The world does not stand still. Health and care services today are quite different to how they looked 20 years ago. There has been constant change in the almost 70 years that the NHS has been with us. And that change continues, driven by the needs of an ageing population with more complex needs, by medical advances, by our shared greater expectations and, of course, by financial pressures.
Where much change in the past has been evolutionary, the current driver of the Five Year Forward View aims to speed transformation so that by 2020 half the population will receive care from providers that are arranged in more integrated ways.
New care models create new challenges for CQC. It is our responsibility to find solutions. As the regulator of health and adult care services, we need to be alert to changes taking place – and we need to be able to adapt and change in real time to the new environment. The key challenge for a regulator in a time of change is to make sure we don't get in the way of innovation – we cannot and must not stop new and different things happening.
The safety and quality of the care people receive will always be a priority. Both can be improved through successful innovation. We recognise that the path to improvement may not always be smooth. It's our job to encourage improvement, so we will support innovation and learn with providers when that road is bumpy. But it also our job to protect and promote the safety and welfare of people and we will take action if we necessary to ensure this.
When a new model of care is proposed, we can't be sure of the outcome. But our first response must be to look forward; we should be asking how we can help change happen, checking that the provider is aware of the risks these changes bring, what steps it is taking to mitigate them and that it has a clear view of the quality it expects to deliver and how it will assure itself that it is achieving this.
The statement of intent we published in July set out the principles that would steer our work with new care models:
Listening and learning – We will listen to providers and will learn with them. We will not have all the answers, and hope to work in partnership with new care models to develop our approach.
Supporting Innovation – We are keen to ensure regulation does not get in the way of innovation, but will continue to take proportionate action if we identify a service which is not delivering the fundamental standards of care.
Working with national regulators and system partners – We are part of the Five Year Forward View board which provides a clear vehicle to offer system leadership and alignment, and we are developing close working relationships with NHS Improvement and NHS England to make it easier to share information about new care models.
Our regional network of inspectors have started to engage with vanguards and our New Care Models national group is ensuring we learn from what we are hearing across the country, using what we hear to inform changes to the way we operate. It is important that we keep talking to those developing care on the ground. We need to understand it, and make sure that we don't get in the way of new ways of delivering high-quality care.
In practice, this means, among other things:
Reviewing our registration and inspection guidance
Evolving our inspection model and strengthening our key lines of enquiry so that we can effectively inspect, rate and report on the impact of new care models
Exploring how we work with services where innovation or change leads to poor quality care, because we understand not all change will be successful.
Building on our place-based reports and our thematic reviews looking at integration to understand CQC's role (if any) beyond reporting on individual providers/locations.
Listening to the feedback from key partners to understand how CQC could build a supportive environment that ensures people receive safe, effective and compassionate care.
As we develop the way work, we have to remain open to new possibilities, to new models of care emerging that we haven't anticipated and be ready to flex and modify our approach so we can support innovation.