Annual report and accounts 2021/22

Our ambition is set out in our strategy, published in 2021. What we have learned from the past 5 years puts us in a better position for the future. Our new strategy combines this learning and experience, and is further enhanced through valuable contributions from the public, service providers and all our partners.

Delivering on our strategy means our regulation will be more relevant to the way care is now delivered, and more flexible to manage risk and uncertainty. It will enable us to respond in a quicker and more proportionate way as the health and care environment continues to evolve. Our purpose and our role as a regulator won't change – but how we work will be different.

Our strategic ambitions are set out under 4 themes: people and communities, smarter regulation, safety through learning, and accelerating improvement. Running through each theme are 2 core ambitions: assessing local systems and tackling inequalities in health and care.

Priority 1: People and communities

Our campaigns on 'Because we all care' continued quarterly across the year, with specific focuses on different audiences. Receiving feedback from people is a key element to our strategy. We use all feedback to help keep track on the quality of care that services provide. Through our 'Because we all care' campaign, as well as through other channels, we promote our Give Feedback on Care service. This year we saw a 51% increase in the volume of feedback we received, with a prominent increase in the primary medical services sector. Across the year we received over 64,000 pieces of feedback, an increase of more than 20,000 compared with 2020/21.

Some of the information we receive is shared with us by people who work, or have worked, for health and care organisations that are registered with us – or people who provide services to those organisations, such as agencies. It is important that people who work for health and care organisations feel they can speak to us about issues that cause them concern and that our response is prompt and appropriate. We describe the concerns we receive from them as whistleblowing enquiries.

In 2021/22 we received 17,937 whistleblowing enquiries. This was a 13.3% increase from 2020/21, when we received 15,827 enquiries. The majority of these (80%) were about adult social care services, while 15% were about hospitals and the rest were about primary medical services.

This year we continued to focus on our digital capabilities. This has enabled us to deliver against our strategy and introduce new data collections. In 2020/21, driven by the need to adapt to the pandemic, we made substantial progress in our ability to monitor services. We continued to build on the learning from last year to further enhance our regulatory monitoring and activity with the use of technology. We recognised the need for further data and insight on the impact on workforce pressures in adult social care, as a result of COVID-19 vaccination becoming a condition of deployment and due to the wider pandemic itself. We created a data collection so that our inspectors, when carrying out inspections or monitoring calls, could collate key data about the sector. At the end of March 2022, we had carried out 3,335 workforce pressure reviews. Thirty-eight per cent of services indicated that workforce pressures had had a negative impact on them, and 27% highlighted a delay in people accessing health care.

Our COVID-19 Insight reports continued to be a key part of our engagement and information sharing with the public, providers and stakeholders across the year. The aim of the Insight reports was to help everyone involved in health and social care to learn from what we know through our conversations and regulatory activity. This year our reports included areas around dental services, how services work together for people with a learning disability, and the quality of ethnicity data recording for mental health services.

• 479 Mental Health Act visits were carried out. The average inspection report was published in under 15 days.
• We published 6 Insight reports during the year.
• There were 26,424 safeguarding enquiries during the year (safeguarding concerns and safeguarding alerts).

Priority 2: Smarter regulation

Throughout the pandemic, we kept our regulatory approach under review. This is in recognition of the changing pressures that health and social care services have found themselves working under. Our priority has always been to support services to ensure people receive safe care. We want to ensure our approach is appropriate and proportionate.

Throughout the year, we continued to ensure that our registration service was responsive to the needs of the sector. We fast tracked applications where the provider intended to deliver services that provide additional health and social care capacity, or that contributed to the control of the pandemic or the treatment of people with COVID-19. During winter, we ensured that any applications that supported winter pressure planning for NHS trusts, clinical commissioning groups or a local authority were also fast tracked.

We made good progress in our ambition to be intelligence-led and a responsive regulator. We have taken the learning from our Emergency Support Framework and launched our direct monitoring approach (DMA). Where the information we have does not find evidence that indicates we need to re-assess the rating or quality at a service, we now publish a short statement on the service's profile page on our website. This helps to inform the public that a review has taken place and that we had no concerns based on the information we held at the time.

Last year, we completed infection prevention and control (IPC) reviews as part of our response to the pandemic. These inspections and IPC methodology have continued to be a key tool. This year we reviewed IPC practices in 4,066 adult social care settings over 4,412 inspections.

• 21,169 services have a public statement published on our website following our intelligence review.
• We carried out more than 10,306 inspections across all sectors, an increase of 46% on the previous year.
• We completed 4,392 direct monitoring calls, across 4,003 services.

Priority 3: Safety through learning

Throughout the year, we reviewed our approach to inspections of services for people with a learning disability and autistic people – part of our work on transforming the way we regulate these services. In our October 2020 'Out of Sight – who cares?' report, we made recommendations for people to receive the care they need, when they need it, to lead fulfilling lives without the need for restrictive practices. In December 2021 and March 2022, we gave updates on our findings and progress against the recommendations. We concluded that not enough progress has been made to address the recommendations, and that there are still too many people in hospital. Once in hospital, they often stay too long, do not always experience therapeutic care, and are still subject to restrictive interventions.

The new Health and Care Act has implications for our future operations. We are committed to co-producing our approach to system and local authority assessment, to ensure it is built on what matters to people using services, avoids duplication with other existing oversight activities, and encourages a shift towards more integrated services and improved outcomes for people using services.

• Through our IPC inspections, we indicated that 96.8% of services were facilitating visits in line with current guidelines.
• We carried out 1,099 IPC inspections of social care services, plus a further 3,313 inspections where we completed an IPC review as part of a wider inspection.

Priority 4: Accelerating improvement

We formally launched our strategy in May 2021 and it is purposefully ambitious. This year has seen us progress the first months of the strategy. Although a lot has been progressed and delivered this year, especially in response to the pandemic, our focus is firmly on the steps, processes and plans we have towards delivering our strategic ambitions. For example, we have a lot more that we want to and will achieve in our work on reducing inequalities in health care. To do this well, we are setting out regulatory equality objectives to ensure we have the right focus and the right plans in place to make sure we continue to progress.

This year we carried out a review of sexual safety in ambulance services, following learning from regulatory activity in the independent ambulance sector. The work has raised awareness about sexual safety issues and the intelligence shared with us has helped to ensure that patients and staff are protected appropriately. We have worked with the sector and stakeholders to improve provider awareness and responses, and limit access for sexual predators seeking to abuse a position of trust.