Recommendation 21

Monitoring information accuracy

Accepted in principle
The regulator should have a duty to monitor the accuracy of the information disseminated by providers and commissioners on compliance with standards and their requirement of honest disclosure.  The regulator must be willing to consider individual cases of gross failure as well as systemic causes for concern.

The Care Quality Commission already has powers to require information and explanations, with failure to provide these or obstructing an inspector constituting an offence, and has started to put steps in place to improve its monitoring. The Care Quality Commission will not be wholly reliant on one information source; its new surveillance model, combined with the existing information resources available to it, will allow it to cross- refer concerns and build up a picture of care. It is also a condition of Monitor’s licence that information provided to Monitor is accurate, complete and not misleading. Monitor can and has pursued cases where information provided to it has been inaccurate.

The Care Quality Commission has developed a new approach to monitoring hospitals’ performance, which helps direct the timing and focus of inspection. It includes measures of data quality, which may prompt assessment of culture, leadership and governance and, within that, information governance. The Care Quality Commission has a strong key role in that area through its National Information Governance Committee. The Care Quality Commission’s monitoring of hospitals includes a range of systemic indicators, such as outliers on different measures over time), and individual events (examples include reports from whistle blowers, safeguarding incidents, notifiable deaths and incidents). All of these are able to trigger interventions, including inspection.

The Care Quality Commission will consider further measures related to data quality as its new system for monitoring providers matures, in order continuously to improve its sensitivity to this aspect of quality of care. Taken together, therefore, the Care Quality Commission already take a range of robust approaches to assessing and verifying the extent to which providers are complying with standards; it is therefore unnecessary to impose a new duty on it.

 

Update

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

The Care Quality Commission will also be publishing its first round of Intelligent Monitoring for GPs. It will be undertaking additional testing and engagement to determine the most useful indicators to inform this work, and will align its definitions of indicators as far as possible with those used by partner bodies such as NHS England and Public Health England.

The Care Quality Commission has always used important information in statutory notifications as an indicator of quality and safety in the adult social care sector, alongside other information about safeguarding alerts and information provided by others such as people who use services, staff and the public. The Care Quality Commission does not have a lot of quantitative data consistently collected across the sector but it is taking steps to improve this. With a new, more thorough model, the Care Quality Commission intends to use all the available information to check whether there is a risk that services do not provide either safe or quality care.

The Care Quality Commission is currently developing the set of indicators for adult social care services. There are limitations in the coverage of national datasets, but the Care Quality Commission will start by making better use of the indicators it is developing, and then determine how it will improve this over time. The Care Quality Commission will be carrying out additional testing and engagement to determine the most useful indicators to inform its work.