ICBs should be ‘explicitly’ tested by the CQC on listening to communities and ensuring their plans include this input, the review into patient safety has recommended.
The Dash review, published by the Department of Health and Social Care (DHSC) earlier this week, said there was currently an obligation for Local Healthwatch to raise concerns about the quality of care with the CQC and ensure patient, user and community input into strategy.
However, the Review of Patient Safety Across the Health and Care Landscape, by Dr Penny Dash, recommended there should ‘instead be an obligation for ICBs (for healthcare) and local authorities (for social care) to be responsible for listening to communities and users, [and] ensuring strategies and plans take into account patient, user and community input.’
It added: ‘This should allow for far more rapid resolution of areas of concern. CQC would explicitly test this in its assessment of ICSs.’
The review, which set out nine recommendations, also called for greater use of AI to identify poor care – a recommendation that features in the 10 year plan.
It also recommended a customised approach to regulation for small GP practices.
While reaffirming the CQC’s role as the independent regulator, the report also highlighted that a one-size-fits-all approach is failing to account for the structural and resourcing constraints in small practices.
‘For some providers, their small size makes it hard to put in place governance structures – for example, in smaller GP and dental practices,’ the review said.
It recommends that the CQC should ‘offer a more customised approach’ to assessing these providers, calling for tailored inspection frameworks by sector and within sectors.
‘For those (usually smaller) organisations where lack of governance structures may be more of an issue… [CQC] should offer a more customised approach,’ the report said.
Under the new proposals, CQC would continue assessing providers against five quality domains, but would be expected to draw on detailed data to target risks, and take provider size into account.
The review was asked to investigate the effectiveness of six organisations responsible for assuring or improving care safety including the CQC, Health Services Safety Investigations Body (HSSIB), Patient Safety Commissioner, National Guardian’s Office, Healthwatch England and Local Healthwatch, and the patient safety learning aspects of NHS Resolution.
This followed on from Dr Dash’s review of the CQC’s operational effectiveness, published in October last year.
That review found ‘significant failings in the internal workings’ of the regulator leading to ‘a substantial loss of credibility within the health and social care sectors’.
Dash review recommendations
- Revamp, revitalise and significantly enhance the role of the National Quality Board
- Continue to rebuild the Care Quality Commission (CQC) with a clear remit and responsibility
- Continue the Health Services Safety Investigation Body’s role as a centre of excellence for investigations and clarify the remit of any future investigations
- Transfer the hosting arrangement of the Patient Safety Commissioner to the Medicines and Healthcare products Regulatory Agency (MHRA), and broader patient safety work to a new directorate for patient experience within NHS England, transferring to the new proposed structure within DHSC
- Bring together the work of Local Healthwatch, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services
- Streamline functions relating to staff voice
- Reinforce the responsibility for and accountability of commissioners and providers in the delivery and assurance of high-quality care
- Technology, data and analytics should be playing a far more significant role in supporting the quality of health and social care
- There should be a national strategy for quality in adult social care, underpinned by clear evidence.
Source: Review of patient safety across the health and care landscape
Recommendation 5 in full
Recommendation 5: bring together the work of Local Healthwatch, and the engagement functions of integrated care boards (ICBs) and providers, to ensure patient and wider community input into the planning and design of services
The statutory functions of Local Healthwatch relating to healthcare should be combined with the involvement and engagement functions of ICBs to listen to and promote the needs of service users. This should incorporate PPGs and patient or user engagement teams in provider organisations. This will:
- ensure greater clarity and improved effectiveness in bringing wider patient, user and community inputs into care planning
- support clearer accountability from all organisations within an ICS to their local populations
Local patient and user engagement teams would be supported by the new patient experience directorate within DHSC.
The statutory functions of Local Healthwatch relating to social care (a very small proportion of the work of Local Healthwatch) should be transferred to local authorities in order to improve the commissioning of social care. The combined functions should:
- provide insights into the work of ICBs and local authorities (as commissioners), as well as strategic planning more widely
- support the co-design of services
- continue to be driven by the needs of local communities, operating locally at place level, while ensuring benefits of scale by influencing across an ICS-wide footprint
The strategic functions of Healthwatch England should be transferred to the new directorate for patient experience at DHSC. The directorate would have an explicit responsibility to:
- encourage feedback
- ensure a significant improvement to complaints functions across the system
This would allow the existing deep patient advocacy expertise of Healthwatch England and Local Healthwatch to have a greater impact, thanks to:
- closer alignment with the commissioning and provision of care
- greater emphasis being placed on the patient voice by DHSC, commissioners and providers
We have considered each of the 3 core strategic functions of Healthwatch England – see ‘5. Healthwatch England’ in the previous section ‘The 6 organisations under review’.
The current role of Healthwatch England to provide advice to the Secretary of State should move to the new patient experience directorate in DHSC.
The current obligation for Local Healthwatch to raise concerns about quality of care with CQC and ensure patient, user and community input into strategy and plans should change. There should instead be an obligation for ICBs (for healthcare) and local authorities (for social care) to be responsible for:
- listening to communities and users
- ensuring strategies and plans take into account patient, user and community input
This should allow for far more rapid resolution of areas of concern. CQC would explicitly test this in its assessment of ICSs.
It is recognised that, for this change to be meaningful and impactful – and to have the confidence of users and patients – DHSC, local authorities and all 42 ICBs would need to fully embrace the ethos, responsibility and imperative to listen to the voice of users. The rationalised and simplified structure locally should enable this to happen in a more meaningful way, while the creation of a patient experience directorate within DHSC should ensure a visible focus on patient and user experience in healthcare across the system.
To fully enact these functions, ICBs and local authorities will need to exploit the benefits offered by digital tools. These should be used to:
- capture and enable patient, user and community inputs
- build associated data and analytical capabilities to:
- ensure robust outputs
- enable accurate assessment of the views of disparate populations and users
As part of its wider responsibilities, a core function of CQC should be to assess whether every ICB and provider is listening to patients and users effectively, using existing local networks.
A version of this story was first published on our sister title Pulse.
