The Care Quality Commission is the independent regulator of health and adult social care in England. Regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, and organisations carrying out these activities have to be registered with the CQC. These include all organisations and settings that provide care and support self-care in people with frailty, such as:
- Organisations providing personal care;
- Nursing, EMI and Residential Care Homes;
- GP Surgeries, Out of Hours and Emergency Care Centres;
Registered organisations are subject to inspection by the CQC. The inspections are normally carried out as a regular, planned visit called a comprehensive inspection. If potentially serious concerns about an organisation are raised (e.g. by those using the service, their carers or by staff), then the CQC has the authority to carry out unannounced, focused inspections.
For any health or social care service, the CQC asks the following questions when inspecting them:
- Are they safe?
- Are they effective?
- Are they caring?
- Are they responsive to people’s needs?
- Are they well-led?
Once an inspection has been carried out, a report is published and a rating for that organisation is given within the report. The CQC award ratings for each of the 5 key areas above, and then an overall “headline” rating. The ratings and a summary of what they mean is given below:
- Outstanding – The service is performing exceptionally well.
- Good – The service is performing well and meeting the CQC’s expectations.
- Requires Improvement – The service is not performing as well as it should and the CQC have told the service how it must improve.
- Inadequate -The service is performing badly and the CQC have taken action against the person or organisation that runs it.
Currently, the CQC usually inspects the organisations it regulates individually. Organisations in a particular area can be inspected at any time, but are not usually inspected at the same time and in a co-ordinated manner. In future, the CQC are planning to co-ordinate inspections across any given health and social care economy so that the hospitals, social care services, GP surgeries, out of hours centres and care homes are all inspected at the same time. The reason behind this is to allow the CQC to find out how well all these health & social care services are integrated and working together, giving a “snapshot” of health and social care for that area.
Although the CQC are not focusing specifically on frailty as a condition at present, the care of people aged 75 years or older, and those with dementia, is closely scrutinised as 2 of 6 distinct ‘population groups’, especially at GP practice level. The CQC also appointed a national adviser for elderly care in February 2015, further emphasising the importance attached to care of the elderly.
The CQC also carry out what is termed ‘themed reviews’. These look at specific standards, sectors or types of care, and include End of Life and dementia care. The dementia care themed review during 2013-14 assessed the care people living with dementia received as they moved between care homes and acute hospitals. The CQC looked at dementia care in 129 care homes and 20 hospitals throughout England, focusing on the following areas:
- How people’s care needs were assessed;
- How care was planned and delivered;
- How providers worked together;
- How the quality of care was monitored
A thematic review of Integrated Care for Older People is also underway. Fieldwork for this review takes place from October to December 2015 and a report will be published in spring 2016:
Dementia Care Review
CQC Older Peoples Easy Read
Background to thematic review of Integrated Care for Older People
CQC future plans for regulating health and social care activities in England