“Taking the first step towards truly regulating through the eyes of the public” – CQC updates on ICS assessment

This week at IH, we watched CQC’s most recent webinar focussing on their new method of assessing integrated care systems. Amanda Williams, the interim director of integration, inequalities and improvement gave a presentation on the latest updates and how the CQC have been working to improve quality assessment across the ICS.

The CQC’s new powers

Amanda began by providing an update on the CQC’s new powers, how these have emerged and what the CQC’s ambitions look like in light of these changes. She said:

“The Health and Care Act has given CQC a new role in reviewing ICSs. Under part 1 of the Care Act, the CQC has a new duty to assess how local authorities are meeting their social care duties. This will allow us to look more effectively at how care providers in local systems are improving outcomes and reducing inequalities.”

“Over the last year, we have engaged extensively with each other on how they will do this. We want to bring together a view of quality across a local area and put people at the centre of driving improvement in care. We have established an expert advisory group who meet periodically to provide dedicated input and that has been really transformative in how we’ve brought together a view of quality across a local area, ensuring we have people at the centre an that our goal to drive improvement in care will be able to be delivered.”

“These powers will allow us to support and deliver the objectives in our strategy, by allowing us to look more effectively at how the care provided in a local system is improving outcomes for people and reducing inequalities in the care that they receive.”

Single assessment framework

“We’ve drawn on work previously done by Local Act Personal by National Voices and the Coalition for Collaborative Care in making it real. Together we have coproduced a personalised care and support framework used by people working in adult social care, local authorities, ICSs etc which sets out what good person centred care looks like and what people should expect from providers, commissioners and system leaders.”

“Using ‘I’ statements to take the first step towards truly regulating through the eyes of the public. In order translate this for providers, we’ve developed a number of ‘we’ statements, so that it is very clear for providers and systems to understands what the expectations are.”

“These form the standards against which we hold providers, local authorities and ICSs to account. The statements encapsulate the views and expectations of real people – we feel that giving them a prominent place in our single assessment framework, really helps the whole health and social care system to be focussed on people at a very human and relatable level.”

“We want to be far more consistent and transparent in our approach in how we make judgments on quality. To address this, we’ve developed a way to categorise and score evidences as part of our assessments. These evidence categories will bring far more structure to our process for assessing quality, all of which are underpinned by best practice standards and guidance.”

“We found that the evidence gathered fell into six categories: peoples’ experience, feedback from staff and leaders, feedback from partners, observations of care, processes and outcomes of care.”

“To design our approach an our SAF, we are working in partnership with NHS England, providers, ICSs, local government organisations, DHSC, HLUHC and other bodies representing strategic partners.”

What they have done so far

“For integrated care systems, we have carried out two test and learn cycles and worked with North East London ICS and South Yorkshire ICS – looking at the three themes: leadership, integration and quality and safety. We covered 16 quality statements, reported on our findings and shared those reports with the two systems.”

“We received a huge amount of really helpful and informative feedback from those systems; the activity really helped us identify areas for learning and for refining. It also helped us think about how CQC engaged with local populations and how we captured peoples experience.”

“The feedback also highlighted the complexity of assessing quality, safety and integration across a whole geography. We must consider all of the other outputs as well, such as the NHS England System Oversight Framework and annual review; the outputs of the local authority assessments and many more. It is important that significant emphasis is placed on the wider determinants of health, and we found that we needed to continue to explore what these looked like.”

Amanda then turned her attention to the broader scope of the CQC. She explained that “interim guidance has been published which talks about our approach to assessing the integrated care systems and these are the quality statements that sit beneath those three themes of leadership, integration and quality and safety.”

“They include how we plan together, link our assessment methodologies, how we plan to gather evidence, report on findings and how we award ratings. As we develop our model and transition to ongoing assessment, this guidance will include more detail and will for form the basis for comprehensive guidance on our regulatory processes.”

Approach from April 2023

“We’ve been developing and building our approach and our powers came into effect on April 1st. We have been thinking about the following question: what does the first year look like? From April until July we have begun forming a national view of performance, initially focussing on themes from one quality statement which is ‘equity and access’. This will show whether systems are working together to support people to access care, to get the support and treatment they need when they need it. It will also reveal how all 42 systems are responding to inequities in access. Our findings will be pulled together and will form our annual state of care publication later this year.”

“Going forward, we plan to pilot our approach with some ICSs before we start formal assessments. continue to work closely with the Department of Health and Social Care on how we deliver further assessments beyond this point.”

National Assessment of Equity in Access

“We’re beginning a national review of the equity in access quality statement across all 42 ICSs. We will review publicly available data and information and we’ve contacted ICSs offering the opportunity for them to take part in focus groups to discuss this quality statement. We will also be making contact with Healthwatch to understand their feedback from their local populations, find out what people feel, what their experiences are in relation to equity and access.”

“Following on from this, we will be undertaking a series of pilots from autumn 2023. They will involve testing against a sub-set of quality statement in our single assessment framework, tailored to integrated care systems. We will work closely with out expert advisory groups, ICSs and stakeholders to test and evaluate our work.”

“The learning and evaluation will conclude with a final published approach to start our formal baseline assessments of all integrated care systems.”

If you would like to learn more about the CQC’s latest guidance, please click here.