How should we inspect and rate ambulance and independent health care services in England?

We have published our initial thoughts on how we will regulate ambulance and independent health care services in England.

The signposting documents elaborate on our broad Plans to change the way we regulate health and adult social care services in the country. 

This includes awarding ratings, using expert inspection teams, and structuring our activities around the five questions that matter most to people who use services - are they:

• safe
• effective
• caring
• well-led
• responsive to people’s needs

The documents present more detailed proposals and pose questions for discussion, before we begin to pilot our new approach in these services from October, alongside a formal consultation.

Ambulance services

Ambulance services care for people with health care needs that are:

• unscheduled - such as emergency 999 calls and urgent hospital admissions requested by GPs
• scheduled - such as transporting people to attend out-patient appointments and day care facilities

They play a major role in ensuring that people receive the most appropriate care for their needs and that fewer people are taken to A&E departments unnecessarily. They regularly work across a range of health and social care providers and wider public services.

In the signposting document, we outline our plans to inspect the following core services on our inspections of ambulance services.

• Responding to life threatening conditions and incidents
• Responding to non-life threatening conditions and incidents
• Services requested by health care professionals
• Patient Transport Services (PTS)

Within these core services, we propose to specifically follow the care of certain groups of people who have specific needs.

We will pilot different ways of getting feedback from people who use services – this can be a particular challenge for patients who have been cared for following a trauma or life-threatening situation where family members and friends are often in the best position to share experiences and opinions. We will make sure that people who use services and the wider public have opportunities to share their experiences of ambulance services and will include Experts by Experience as members of the inspection teams.

We will use a four-point rating scale (below) following our inspections.

• Outstanding
• Good
• Requires improvement
• Inadequate

As ambulance services can vary in terms of their size, degree of activity and geographical spread, we will explore at what level ratings will be meaningful to the public; for example, at a provider, regional or service level.

Independent health care services

By independent health care, we mean all secondary and tertiary health care provided by a non-NHS organisation (including NHS-funded care provided by a non-NHS organisation) but not specialist mental health and primary care services.

The sector delivers a wide range of services for both adults and children, including specialist and enhanced health care from a variety of settings. These range from large hospitals, which operate under a single corporation with multiple locations, to single specialties (eg cosmetic surgery clinics) and individuals delivering single speciality services.

We will ensure that our new regulatory model, while tailored to each sector and type of service, treats providers equally when they deliver similar types of services. For example:

• for hospitals - we plan to identify 'core services' that we will always visit on our inspections as we have done for acute NHS trusts. Some will be the same as the NHS (eg maternity services), whilst others may be different (eg cosmetic surgery), reflecting the different range of services provided. This would allow people to make comparisons if the same types of services are being delivered.
• We plan to look at single speciality services in the same way wherever they are delivered. For instance, we will look at cosmetic services in the same way whether delivered by a single specialist provider or as part of a range of services delivered in a large independent health care hospital.
• We plan to adopt a rating system for independent health care similar to NHS acute services, in which ratings will only be awarded following an inspection and against the five key questions. We are exploring how to work in partnership with other regulatory bodies including where there may be opportunities to undertake joint inspections. Also, we will look into how to make the best use of information from accreditation and peer review schemes to inform our regulatory and inspection processes.

Prof Sir Mike Richards, Chief Inspector of Hospitals at CQC said: “We recognise that there is much for us to do to strengthen how we regulate ambulance and independent health care services in England. These signposting documents set out our priorities for improving how CQC monitors, inspects and regulates these services and the conversations we want to have with people as we develop our new approaches for them. We are keen to develop our new regulatory models in partnership with those who deliver and use the services within them.

“The programmes of work are hugely important. They will help us to make sure that we deliver our purpose – to make sure services provide people with safe, effective, compassionate, high-quality care and to encourage care services to improve. We look forward to hearing what people think about our plans ahead of our formal consultations in the autumn.”

We will officially start our 'new approach' for ambulances and independent health care services in April 2015, with formal ratings to begin in July 2015.

Are you interested in our other regulatory plans?

Last week, we launched our formal consultation on how we plan to monitor, inspect and rate care homes, hospices, home care agencies, acute hospitals, mental health, community health care, and primary medical services.

The consultation will close in June so Have your say before the 'new approach officially launches in October.