CQC’s role in regulating closed cultures
Our concerns with the mental health sector (inpatient units)
Our response to COVID-19
How we are improving what we do
17.1. The percentage of unannounced inspections in hospitals with wards for people with a learning disability or autism has increased from 62% in Q1 2019/20 to 77% in Q4 2019/20.
17.2. CQC undertakes shorter, unannounced inspections, which can take place at weekends. We have used out of hours inspection visits to uncover regulatory and human rights breaches and taken action as a result.
17.3. Mental Health Act Visits are almost entirely unannounced visits to wards. Around 1200 visits are completed per year – they may be carried out during weekends or evenings although this is not a regular approach due to the reduced access to patients and clinical staff out of normal hours.
17.4. Our guidance to inspectors says inspectors should look at all the evidence to assess the truth of people’s experience in using the service by always carrying out unannounced inspections; always using an Expert by Experience; and carrying out evening and weekend inspections.
17.5. We are currently rolling out training to all inspectors on closed cultures, given their new prevalence in all settings. As of the 1 July 2020, 804 colleagues have completed this. All operational colleagues will have completed this training by the end of August 2020 and there will be follow up sessions throughout the year.
18.1. CQC’s new Give Feedback on Care service launched in January 2020. It captures information about people’s experiences of the care services they or their loved ones use or that they have experience of through their work. People can give feedback on the phone or online.
18.2. The new service was designed around the needs of users and a full accessibility audit (carried out by the Digital Accessibility Centre) was completed, which involves testing by people with physical, sensory and mental impairments.
18.3. Concerns raised by patients and their families will be considered earlier in CQC inspection processes, along with a strengthening of our engagement with advocates for people who use services.
19.1. CQC is conducting a review of its methodology for how we respond to concerns in co-production with inspectors and people who use services.
19.2. CQC has developed a decision-making tool for inspectors about taking regulatory action where there are inherent risks or warning signs of a closed culture. This means also that a focussed inspection should be triggered more consistently when there are concerns raised.
19.3. CQC has developed a new insight monitoring tool to draw together information and analysis about independent mental health and learning disability healthcare services which was launched in December 2019.
19.4. CQC has introduced guidance for colleagues in our call centre to help ensure we are collecting as much information as possible, and to help identify safeguarding and vulnerable groups, and signs of closed cultures.
19.5. The number of concluded successful prosecutions has risen from 5 cases a year for 2017/18 and 2018/19 to 14 cases this year so far, with further prosecutions underway.
19.6. CQC is supporting DHSC in its review of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, looking at whether the scope and extent of CQC’s enforcement powers is sufficient.
20.1. We expect services to ensure that they are supporting people to stay in touch with family members in line with national guidance.
20.2. Our new closed cultures guidance highlights that it is important for services not to put in place blanket restrictions such as restricting all family visits and this should be considered on a case by case basis. We will be highlighting good practice where this happens.
21.1. The independent reviews commissioned by CQC in the wake of the Panorama on Whorlton Hall in May and June 2019 have produced important and valuable recommendations which we accept in full and we are in the process of implementing them entirely, via a dedicated ‘closed cultures’ team. The Noble review published in January 2020, and the Murphy review published in March 2020. Phase Two of the Glynis Murphy review will be presented to CQC Board next year.
21.2. We started a major organisational transformation programme in 2019 which will deliver significant benefits for people who use services, providers, stakeholders and our colleagues. It will strengthen our technology, processes, capability and culture to ensure we can successfully deliver our future strategy from 2021 and be an efficient and responsive regulator.
21.3. Strengthening our regulation to improve how we keep people safe, particularly those who are in the most vulnerable circumstances, is part of that programme – so that CQC can better identify and respond to services that might be at risk of developing a closed culture.
21.4. We have been working to strengthen how we collect intelligence from people who contact us with information of concern. We will now be able to report against population groups and protected characteristics as well as the location of care.
28 July 2020
For further information please contact:
Parliamentary and Stakeholder Engagement Manager
Care Quality Commission