CQC seeks boost in credibility
Just when the shambles of re-registration is about to be revealed, the Care Quality Commission has attempted to divert attention by releasing misleading information about “taking strong measures to protect people’s safety”.
For the best part of this year, the staff of the CQC have been struggling to complete the unnecessary and costly process of re-registering care homes and home care agencies. They have been unable to attend to the real task of checking that all social care services are truly caring and safe.
However, they have managed to dupe the national media into publishing stories that give a very different picture. In precisely six cases, the regulator took legal action to close services and in none of those case would it have been the CQC inspectors that first discovered the abuse or neglect and took prompt action.
And those six cases represent one in every 4,000 services or 0.025% of the total of 24,000 care services. While the CQC do say that the “closures represent a very small fraction of the 24,000 services in England” and “stressed that the vast majority provide good care”, it goes on to list concerns such as the “verbal and psychological abuse of residents” and “poor sanitary conditions” and then tells us of the fifty-one services that have closed voluntarily after getting a “poor” rating from the CQC.
On one hand the CQC has been redesigned to reduce its work and further reduce its workforce. Homes that have been rated poor or even “adequate” in the past represent additional work for any regulator, while homes that comply efficiently and promptly with the bureaucratic requirements of the regulations are deemed not to need inspection. This is the real purpose of the new registration system: to cut out the messy and time-consuming business of actually visiting services and seeing what they are like in reality.
In less than ten years a succession of social care regulators have sought to reduce their contact with and presence in care homes while boosting their own national profile, not to mention the proliferation of very highly paid bureaucrats who “manage” the organisation. We started with a minimum of two inspections a year and direct response to complaints from residents and relatives, and we have arrived at a point where “site visits” take place only in response to repeated complaints or accusations of neglect and abuse, and sometimes only after the police begin investigations. And yet the CQC claims that this is a much “tougher” regime!
For 24,000 regulated services there are 800 staff in CQC. That is one member of staff to 30 services. If half of those are inspectors (one inspector to 60 services), how can they possibly give the time and attention required? Will there even be “inspectors” in the new CQC?
If this state of affairs was as well publicised as this last diversionary press release from the CQC, there would be demands for change. It seems that politicians have not understood the degree to which the inspection of social care has been hollowed out - the exterior is very grand but there’s nothing of substance inside.
Yet, there were small signs of potential change for the better in the “You and Yours” (Radio 4 29.9.10) interview with Jo Williams, the Chair of the CQC, who said that inspectors would visit “at a minimum every two years”. (That’s nowhere near enough but it’s better than the previous minimum of every three years.) She also admitted that “a rating at a point in time has a limitation” (and that’s assuming the rating was accurate in the first place). But, more encouragingly, she spoke of developing the role of “Healthwatch” in relation to care services. This implies that the CQC are actually beginning to think creatively about local inspection and involving residents, relatives and the public. Let’s try to build on that!
The Association of Care Managers calls for a new approach to regulation and inspection of adult social care:
Prioritise the quality of care and the rights and safety of the people who use the services – this is the primary purpose of inspection
Inspect services as often as necessary but at least once a year
Inspectors should aim to prevent bad practice rather than to condemn it after it has occurred and after residents have suffered
Inspectors should be locally based and known – and accessible - to the public and users of the services
Inspection reports should be written for the public
Inspectors should work directly with residents and relatives, staff and managers of individual homes, NOT with the provider groups and organisations
Inspectors should respond to and investigate complaints, and be willing and available to visit the service without notice and at any time
Inspectors should understand how the services work and be willing and able (when appropriate) to help services to improve
People who use services should have a formal and influential voice in the assessment of care.
We believe all of this can be achieved without increasing inspection fees. However, it will mean a total reorganisation of the CQC, dismantling the centralised bureaucracy and grandiose management structure, and setting up local Healthwatch inspection teams employing independent inspectors who will be judged by - and paid by - results.
ACM supports the effective inspection of care services, concentrating on the rights, safety and wellbeing of those who use the services.
John Burton, Head of the Association of Care Managers