This month’s Ridout Report summarises the ways in which CQC says it intends to operate moving forward, particularly in the field of adult social care. This follows the publication by CQC on 17 October 2013 of the responses to their recent consultation (‘A new start’) and the publication two days before this of ‘A fresh start for the regulation and inspection of adult social care’ (which contains an introduction by the new Chief Inspector for Adult Social Care, Andrea Sutcliffe). Both papers are available on CQC’s website. The Chief Executive David Behan also recently set out his future plans in a speech which he gave at the ‘Commissioning in Healthcare’ forum on 8 October 2013.
The five questions – with a particular focus on leadership
According to the ‘new start’ paper, there was ‘strong’ support for CQC asking the five ‘key questions’ as part of their inspection process (is the service 1) safe 2) effective 3) caring 4) responsive and 5) well led?). CQC ‘will develop’ guidance about what these questions mean for different types of service. In his recent speech on 8 October 2013, David Behan particularly emphasised the fifth question. He said that the culture of an organisation and how happy the staff were, was linked to whether the leadership was good or not and would be a particular focus for CQC inspectors moving forward, because studies had shown that you could not get happy customers without happy staff. According to the ‘fresh start’paper, there will be a ‘much stronger focus on leadership, governance and culture’ to determine whether a service is well-led or not. The Leadership Qualities Framework developed by the National Skills Academy will be something which ‘could guide’ CQC’s assessment in this area. The ‘fresh start’ paper also suggests that ‘tougher action’ is going to be taken against services who are without a registered manager for too long. From April 2014, inspection reports are also due to be written ‘with a narrative that focuses on the five questions, and a stronger focus on leadership, governance and culture.’
More rigorous tests for registration with CQC
According to ‘A new start,’ CQC staff supported the proposals for introducing a more rigorous test of services that apply to be registered (they received very few responses in relation to this issue from other people). More information will apparently be gathered about the fitness of a provider to operate and CQC will also be assessing the suitability of proposed premises, policies, procedures, equipment and staffing arrangements and the likely effectiveness of quality management and improvement systems. According to ‘A fresh start,’ CQC will now be ‘making sure’ that providers have the ‘right values and motivations for providing care’ as well as the right skills and experience.
There were mixed views about the introduction of a ratings system and whether the new ratings labels were clear or fair. These ratings (which are due to judge providers on a four-point scale as either ‘outstanding’, ‘good’, ‘requiring improvement’ or ‘inadequate’) will not be applied retrospectively according to David Behan’s recent speech, and providers will be given notice before the system starts. According to the ‘fresh start’ document, there will be guidance published on the ratings system in December 2013, followed by further details in April 2014. The ratings themselves will not start being put in place until October 2014. There is a suggestion that the labels may change and that CQC may replace the label ‘inadequate’ with the label ‘poor.’ There is also a suggestion that the ratings may be applied in relation to each of the 5 questions, so a provider may get 5 different ratings for each one. The paper indicates that a provider with safeguarding issues which have been responded to well could have a low rating on safety but a higher rating on whether or not it is well-led. It is not yet clear what the appeal process will be for a provider wishing to challenge their ratings, but CQC does state that they are ‘currently considering’ this and ‘will work with people to develop (their) thinking on this.’ This is also going to be part of their Spring 2014 consultation process.
Expert inspection teams
There was ‘strong’ support, following this consultation, for both the use of expert inspection teams, led by Chief Inspectors, and the use of inspectors who are ‘experts by experience,’ as they have been service users themselves. According to the ‘fresh start’ paper, the frequency of inspections will be based on the rating of the service and CQC wants to ‘discuss’ the option of asking providers to pay for additional inspections if they believe the quality of their service has improved following a poor inspection. This is also likely to be raised again as part of the Spring 2014 consultation.
CQC did not ask a specific consultation question about this, However, the ‘fresh start’ paper states that CQC wants to have an ‘open conversation with people about the use of mystery shoppers and hidden cameras…..while respecting people’s rights to privacy and dignity.’ This was also referred to in a recent article on the BBC’s website on 15 October 2013 (seehttp://www.bbc.co.uk/news/uk-24523895). We hold the view that this would raise very difficult practical and legal issues, both in relation to service users and in relation to providers, particularly in view of Human Rights legislation. This is something which is also likely to be raised by CQC as part of their Spring 2014 consultation.
A duty of candour
There was ‘strong’ support for the introduction of a statutory ‘duty of candour’. According to ‘A new start’, the Department of Health is intending to put in place a statutory duty of candour as a ‘registration requirement’ and ‘all registered providers’ will have to ‘inform people if they believe treatment or care has caused death or serious injury and provide an explanation and, where appropriate, an apology.’ The Department of Health is intending to publish the draft duty of candour regulations for consultation in Autumn 2013. We would invite you to look at our news update for 19.2.13 for further details about our view on this proposal.
There was apparently ‘some confusion’ following the consultation about what the link will be between the proposed ‘fundamentals of care’ and the current regulations. The ‘fresh start’ paper states that in Autumn 2013 the Department of Health will be consulting on regulations which, if they become law, will set fundamental standards which providers must not breach. If they do breach them, it could lead to a direct prosecution of the provider, without the need to serve a warning notice first.
Subject to the Care Bill receiving Royal Assent, from April 2015 CQC state that they will become the ‘financial regulator’ for the sector, overseeing the finances of 50-60 care providers that would be difficult to replace if they were to go out of business. CQC will be requiring ‘regular financial and relevant performance information’ about these providers, as well as ensuring that they have ‘sustainability plans’ in place to satisfy them that they can manage their financial risk appropriately. CQC is also due to be tasked with overseeing and co-ordinating the process where a provider is not able to continue providing a service for financial reasons. CQC has indicated that it will be ‘working with stakeholders and providers during the spring and summer of 2014 to develop plans for taking on this role in 2015’ and this ‘may’ include consultation on some aspects of the market oversight role.
There are clearly issues which have yet to be resolved as part of future consultations. We would strongly urge providers to take part in all of these upcoming consultations in order to ensure that their views are voiced in the months ahead. Ridouts will be publishing updates for the sector on each consultation exercise undertaken by CQC and the Department of Health which will be available on our website.