Who benefits from CQC? It is difficult to see that CQC is of any possible benefit to residents of care homes and their relatives, or to people trying to find a suitable care home. Yet care home residents pay £100 a year for the “service” that CQC claims to provide.
Following questions in Parliament, the Care Quality Commission has produced the following answers about the inspection of care homes:
1. There is an average of 336 days between any sort of inspection and “service reviews” (which means mainly desk-based reviews or assessments rather than “site visits”).
2. There has been an average of 527 days between “key inspections”. (CQC no longer do “key inspections”.)
3. It has taken an average of 69 days between inspecting a home and publishing the report on the website. (What possible explanation can there be for half the inspection reports taking ten weeks or more to produce?)
4. On average each inspector is responsible for 50 care homes or services. (It is not humanly possible to inspect this number of homes regularly in any depth.)
Remember these are average figures. Many homes have not been inspected for years and will not be inspected again unless something dramatic happens to force CQC to make a “site visit”.
Many local authorities inspect homes for themselves because CQC no longer inspect homes. CQC now rely on “self-assessment” by the home itself and information provided by local authorities to judge whether a care home is up to standard. And they rely on repeated and urgent whistle-blowing to trigger a “site visit”.
Complaints from local authority funded residents go to the local authority, and now complaints from “self-funders” go to the Local Government Ombudsman. Like its predecessor, CQC does not investigate individual complaints.
So, what exactly does CQC do for residents in return for £100 a year?
In an attempt to justify its existence CQC issued a press release on September 29th claiming that “Thirty-four care homes and eight agencies providing care in people’s homes have closed in the past 12 months following regulatory action” and “In six cases, CQC had issued a legal notice to close the service. In the remaining cases, owners closed or sold the service after CQC took enforcement action.”
When these claims have been investigated (by Private Eye and Compassion in Care) and after Parliamentary Questions have challenged CQC to substantiate them, CQC have failed to provide the evidence to back up their story. “ . . . some of the homes said to have been poor or closed after enforcement action by the CQC were still up and running under the same management or ownership, others changed use, some reregistered in a different way, one shut voluntarily after an upgrade - and some are not rated as poor and should not be on the list at all.” (Private Eye No. 1275 12th November)
Why this matters to the Association of Care Managers (ACM)
ACM is a professional association that requires its members to put the rights, safety and wellbeing of those who use the services first. Effective independent inspection is essential to running good social care services.
CQC has tried to divert attention from their own failures by making what appear to be misleading and unfounded claims about the services that ACM members manage.
CQC appears to have lost touch with its core task and have let down the very people it was set up to serve (and who pay for it). ACM members aspire to the highest standards and welcome effective inspection. Managing a care service is a complex and demanding professional commitment. The improvement and development of a service take time, skill, and leadership. While in the past some inspectors (and the commissions that employed them) have been officious and bureaucratic in their approach to inspection, there were always knowledgeable and experienced inspectors who put the rights, safety and wellbeing of those who use services first by being helpfully critical and by supporting and encouraging good practice.
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