The regulation of adult social care by the CQC in and beyond the Covid-19 emergency

Chris Payne summarises and discusses the CQC’s webinar “An update from the CQC” about how the regulator is operating during the current Covid-19 crisis.

In an “Update from CQC” webinar on the 22 July 2020, Sue Howard, Deputy Chief Inspector of Adult Social Care for the Care Quality Commission (CQC), discussed the impact that the Covid-19 outbreak has had on the regulation of adult social care services. She started by thanking care providers for their immense efforts in dealing with the challenges of Covid-19. She also spoke about CQC’s role in “championing” the care providers to ensure that they got the support they needed.

Continuing regulation

She emphasised that despite having to make substantial changes to CQC’s ways of working and inspections, the Commission has never stopped regulating. She also indicated that the crisis had presented opportunities to review its customary ways of working and to explore and test new methods, which could feed into the new Strategy 21: Smarter Regulation for a Safer Future, which is currently being consulted and worked on with a planned launch date for Spring 2021.

Although CQC suspended regular on-site inspections at the start of the Covid-19 outbreak it has maintained close oversight of services considered to be urgent risk. In general, it has been able to maintain its regulatory role through its “Insight” activities by gathering, analysing and acting on relevant information and working closely with “partner” agencies including for service user, care providers and public health and social care organisations, and the Association of Directors of Adult Social Services (ADASS).

Importance of working with other agencies

The Deputy Chief Inspector emphasised that the partner agencies must work closely together in order to learn. “Transparency promotes learning – one doesn’t happen without the other”. It was vital to listen to the people using services and care providers with feedback into the local systems, including the service commissioners and public health bodies that are having an increasingly pivotal role in controlling the spread of Covid-19. In the Q&A session that followed the presentation, in which there were several questions about testing and PPE, she repeatedly reassured her audience that CQC was representing the voice of service users and providers to obtain the resources and support needed to maintain their quality and standards of care throughout the emergency period.

Information gathering tools

Sue Howard described the key information gathering tools during the emergency as:

  • the Emergency Support Framework (ESF), which has consisted of structured telephone conversations with care providers, mainly registered managers, to discuss how and how well they have managed during the main lockdown period and as that has eased

  • #becauseweallcare, which is an initiative taken with Health Watch England to find out more about how people have experienced the care and treatment provided during the crisis

  • Provider Collaboration Reviews (PCRs), which is aimed at finding out how care providers have worked together and how they had been supported to work together

  • inspecting by priority/risk, which has focused on “urgent risk”, but soon might be extended to “high risk” eg services that have been rated consistently “inadequate” in the near future.

In addition to these activities, CQC will be carrying out about 300 thematic reviews on the lessons to be learned about infection control management from the Covid-19 experience.

Emergency Support Framework

At a later point in the presentation the Deputy Chief Inspector explained how ESF findings might be used. In general, summaries of the discussions would not be made public or shared with partner agencies. CQC would continue to refer safeguarding and other concerns, for example, staffing shortages to the appropriate agencies. It would also share overviews of findings with local health and social care authorities. She continued to emphasise that CQC’s main concern in using the ESF was to support providers through the emergency period to provide safe care to the people using their services.

Infection control practice

To reinforce this message she also provided examples of how care providers had creatively supported people with impaired capacity to adopt recommended infection control practices such as hand washing and keeping physical distance. One was the use of glitter in water to represent “germs” that enabled people to practise their handwashing. Another was the use on walls of hand - shapes two meters apart each with a piece of cotton wool stuck to it as the virus, which reminded people of the importance of social distancing. A third example was the learning to “elbow -bump” instead of hands shaking as a safe means of maintaining physical contacts.

Provider Collaboration Reviews

The PCR project scheduled for July and August is based on CQC’s Building bridges, breaking barriers: Integrated care for older people (2017) review and is designed to find out how well providers and partner agencies have been able to work together to combat Covid-19 in their respective localities. It will support care providers by sharing learning and enabling them to re-establish services and pathways locally, and to prepare for any “second wave” of Covid-19 and other usual winter respiratory infection outbreaks. The learning will come from the experiences of service users, their families and care providers. The Deputy Chief Inspector did not describe the project methodology, but referred to its Covid-19 Insight publication, now in edition 3, and regular provider bulletins that will help to disseminate the findings. Project sites are in all parts of the country.

On-site inspections

As the current restrictions ease, CQC will move into a transition phase, which will involve a return to on – site inspections in some cases in response to the assessment of risk, and some remote or virtual assessments of domiciliary care services, which will also test the validity of making quality ratings through these methods.

However, the Deputy Chief Inspector emphasised strongly that although, within CQC’s new strategic framework there would be greater use of new digital platforms and technology, they would not and could not abandon carrying out on-site visits. “Crossing the threshold” will continue to be a requirement of the regulatory framework with which CQC operates.

New strategy

CQC plans to launch its new strategy in the spring of 2021. It will continue to provide a system of regulation that ensures people are kept safe and their needs are met and one that is driving and supporting improvement. It will aim for “smarter regulation” through the development of new digital platforms, smart phone apps and use of new technology generally.

Discussion

The webinar can be found on https://www.bigmarker.com/closerstill-media/An-update-from-the-CQC?bmid=27697dfe3fd1 and contains a 20 minute presentation followed by 40 minutes of questions and answers. The Deputy Chief Inspector gave considerate responses to well over 30 questions, which added to the impression she gave throughout the session of genuinely wanting to support people during this critical period. Some questions lay outside the remit of CQC so not all could be fully answered. It will be important to find out if the ESF discussions are actually being experienced as supportive or threatening. With the PCRs it will be useful to find out what local support was given to providers to enable them to collaborate in addition to finding out how much actual collaboration there has been and over what. The findings from the thematic reviews will hopefully contain some important lessons for future infection control management, particularly over the thorny issues of admissions policies, staff deployment, testing, and the availability and use of PPE.

Conclusion

The impression from the session was that CQC has adopted almost an advocacy role on behalf of the care sector during the crisis. It has achieved this by being at the interface between care services and the government departments that have been responsible for the swathe of interventions required to deal with the outbreak on which it might advise but over which it has no direct control. This has created challenges for its role as regulator over and above the fact that it has had to suspend many of its customary regulatory activities. It remains to be seen if the position CQC has taken of championing the care provider will cause it any role conflict once it resumes its normal compliance — based regulatory activities.