Regulator sends early warning to NHS trusts to tackle problem areas before new registration system

18 June 2009

Care Quality Commission says it may place conditions upon registration if standards aren't met.

The Care Quality Commission (CQC) today (Thursday) urges NHS trusts to do more to comply with essential standards or risk strict conditions being placed on their licence to operate in the future.

The regulator will introduce a new registration system from April 2010, meaning all health and adult social care providers, including NHS trusts, must meet new national standards to be allowed to function.

The CQC is today publishing information on what the NHS thinks of its compliance against the existing standards in what is the first stage of this year's annual NHS performance assessment.

All 392 NHS trusts have made their fourth annual declaration on whether, during the year to March 31, they complied with core standards, designed to ensure care is safe and of acceptable quality.

The CQC says the declarations suggest important improvements over the past four years, with more trusts declaring full compliance and nine out of ten trusts saying they met at least 90% of the standards.

But the regulator is concerned that only half of trusts said they met all current standards and that there was significant variation between regions. CQC said compliance with the core standards will be used a key indicator of whether a trust meets the new registration requirements.

CQC will take a view on whether the declarations are accurate after carrying out a rigorous cross-checking exercise using thousands of items of performance data, information from patients and the public and inspections. It may change a declaration following this process.

This year, the Commission has collected even more information from patient groups about their experiences of care in the NHS, including for the first time Local Involvement Networks (LINKs) and also from Learning Disability Partnership Boards. This is key information used to cross-check the declarations.

CQC's analysis of the declarations shows:

• More trusts say they met all standards: Half of trusts say they met all standards, compared with only one in three in 2005/6. The proportion of trusts that say they met at least 90% of the standards has also increased, up to 92%, compared to 74% in 2005/06. Much of the improvement has been driven by increased declared compliance in the primary care sector.
• More trusts say they met standards that have proved challenging for the NHS in the past: More trusts say they met standards relating to decontamination, equality and diversity, choice and access, managing patient records and minimising risks associated with medical devices. These are all standards which the NHS has previously found challenging and are among the standards for which fewest trusts say they comply.
• Fewer trusts say they met key standards on child protection, safety and employment checks: There was greatest decline in declared compliance with standards relating to child protection, implementing patient safety alerts, ensuring confidentiality of patients' information, learning from safety incidents and ensuring appropriate employment checks. Last year, the regulator conducted in-depth reviews or studies relating to the first four of these. It may be that the increased focus has forced some trusts to look more closely at compliance and what constitutes good practice.
• The declarations suggest significant improvement in the primary care sector, but no change in the acute sector: The greatest improvement in declared compliance is within the primary care sector, following low levels of compliance over the previous two years. Forty-six per cent of primary care trusts declared full compliance with the standards for services they provide directly and 52% declared full compliance for services they commission. Last year 23% of PCTs declared full compliance. The proportion of acute trusts that declared full compliance has remained static over the past three years at around 46%, but up from 34% in 2005/06.
• More trusts say they met infection control standards: More trusts declared compliance with the three standards relating to infection control, particularly on decontamination of equipment. But one in five trusts still said they did not comply with at least one of the three. The improvement was driven by higher levels of compliance among primary care trusts with the proportion of acute trusts declaring non-compliance remaining static at around 24%. There were ten trusts that declared non-compliance with all three standards. NHS trusts have already registered under requirements relating to infection control. The Commission will examine each declaration carefully to establish whether it affects registration status.
• There is significant regional variation in trusts' declared performance: While there have been improvements in reported compliance in all but two strategic health authority regions, there remains significant variation. While 70% of trusts in the North West region reported full compliance, an improvement of more than six percentage points, only 18% of trusts in the South East Coast region reported full compliance, showing no significant improvement since 2005/06. There was significant improvement in the South Central region, with 58% reporting full compliance compared to 29% the previous year.

Cynthia Bower, CQC Chief Executive, said: "These declarations are an important piece of the jigsaw when it comes to building a picture of NHS performance. They tell us what trusts themselves think of their compliance with standards and they provide a key indicator of whether the organisation is on track to meet the new registration requirements.

"The NHS has delivered steady improvements in compliance and that should be commended. But it remains concerning that all trusts aren't meeting core standards on safety and quality, five years after they were introduced. I urge those trusts affected to raise their game in the areas identified and get compliant over the next few months. We will not hesitate to place conditions upon trusts' registration, as part of our new statutory powers.

"I would stress that it is often good news when a trust owns up to a problem because that suggests they have taken the first step to getting it sorted. It is also important to be clear that we will be checking every single declaration with great care to ensure that we get the most accurate picture possible for this year's performance ratings. We will penalise those that have declared inaccurately."

The CQC has a range of new enforcement powers, ranging from fines to closure, that it will use alongside the registration system to drive improvement in services.

In October, information on compliance with the core standards will be considered alongside data about whether trusts are meeting national targets. The Commission will then give a rating for the quality of services at each trust.

This year, for the first time, primary care trusts will be given two ratings - one for the quality of services they provide and one for the services they commission.

Notes to editors

Registration of health and adult social care providers will be phased-in from 2010 and the National Minimum Standards and the Standards for Better Health will be in force until services are required to register.

The Department of Health has recently completed a consultation on registration requirements and will take final legislation through Parliament. It is expected that NHS providers will be the first to register under the new system. They will be required to declare their compliance with the registration requirements and guidance in January 2010, with registration by 1 April.

All providers of adult social care services and independent providers of healthcare services will be registered under the new system by 1 October 2010.

From 2011, registration will, subject to legislation, begin to be introduced for general practices, all dental practices, and private and voluntary ambulances.