Thursday 13 December 2018
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The state of care home regulation

Message to Andrew Lansley and Paul Burstow:
Apparently it takes a Health Select Committee several weeks, much weighty deliberation, and a good deal of money to reveal to you, to the world of social care, and to the country that CQC isn’t working. We know it isn’t, and we’ve been telling you for years. Residents of care homes need an effective inspection system that is on their side. Don’t be taken in by CQC’s promises of reform: they designed and imposed the current useless system, so why believe that the same people will design anything better? Save time and money and LISTEN to people who know about care homes, and then ACT.

CQC is preoccupied with procedure, bureaucracy and self-justification
Ever since the introduction of a national inspectorate in 2002 – first NCSC, then CSCI, and now CQC – inspection of care homes has been going in the wrong direction. There is now less on-the-ground inspection than ever before and more reliance on remote information collection (much of it from the home itself) and analysis. This procession of expensive quangos have let down the residents of care homes and their relatives while rewarding themselves with massive salaries and pensions. Although government has been embarrassed and exasperated by their repeated failures, the regulators have somehow managed to fool successive ministers into thinking that there is no alternative to their centralised, bureaucratic approach.

Inspectors need to know homes
There is an alternative, and it could be achieved under current legislation. Inspection of care homes could be localised and, to use the currently fashionable jargon, “personalised”. Inspectors need to know homes – the manager, the staff, the residents and the relatives. They need to be in the homes at different times including evenings, early mornings and weekends – even at night if they are concerned about night care. And inspectors must be accessible and responsive to complaints and concerns. If a relative says the home is short-staffed on a Sunday afternoon, the inspector needs to drop in and see for themselves.

Remote, expensive and ineffectual
Such inspection can only be achieved by local inspection, and by a complete change of approach by CQC. Inspection of care homes is needed to check that they are caring, homely and safe, not to collect government statistics and to mire the public’s image of care homes. All the regulators have set up their organisations to demonstrate their own effectiveness and to justify their continued existence. They are remote, expensive and ineffectual.

Care Quality Commission inspection fee: £3.50 per week per resident
Currently residents of some care homes pay about £182 a year for inspection whether their home has an inspection or not. Residents and their relatives have no direct access to inspectors and rarely read the reports. The CQC website tells prospective residents nothing about the quality of care. If we stripped out the huge bureaucracy and hierarchy of CQC, we could achieve good value and a reliable inspection service for half the current fee. Residents and relatives need to be able to see what they are paying for, so it would be a good idea to highlight inspection fees on their bills: Care Quality Commission inspection fee: £8 per month. The local inspector would then be held to account and expected to respond to complaints . . . and sacked if they didn’t come up to scratch.

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 with lower 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
September 2011