Care home inspections are not fit for purpose. Providers need support, not more scrutiny
Posted on 25/08/2017 by
Inconsistent assessments and an inflexible appeal process make a mockery of care quality regulations. Now even the CQC recognises the need for change.
Is the Care Quality Commission’s inspection regime fit for purpose?
A recent report by the Care Quality Commission (CQC) states the need for improvement in the UK care system. While 77% of care providers were rated as good, almost a fifth required improvement and 343 organisations were described as inadequate.
These findings are not a surprise in the context of ongoing budget cuts. The need for accountability in care homes is clear, but in a climate where poor ratings can have enormous implications for business, many providers are reluctant to challenge inspection outcomes.
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This begs two important questions: is the CQC’s inspection protocol fit for purpose, and does the CQC place itself under the same rigorous scrutiny it does care providers?
Look deeper into inspection protocols and a worrying picture begins to emerge. Many care providers, disarmed by the lengthy process and financial pressures, are becoming frustrated by a system that is both inflexible and inconsistent.
Consulting on change
The CQC itself recognises the need for change and has started a second set of consultations intended to shape the next phase of health and social care regulation in England.
The first consultation, which closed in February, proposed changes to assessment frameworks, how the CQC registers services for people with learning disabilities and its approach to regulating NHS trusts. This time around, all eyes are on how it will monitor, inspect and rate new models of care.
The CQC has outlined its intention to focus more on underperforming providers. Facilities rated outstanding and good will have the periods between inspections lengthened from two years to three and two-and-a-half years respectively, while struggling organisations will continue to receive six-monthly audits. The CQC’s planned changes also point to new methods for gathering information, such as more unannounced inspections and shadowing providers for longer.
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This approach could, however, simply widen the divide between high-performing and struggling providers, and put those experiencing difficulty under huge pressure. These proposals must be expanded to outline what support will be given to failing institutions, as well as this additional layer of scrutiny.
Fundamentally, the overall management of the inspection process must also improve. There should be a dedicated point of contact within the CQC for each provider, with the autonomy and flexibility to address the kind of small issuesthat can quickly escalate.
Changes also need to be made to the way providers can challenge the findings of their inspection reports. The CQC’s most recent impact report reveals that providers are more willing to accept negative findings and fixed penalty notices than challenge the CQC, and are often left frustrated by the commission’s refusal to disclose inspection notes.
Providers will be familiar with the two-stage challenge process. This starts with the factual accuracy stage – where providers are given the opportunity to make factual changes before the draft report is published – and culminates in the ratings review stage. This system is not only inflexible (providers have just 500 words in which to set out their challenge, even if they challenge all five ratings), but the whole application is veiled in mystery.
What the CQC fails to make clear is that there is a triage stage before a ratings review is even presented to somebody who can make an objective decision – and we do not know the criteria.
The latest reporting on ratings reviews shows that out of 499 applications filed, 337 were closed on the basis of no grounds and only 32 were successful. In practice, reports are published before analysis of a ratings review challenge anyway.
It is perhaps no surprise that less than 7% of rating reviews for adult social care providers result in increased ratings. With such limited opportunities to challenge, providers are now facing the prospect of an increase in unannounced inspections.
The key for providers is to act now and be prepared in advance of any unscheduled inspections. Make a note of the questions asked and make a record of all plans, strategies and documents that were presented to the inspector.
This way organisations will be in the best possible position to generate their own record of the inspection process – and not be left relying on the CQC.