Emergency Support Framework

Our interim approach has a number of elements:

• using and sharing information to target support where it’s needed most
• having open and honest conversations
• taking action to keep people safe and to protect people’s human rights
• capturing and sharing what we do.

Our emergency support framework is not an inspection, and we are not rating your performance.

This is a flexible process, which we’ll regularly improve as we learn from how the pandemic develops as well as from your feedback, and we will adapt it to different types of service in each care sector that we regulate.

We will use information to identify key trends and issues and share it with local and national partners to help them mitigate and manage risks, and to mobilise additional support where it’s needed most.

This information will help us make informed decisions and support the wider health and social care system to respond to issues at local, regional and national levels.

A key part of the approach involves calling you to have open and honest conversations so that we can support you to resolve any issues and make tough decisions to help you to keep people safe.

Our conversations will help us to understand and explore:

• the stresses and challenges for care providers and for the wider care system
• how services are using innovative ways to manage, so that we can share learning.

Inspectors will use the information about your service, from both existing and new sources, to decide whether they need to call you for a supportive conversation.

They will also use their additional knowledge and experience of your service to prioritise calls – so services with a higher risk will have priority.

A service with a higher risk level will have more contact from their inspector, as we will continue to monitor and engage with you until the emergency period is over. This approach means we’re able to target our support and action most effectively.

• safe care and treatment
• staffing arrangements
• protection from abuse
• assurance processes, monitoring, and risk management.

For each area, we will informally explore and discuss some short questions with you. These mostly focus on how prepared you are and how your service is managing in this pandemic.

We want you to ask questions if there’s anything you need help with

Our calls should not take more than an hour, and many will be shorter. Where we can, we will call you using Microsoft ‘Teams’. (Otherwise a telephone call)

Inspectors will contact you first to arrange a date and time to make the call so that you can plan and make the best use of your time.

The call is arranged in advance, but if the manager isn’t available because of illness or emergency, the inspector can ask to speak to another appropriate senior member of staff.

We will send you an email with a summary of our conversation as a record, which will be attached to the email in a PDF format. 

During the conversations with you, inspectors will make a note of the details of:

• the discussion around the four key areas
• the challenges and stresses for your service, and for the wider local care system
• any examples of good practice and innovative ways of responding to challenges that you tell us about.

As our conversation is not a regulatory process, we will not make an audio recording of the calls.

In exceptional cases an inspector may need to ask for evidence about specific risks and issues. To do this, they can ask you to ‘share your screen’ during a call or ask you to send an email attachment.

We emphasise that this emergency process is not an inspection, the summary record is not an inspection report, and there is no rating as a result. This means that usual steps such as the factual accuracy process do not apply.

We will not publish summary records on our website.

We will not publish the summary record on our website.

To ensure transparency, at a national level, we will share information on decisions we’ve taken as part of this process.

This is what the CQC says:
"We will use this emergency approach in all health and social care settings registered with CQC during the pandemic, and for a period afterwards"

1. During the pandemic
2. and for a period afterwards

So although introduced specifically for the pandemic, the CQC is leaving the door open to carry on with this even after the pandemic.

The interview approach is not too disimilar to the Annual Regulatory Review for GP Practices, and no one should be surprised to find the two merging and this becoming a permanent feature for all Providers.

This conversation with the manager is part of a formal assessment and performance review of the Provider. It may be a precursor to an inspection and enforcement action. It is a regulatory process NOT a casual off the record conversation.

• The CQC says it's not an inspection, however, they take notes which will be kept on your file
• If there are concerns, it will trigger a follow up call and even an Inspection, so again, this is an official review
• The decisions may be shared with others such as Social Services, and trigger other visits
• They do not change your official rating, but CQC log this on their internal "Risk Assessment and Ranking System"

Be Prepared

• It's not an inspection but notes have been made and they go on your file. It will be part of your history
• You can have a friendly conversation, but it is safer to treat every conversation with an Inspector as if you are making a "formal" representation to the Regulator
• If you're not sure, say so. It is better to be honest, fix things, and then update the Inspector. You will be on the right side of the law and earn their trust and respect
• Work on the basis that any future Inspector will have access to these notes before the next Inspection

So even though it isn't a normal inspection, this interview is an Official Review and it is part of the overall inspection process

The interviews are not random, Providers are selected based on their risk profile.
This is recorded on an internal tool, which ranks you based on your service risk, past inspections, complaints, public concerns, whistleblowing and stakeholder reports etc.
The local inspector will review and adjust this internal "Ranking" taking into account other information, intelligence, and details you provided earlier.

Leaving aside Hospitals, Providers in the highest risk category are Residential Care and particularly those who deal with specialist care, vulnerable adults, and higher age groups.

• Your immediate concern should be that they have placed you in the high risk category
• This does not necessarily mean you are being targeted, it might be that you have high-risk patients

Be Prepared

• Be well prepared for the interview, your performance will be important
• Be ready for a potential inspection, it can’t do any harm to start early

The CQC states that they will not publish or share your report, but they will do the following:-

• Share "information on decisions we’ve taken as part of this process" at a national level
• Share the information "to help support the wider health and social care system ..."
• Share data “to support our regulatory planning during and beyond the pandemic.”

Be Prepared

• So YES the results will be recorded and shared, and they are not specific about what exactly will be shared
• They will share "assessments and decisions" with other departments

There is a distinction between We will not publish Vs We will not share

• The Inspector will take notes but not an audio recording
• These notes will be summarised and sent to you
• You will not be asked to comment on factual accuracy, because it's not like an inspection

At the end of the Interview, you will be sent a written report, which is a formal record, but you will not be asked to confirm factual accuracy.
The danger is that any inaccuracies and omissions that go against you will remain unchallenged, uncorrected, and be part of your permanent record.

Be Prepared

• Make your own notes of the conversation as best as you can
• Fact check the summary/report as soon as you get it
• Speak to or write to the Inspector ASAP, asking for your corrections to be noted, politely of course

The CQC says it is "not an Inspection ....This means that usual steps such as the factual accuracy process do not apply"
This is contradicted in their webinar in which they state at 18:22 minutes that if you feel this "doesn't accurately reflect your discussions with the Inspector, you should discuss this with them..."

• Expected length: Max 1 Hour
• This will be done using Microsoft Teams or telephone interview
• For Teams, you don’t need a video camera but will need a working microphone

Be Prepared

In "Exceptional circumstances" they can ask for evidence and “share your screen” OR ask you to send information via email.
If you are unsure or concerned, don't panic, ask politely if you can make a note and send this by email once you have finished.

Attendees: You can decide who attends. It will usually be the Registered Manager at least, and you can have another senior person like a Partner, Director or Nominated Individual. It is always useful to have a confident and knowledgeable person next to you.

Be relaxed and casual, this is not an interrogation, the Inspector will be trying hard to establish a friendly rapport with you, and will genuinely be there to help with any issues you have concerns about.

The format and intention of this is very similar to the "Annual Regulatory Review" that GP Practices have been subjected to.
Think of this as a telephone based Inspection to discuss:-

• Issues with your performance, if any
• Whether you have key processes in place
• Do you want to report anything?
• How are you dealing with specific issues?

The topics CQC want to discuss:-

• safe care and treatment
• staffing arrangements
• protection from abuse
• assurance processes, monitoring, and risk management

Be Prepared

The agenda covers Safety, Care & Treatment, Staff, Abuse and Safeguarding, Quality Assurance, and Risk Management
That's a wide range of topics covering everything an inspection would, and "If it walks like a duck....." Luckily it only lasts an hour.

Be careful out there: This is a Regulatory Interview

This is a Regulatory Review

The Inspector will genuinely want to be helpful, but they also have to wear a Regulator's hat

Friendly and supportive part:-

• Are you unsure about any issues, how can I help you
• Do you need guidance, I can advise you and/or tell you who can help
• Are you having difficulties with resources like PPE, here are some suggestions
• Is there a challenging issue? I might be able to advise
• Tell me about how you solved problems, we are collecting examples of best practice

Regulatory compliance part:-

• Tell me about your recruitment procedure
• What contingency plans do you have for staff shortages
• What risk assessments have you done to cope with the COVID crisis
• What changes have you made to staff training
• Have you had any incidents that cause you concern?

Be Prepared

The Inspector's job is to protect the public. Making sure you are operating safely, and even helping you to do so is another way of ensuring the public is protected.
Use this interview as an opportunity to provide this assurance to them.

Again: Be careful out there: This is a Regulatory Interview

The CQC had published detailed framework for GPs and Dentists, but only a generic framework for other Provider types.
This is changing on an ongoing basis so you are advised to get it directly from the CQC site.

Here are the topics originally published, most have now been withdrawn:-

• Discussion questions for adult social care services
• Discussion questions for GPs
• Discussion questions for health and care providers in the criminal justice system
• Discussion questions for independent ambulance services
• Discussion questions for independent doctor and clinic services
• Discussion questions for independent services for people with a learning disability and/or autism
• Discussion questions for independent single speciality dialysis services
• Discussion questions for primary care dental services
• Questions for inspectors on infection prevention and control for NHS acute and mental health trusts