Strong foundations

Andrea Sutcliffe, Chief Inspector of Adult Social Care at the Care Quality Commission.

On Monday CQC published a consultation document on our future fees strategy. Our funding is already a mixture of grant-in-aid resources from the Department of Health and fees from providers. However, the Treasury is expecting all regulators to move to full cost recovery on fees, hence the increases set out in the document.


I fully understand the concerns this has caused providers. I recognise the financial pressures that adult social care is experiencing and, while for some providers the amounts are relatively small, in a world of tight margins any increase in cost is unwelcome.

However, it is important that this sector has a strong regulator capable of setting clear expectations, monitoring and inspecting against those standards, providing clear information for the public and holding providers to account when services fail. We need to do that in the most efficient and effective way possible to demonstrate value for money and impact.

At the same time as increasing fees for providers to comply with the Treasury requirements, we are also being asked to look at making savings to further reduce our reliance on grant-in-aid. All government arm’s length bodies are being asked to do this, so there is no suggestion that CQC is being singled out, but in advance of the comprehensive spending review (due on 25 November) it is sensible planning.

Improving registration

None of this is easy for CQC or providers so we need to do whatever we can to improve our efficiency and minimise burden. One way of doing that is to make best use of technology and Monday also marked the launch of our new provider portal registration system, which enables providers to register online.

To date we have operated a largely paper-based system, which can be cumbersome and time-consuming for applicants and CQC staff. The new approach will mean that providers will not be able to submit incorrect basic information, which should reduce the numbers of applications rejected at the initial validation stage. It also means that online advice and guidance can be available as the forms are filled, which I hope will improve the application experience.

We have much more to do in registration to streamline our processes further as we indicated in A Fresh Start for Registration earlier this year, but I am pleased that we have been able to achieve this milestone and use it as a strong foundation for further work.

Looking ahead

This theme was reflected in another document Building on strong foundations, published last week, setting out the challenges for the future of quality regulation in health and social care and some of the choices we face in responding. It’s not a long read so I hope you will take the opportunity to have a look and give us any initial feedback to help shape the formal consultation on the 2016 to 2021 strategy we will launch in January next year.

Our intention in sharing the document is to encourage a conversation with everyone interested in what we do so that you can help to shape and design our future strategy — and what better place to have that conversation than the Adult Social Care External Coproduction Group? Which is what we did yesterday!

Coproduction conversations

Regular readers of this blog know how much I value the rich and diverse contribution this group makes to our work, and yesterday was no exception. We concentrated on three areas — a general consideration of the factors that we need to take into account; how we could evolve our approach to adult social care inspections; and the value of assessing quality in a place.

A day’s worth of discussion can’t be reflected in a few short words but some key points to consider further emerged:

  • How regulation works with commissioning and the need to reduce duplication.
  • How we can use our evidence base to influence and support research.
  • How can CQC share good practice on organisations improving up the scale from inadequate to requires improvement, good and outstanding.
  • Making sure we don’t change the methodology too much.

The discussion about inspections focused on the assessment of corporate organisations and generated some differences of opinion with some highlighting the value of looking at things once across a group with others emphasising the continued importance of a location-based inspection. There was agreement that presenting transparent information about a corporate organisation’s performance would be helpful.

On the question of assessing quality in a place, the group posed some good challenges. Who is the audience? What value will this add (and at what cost)? How would organisations or systems be held to account? So, lots more to think about there.

Bonfire flames and Christmas presents

We do have serious discussions at the coproduction group but we like to have a bit of fun too. Yesterday was Bonfire Night so we asked for suggestions of things participants would like us to stop doing (or not start) to cast onto the bonfire; and as it was our last meeting before Christmas, what Christmas presents should we have of things we should start or continue to do.

One of the flames on the bonfire was a request that community service providers that move offices should not have to go through the whole registration process — I couldn’t agree more and work is already underway to tackle this.

One of the Christmas presents said “people are at the heart — keep them there”.

I promise we will.

Originally published at

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