Care Quality Commission
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Winter pressures for health and care services: How we are responding

We previously published our response to measures announced by the Secretary of State to address winter pressures in health and care services. This involves adjusting our regulatory activity until the end of March 2023.

It is a winter quite unlike any other. Health and social care staff have been working tirelessly to provide safe, high-quality care in the face of existing pressures. As a responsive regulator, we must continue to work with health and care providers to fulfil our role, while appreciating the context providers are working in.

We will always act in the best interests of people who use services – so while it’s appropriate to recognise the need for providers to focus on delivering care, we will always balance this with our responsibility to check that the safety of people using services is maintained.

These are our plans to support providers to ensure people receive safe care.


We will:

  • Prioritise applications from new services that will add capacity to help the current challenges in health and social care.
  • Continue our rigorous approach to registration of services for people with a learning disability and/or autistic people in line with Right Support, Right Care, Right Culture.

Hospital services

We will:

  • Respond to only the most serious risks in NHS organisations where there is a high risk of harm to people. This includes in NHS acute hospitals, ambulance, community health and NHS 111 services. We will identify this risk through data, information of concern we receive and intelligence we share with NHS England. The decision to inspect during this time will be made at the highest level of Chief Inspector.
  • Continue to inspect mental health services as planned due to the high prevalence of risk.
  • Continue our national programme of inspections in maternity services. We will minimise the impact on senior leaders in trusts by prioritising inspections where we have evidence of the greatest risk. We will continue to be flexible with both the time allowed to respond with comments on the factual accuracy of draft inspection reports and when we publish the final reports.
  • Continue to inspect and monitor independent health providers as planned
  • Continue to conduct Mental Health Act (MHA) monitoring visits to ensure that the rights of people detained under the act are protected.
  • Promote our PATIENT FIRST and PEOPLE FIRST tools. Both highlight examples of good practice and are practical resources for providers to guide safe urgent and emergency care.

Primary medical services

GP providers

including NHS and independent sector providers working with the NHS, out-of-hours, NHS 111and urgent care services

We will:

  • Respond to only the most serious risks where there is a high risk of harm to people. We will identify this risk through data, information of concern we receive and intelligence we share with NHS England. The decision to inspect during this time will be made at the highest level by our Chief Inspector.
  • Pause some previously planned inspections of GP providers. In most cases these inspections will have been planned because our monitoring data does not reflect the most up-to-date view of the quality of care being provided alongside a potential risk due to the length of time between inspections.
  • Pause our monitoring calls with GP providers, other than in situations of the highest risk.

Dental and other primary medical services

We will:

  • Continue our inspections and monitoring as planned.

Adult social care services

We will:

  • Continue to inspect and monitor both residential services and services in the community as planned.
  • Contact registered homecare providers who wish to deliver care in a care hotel setting. This is to explain and advise them where to find the appropriate guidance and contacts in their local area.
  • Increase the number of inspections of care homes and homecare agencies with a current rating of requires improvement. Inspections will be carried out where there is information to suggest there has been improvement since our last inspection. Following these, we may find providers have improved and should be rated as good or outstanding. This could then result in more services that commissioners consider suitable for funded placements and help create more capacity. Where inspections do not find sufficient evidence that the quality of care has improved, the rating will reflect this. We’ll also prioritise monitoring calls to services where our evidence shows there has been improvement.
  • Work with the Directors of Adult Social Services across England to identify care homes or homecare agencies across England where we could inspect to assess whether ratings can be updated. We aim to carry out around 300 of these inspections by the end of March 2023 where:
    • services are rated as requires improvement, but commissioning or inspection teams believe that rating no longer reflects the quality of the service
    • services are registered and active, but locations are ‘unrated’ as we have not yet inspected them, and the lack of regulatory history prevents commissioning them
    • providers have confirmed they have staffing resources available to meet the needs of additional people who may use the service
    • providers have confirmed they are prepared to accept funded placements.

Encouraging people to give feedback about their care

We will:

  • Increase our activity to encourage and enable people to share their experiences of care with us throughout this period.

These changes to how we regulate during this winter period will not affect our planned next steps in delivering our strategy. Read more on the plan and phases of this transformation approach.

Winter pressures in the NHS: our response

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