Recommendation 49

Routine and risk related monitoring


Routine and risk-related monitoring, as opposed to acceptance of self-declarations of compliance, is essential. The Care Quality Commission should consider its monitoring in relation to the value to be obtained from:

  • the Quality and Risk Profile
  • quality accounts
  • reports from Local Healthwatch
  • new or existing peer review schemes
  • themed inspections

The Care Quality Commission is fundamentally changing the way it monitors providers on the quality of their services. Through its Chief Inspector of Hospitals, it has introduced a new system in the hospital sector. The Chief Inspectors of General Practice and Adult Social Care have been appointed, and will similarly lead the development of new approaches in their sectors.

The Care Quality Commission has consulted on and started implementing a new approach to monitoring providers, based on identification of the indicators that are most important in signalling potential concerns in each type of care. This has started in the hospital sector, and the Chief Inspector of Hospitals has been clear that information from people who use the service, or their representatives, information from accreditation and peer review, and information from other oversight bodies are also important alongside indicators from national data. In October 2013 the Care Quality Commission began regularly publishing its analyses of the indicators for each hospital trust.

The Care Quality Commission will continue to develop the approach to monitoring hospitals, and extend it to mental health, community health and ambulance providers both in the NHS and the independent sector. The Chief Inspector of General Practice, on behalf of the Care Quality Commission, will bring forward proposals for his sector and consult on them. A signposting document on adult social care, A fresh start for the regulation and inspection of adult social care, was issued in October 2013 by the Chief Inspector of Social Care.

The Care Quality Commission is engaged in a review of quality accounts that the National Quality Board has requested and will play its part in ensuring that quality accounts add value, are robust and have accountability for inaccurate or inappropriate information.

The Care Quality Commission is developing memoranda of understanding with all the medical, nursing and midwifery royal colleges in order to explore the potential to use their accreditation schemes in its monitoring, where that can encourage achievement of best practice standards and avoid duplicated inspection.

The Care Quality Commission is reviewing its approach to themed inspections, including how they can contribute to its broader monitoring of providers.


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 related 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. In March and July 2014, the Care Quality Commission updated its surveillance model for acute and specialist NHS trusts.

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 receives an individual report and banding, similar to those for acute hospitals. The bandings range from one to four.