At the March 2017 CQC Board Meeting the consultation on ‘Registering the Right Support’ guidance was highlighted by a Board member as a document setting “out very specific conditions under which [CQC] would register housing for people with learning disabilities so there couldn’t be more than…five or six people in a unit.  [CQC] said you couldn’t have campus type accommodation…so…[CQC has] taken a very tough line in saying these are the standards and [CQC] won’t register.”

David Beehan was quick to point out that the CQC Board had yet to complete its analysis on the consultation document responses, the matter was still under discussion, and CQC hadn’t got to a fixed position on it.  It looks like some Board members have already made up their mind.

CQC is becoming a “market shaper” and a number of providers wishing to expand their existing LD provisions or register new LD provisions, which do not fit with the model set out in Building the Right Support, are finding that their applications are being refused.

In highlighting the guidance around learning disability provisions the Board member was questioning whether there should be a similar set of standards that CQC could use with care homes.  The Board member gave two suggested standards; the first being that every care home could have an iPad in their reception area on which relatives could make comment following a visit; and the second being that every care home should allow residents or relatives to put sound recording devices in the home.

One wonders if these are “off the cuff” comments or something that has been discussed internally.  It is hoped that it is the former as both these suggestions are ill thought through and raise a whole host of questions.

Who is going to fund this expensive comments box?  What does this really add? Does it really improve outcomes for service users? What’s wrong with a pen and a piece of paper?  And on what conceivable grounds could a home’s registration be refused because it hasn’t got an expensive bit of (superfluous) kit?

In the same Board Meeting David Behan admitted that he doesn’t know what special measures, in an adult social care context, actually means and that the label does not add anything to the rating of Inadequate.  Special Measures in adult social care does not trigger external assistance to help a home improve as it would for an NHS trust or a GP surgery.  An Inadequate home which gets labelled as failing, with no help to improve, but has to fork out for an iPad just does not sit very well with me.

At the Board meeting it was suggested that cameras may be too invasive but sound recording technology could be allowed in all homes.  Matters surrounding privacy, dignity and capacity are just a few of the many issues that would need to be addressed before recording devices of any nature were placed into Homes, as standard.  However, won’t a sound recording device cause more questions to be raised than it answers in the event something is captured on the device?

The Board member said “We need to set a standard for care homes”.

One wonders where this member has been for the last few years.

We have regulations (which include the Fundamental Standards) that set out what homes need to do in order to get registered and maintain their registration.  These are the standards.  CQC has already gone one step further and provides guidance on how regulations can be met.  There are also the KLOEs which set out the Characteristics that Homes should demonstrate to achieve particular ratings. CQC has already guided providers as to the standards expected of them.  There has to be an element of discretion and flexibility available to providers to promote person centred care and good outcomes for service users.   As much as CQC thinks it knows best, setting a rigid set of criteria that has to be achieved before registration is even granted (and in turn, maintained in order to preserve registration) will stifle the sector, innovation and potentially place service users at risk.

As noted above, one hopes that these are the musings of a sole board member but it does flag potential concerns with the CQC’s thought processes.  We are seeing CQC saying to learning disability providers that accommodating 7 or more service users does not promote good outcomes.  How this argument can be sustained for all providers, for all homes, or all situations remains to be seen but CQC is potentially creating a self-fulfilling prophecy and good outcomes for service users may not be achieved for all if rigid adherence to this policy is maintained.  Everybody in the sector wants good outcomes for those we care for but CQC has to be careful to ensure the standards they seek to set really do achieve this.

It’s hard to see how owning an iPad and having recording devices in a home promotes and achieves good outcomes.  They certainly don’t in isolation.  CQC needs to be careful not to put in place more and more hurdles for providers to jump over unless the end game is one in which service users ultimately benefit.