When the Care Quality Commission took over the work of the Commission for Social Care Inspection, most of us thought that they would continue inspecting and reporting on care homes. But that is not what has happened.
We were duped and the public were duped.
The last shreds of information about care homes on the CQC website are out of date, inaccurate and confusing. Someone looking for a home to move into would get very little sense or direction from it. So, in terms of inspectors providing information for prospective residents and their families, CQC is not of much use.
CQC does everything, and, in trying to do everything, it does nothing. In the rush to register all the providers - an exercise that was entirely unnecessary for care homes - inspectors in CQC were taken off inspection duties and had to spend months ploughing through the registration applications. Inspections, which had already become rare, fell a further 70%. The instructions were to register anything that could be registered, but to block the flow of applications by being extremely pedantic about the tiniest mistake.
What exactly was the point of registering providers that should not have been registered because they were clearly not up to standard? I’m referring here to the evidence that is coming out of the Mid Staffs Hospital Enquiry where it was admitted that Hospital Trusts were registered even though they had very poor reports from the previous regulator. Of course, as with care homes, if they didn’t register them, they would not be permitted to remain open. It was an exercise of sheer bureaucratic stupidity.
Now that the registration exercise has been completed for care homes, CQC claims the 70% shortfall in inspections will now be made good. It won’t. Amanda Sherlock (Director of Operations) told the enquiry that typically each inspector (working from home, by the way) is responsible for about 50 providers.
That would be too many care homes to take on as an inspector. But, if you imagined that there were inspectors for care homes and other inspectors for hospitals, dentists, day care, adult placements, ambulance Trusts, hospices and all the other providers of health and social care that CQC regulates, you would be wrong. (CQC now prefers to call its inspectors “regulators”, and inspections “site visits”.)
A CQC inspector is responsible for approximately 50 varied providers. According to Sherlock, typically one of these would be an NHS Trust, five or six would be independent healthcare organisations, five or six would be dentists’ practices, and the remainder (around 35) would be adult social care “locations”. In addition, next year, an inspector will take on around nine GP practices.
What emerges from the evidence (at the Mid Staffs Enquiry) is that inspectors have an impossible task. It can’t be done. One inspector cannot “inspect” and be sufficiently familiar with that range and number of providers to have any chance of knowing what’s going on in all of them.
But the trick - the deception - is that we have been told a story about CQC doing what has always been called “inspection”, but that is not what they are doing at all. CQC are doing what they have been asked to do while government (previous and current) pretends that there is proper oversight of care homes. It’s a cruel lie, knowingly perpetrated.
CQC have created a completely new system which relies on a central data gathering technology that produces a quality and risk profile for each service. This, in turn, informs the “inspectors” working from their own homes in isolation. The central information system collects anything it can find to produce a risk assessment on providers, and, in spite of not dealing with complaints from users and not getting regular reports from inspectors, CQC claims that this system is much more effective in keeping an eye on providers than actually going to see a place. Inspection as we knew it is finished.
CQC has become a licensing authority. Providers must simply “comply” to remain licensed.
A care home for sixty-one residents pays £11,100 for its licence. That is £3.50 per week for each resident. For what? It is simply a tax levied - ultimately on care home residents - to run CQC. All the home gets for this money is some more forms to fill. The residents pay their £3.50 a week to lose the attention of the manager while she or he struggles to satisfy the demands of CQC.
At CARE LIVE John Burton will be talking about the upside-down world of social care and calling for a return to local inspection that concentrates on the needs, rights, and wellbeing of residents.
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