Wednesday 17 October 2018
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CQCs last gasps - do not resuscitate!

Burstow in the Commons and Howe in the Lords continue to speak as if CQC is doing a grand job. They are bluffing. Since Winterbourne View and Southern Cross have brought the regulator’s failures to public attention, a flood of hostile parliamentary questions about CQC has exposed just how hollow are the Commission’s claims to protect residents and patients.

It is dishonest to suggest (as Burstow has done) that having an inspector sitting in a care home lounge “24/7” is the unaffordable and only alternative to CQC’s remote-control style of regulation.

CQC has neither the staff nor the expertise, neither the methodology nor the systems to protect the people who rely on them. They have postponed registering GP practices because they (at last) admit that they can’t cope.

The Care Quality Commission (dubbed “Can’t Quite Cope” by Private Eye) is dealing with what John Seddon (Vanguard) calls “failure demand”. Their whole work is now devoted to attempting to clean up the mess that their failures have brought about. This leaves them unable to attend to their core task, and will thereby put them in an escalating spiral of failure demand.

Some of us (actually very few) could see this coming and said so. We were told to give CQC a chance to prove themselves. Well, they’ve had their chance. The Labour Government set up CQC with people at the top who were specially selected to do as they were told, in other words, chosen for their compliance - “yes” people all. CQC got rid of dissenters, and gagged the grumblers. Compliance was the watchword and not only for “essential standards of quality and safety”; compliance has permeated the whole sector of care and health.

In a feeble attempt to demonstrate that it is still breathing, CQC splutter out the occasional inspection report . . . sorry, “review of compliance”. A recent report finds that a home rated as “good” two years ago is now far from good. But, oddly enough, CQC had sent in an inspector to check the medication twice since, but they checked only the medication and apparently nothing else. Suddenly, acting on some urgent tip-offs, CQC find that the home is a dangerous and neglectful place: “poor assessment, planning and delivery of care”, dirty and unhygienic, and very short of staff. Leaving homes alone until the chorus of complaints gets too loud to ignore is so obviously wrong, yet Burstow appears to think CQC’s “methodology” is fine. (The two medication inspections, one of which took five hours, are described as “random” - “short focused reviews”. Using the word “random” to mean its exact opposite displays both sloppy thinking and ignorance on the part of CQC. Is there no one in CQC who dared to point this out?)

In an equally misleading tactic to distract attention from its failure to do the job it’s paid for, CQC has revealed (Daily Telegraph 18.6.11) that 4,000 care homes, caring for 100,000 people, fail to comply with at least one of the essential standards. This is meaningless but of course it sounds dramatic and is intended to persuade the public that CQC is out there protecting vulnerable people. But if you look at the CQC website and it’s very difficult to establish which homes are “compliant” and which are not, so what use is CQC to people who look to it for information on care homes?

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 the most recent increase in 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
June 2011