Recommendation 20

Policing fundamental standards

Accepted in part
The CQC should be responsible for policing the fundamental standards, through the development of its core outcomes, by specifying the indicators by which it intends to monitor compliance with those standards. It should be responsible not for directly policing compliance with any enhanced standards but for regulating the accuracy of information about compliance with them. 

In June 2013 the Care Quality Commission issued A new start – Consultation on changes to the way CQC regulates, inspects and monitors care.  Following this extensive consultation, in September 2013 it carried out its first new-style hospital inspections. The new approach to inspections is based on an overall view of quality and safety, divided into five domains, and includes ratings on each domain as well as overall ratings. This is a substantial change from the previous approach, which focused only on policing compliance with standards. The new-style inspections are underpinned by a published list of indicators, which formed part of the consultation. The inspection approach will include checking providers’ governance arrangements, as necessary checking information governance, and the provider’s ability to assure its performance information generally. The Care Quality Commission’s ratings are also likely to consider specific enhanced standards, as the National Institute for Health and Care Excellence quality standards will be taken into account when awarding a rating, particularly at the ‘good’ and ‘outstanding’ levels.

However, it would not be appropriate for the Care Quality Commission to be responsible beyond this for regulating the accuracy of information about compliance with enhanced standards. By means of contract management, commissioners will have the specific lead responsibility for holding providers to account for the accuracy of information they provide on performance against enhanced standards. The Care Quality Commission’s monitoring will look more broadly at the provider’s capability to use information effectively for assurance and improvement, with an expectation that it will disclose relevant information fully and honestly.


The Care Quality Commission will be responsible for policing the fundamental standards when they come into force in April 2015. This will be based on the Care Quality Commission’s new approach to inspection. Under the leadership of the Chief Inspectors the Care Quality Commission has put in place specialist inspection teams that subject providers to greater scrutiny. Inspections now routinely involve expert inspectors and people with experience of receiving care.

The Care Quality Commission provides regular performance reports to its Board on the quality and safety of health and care services it finds through its inspections. It has also put in place a performance and evaluation programme to assess the impact of its regulatory approach. This is designed to provide:

  • evaluation, analysis and insight on the impact and outcomes of regulation, as viewed and experienced by all stakeholders – providers, people who use services and the public, partners and other stakeholders
  • evaluation and performance measures in relation to the quality, effectiveness and efficiency of the Care Quality Commission’s regulatory approach and delivery
  • data collection and analysis on the costs of regulation
  • a framework to analyse and interpret findings, to inform assessment of the Care Quality Commission’s value for money.

The Care Quality Commission commissioned the Manchester Business School (Kieran Walshe and Denham Phipps) to investigate how evidence and research could be used by the Care Quality Commission to evaluate how well its current regulatory arrangements in health and social care work. The findings of this report supported the restructure of the Care Quality Commission into sectoral based directorates and demonstrated the need for specialisation amongst inspectors. It also drove the development of the Care Quality Commission’s standards and ratings framework, leading to the Care Quality Commission becoming a regulator that uncovers poor care but also that recognises excellence in service providers.

The Care Quality Commission has recently engaged Frontier Economics to undertake a review of its operations, enabling it to understand and demonstrate the ongoing impact of its regulation; and to assess its value for money.