report