Kieran Walshe Professor of Health Policy and Management Manchester Business School, UK

1. Item 5 Paper No CM/01/13/04 Care Quality CommissionBoard presentation – 7 February 2013Developing a strategic framework to guide CQC’s programme of evaluation Kieran Walshe Professor of Health Policy and Management Manchester Business School, UK kieran.walshe@mbs.ac.uk

2. Overview • A review of the current regulatory model • Focused review of four areas: • Differentiation in regulatory design • Standard setting • Risk assessment and proportionality • The inspection workforce • Comparisons with four other regulators – two in healthcare in other countries, two in other sectors in England – plus review of relevant research and existing CQC data

4. Regulatory model: key issues • Focused on “safety net” regulation with limited capacity and capability to drive improvement • Some inherent issues with generic model/approach; QRPs and risk assessment; and information provision • Likely to be low impact and VFM as it stands • Strategic review indicates major changes in regulatory model – particularly in improvement, differentiation

5. Comparison with four other regulators • Joint Commission for the Accreditation of Healthcare Organizations – main US regulator for acute care • Inspectie voor de Gezondheidszorg (Dutch Healthcare Inspectorate) – oversees healthcare organisations, professions and technologies • Office for Standards in Education, Children’s Services and Skills – regulates/inspects schools, FE, early years, childminding, children’s social services, etc • Homes and Communities Agency – regulates providers of social housing – “registered social landlords”

6. Differentiation in regulatory design • All other multisector regulators differentiate – often common methods and processes but tailored standards, guidance, inspection staff, intensity of oversight • Rationale for differentiation – size/scale of sector, complexity and level of risk in services, size/no of providers, range of performance/heterogeneity • CQC could pilot differentiation in/with one or more sectors – probably the larger sectors with most heterogeneity

7. Standard setting • Variation in approach taken by other regulators but tend to have standards that are specific to sector, are more maximal or discriminating, and to involve sector in framing/setting standards • CQC could pilot the development and use of tailored guidance based on existing standards (building on experience of themed inspections) and pilot use of standards from other sources eg NICE

8. Risk based regulatory approaches • Other regulators - risk assessment at sector/service level common but risk assessment/targeting at organisational level limited/problematic – data not good enough to predict risk • CQC could pilot a simplified form of risk assessment based on its own inspection findings • CQC could consider other uses for the performance data collated for QRP – in providing/publishing information

9. The inspection workforce • Inspectors need competence in three domains: content knowledge, regulatory process, and interpersonal skills • The professional judgement and “people skills” of inspectors are very important – other regulators all use senior, experienced and qualified staff and invest in their training/development • CQC could audit the existing content and regulatory expertise of its inspection workforce, and pilot specialisation in one sector or with some inspectors • CQC could develop a more formal and extended initial training and continuing professional development programme for inspectors

10. Conclusions • Scale and pace of change in regulatory model envisaged by strategic review • Can pilot important changes quite quickly – use scale and capacity of CQC • Need to test and evaluate changes as they are developed and before they are rolled out • Should use CQC’s routine data set to provide ongoing measures of impact and effectiveness