Recommendation 57

Care Quality Commission evaluation of detecting and responding to warning signs

The Care Quality Commission should undertake a formal evaluation of how it would detect and take action on the warning signs and other events giving cause for concern at the Trust described in this report, and in the report of the first inquiry, and open that evaluation for public scrutiny.

The Care Quality Commission has carried out a significant review of how it uses information to identify potential failures in the quality of care in hospitals. Taking each of five key questions – is a service safe, effective, caring, responsive and well led – the review undertook to define an ‘ideal’ set of indicators that the Care Quality Commission could routinely monitor to identify these potential failures. The review then scoured national and international best sources in quality measurement. A short list of potential measures was then identified and tested through analysis and a series of engagements with the sector and experts in the measurement of quality. In A new start – Consultation on changes to the way CQC regulates, inspects and monitors care the Care Quality Commission consulted on the set of indicators. It analysed the resulting set of indicators, and published on 24 October 2013 for the first time the analysis outputs, which it will publish quarterly. This way it will ensure wider feedback on its approach.  It is also committed to on-going evaluation of the indicators to learn and improve the new approach.


The Care Quality Commission has put in place a system of Intelligent Monitoring to help decide when, where and what to inspect. This draws information and data from a range of sources to identify providers and services where there may be a greater risk of providing poor care. The evidence from the Intelligent Monitoring system is used to prioritise which providers will be inspected and the lines of enquiry during an investigation. The system triggers a response, for example, where there are a statistically significant number of severe harm incidents or avoidable deaths at a provider. “Never events” trigger an automated elevated risk in Intelligent Monitoring which inspectors follow up individually. The data it looks at includes information from:

  • staff
  • patient surveys
  • mortality rates
  • hospital performance information such as waiting times and infection rates

In October 2013 the Care Quality Commission began a pilot of its intelligent monitoring programme for acute and specialist NHS Trusts. The pilot looked at more than 150 different sets of data (indicators), which relate to the five key questions the Care Quality Commission asks of all services – are they safe, effective, caring, responsive, and well-led? Using this data, the Care Quality Commission grouped all acute NHS trusts into six priority bands for inspection (The bands are based on the likelihood that people may not be receiving safe, effective, high quality care). The Care Quality Commission completed its latest round of Intelligent Monitoring of trusts in July 2014.

In November 2014, the Care Quality Commission published Mental Health intelligent monitoring reports, which display the results of its analysis of Tier 1 indicators for all Mental Health NHS trusts. Each trust will receive an individual report and banding, similar to those for acute hospitals. The bandings will range from one to four.

In November 2014 the Care Quality Commission published its first round of Intelligent Monitoring for GPs

Draft Intelligent Monitoring models for the Adult Social Care sector have been in place since October 2014, with separate sets of indicators for residential, community and hospice services. The Care Quality Commission will continue to develop these models with providers and stakeholders to develop a more robust Intelligent Monitoring system within Adult Social Care during 2015/16 and beyond