What should inspection reports look like? What information should they contain? And can they be all things to all people?
In January 2019, the CQC introduced a new adult social care report writing template with the aim of producing “easier to read reports which say more with less words.” We saw a move away from long form reports to ones with more short form bullet points, with standard phrases that inspectors could select from a drop down menu. The purpose of this was to promote consistency in report writing. One has to question whether this does produce consistency or rather creates bland replicated reports with inspectors having to find phrases that “fit” with the facts. How can people understand what a home is really like if it contains the same phrases as every other home? Just as the CQC want to see personalised care plans, surely every home has the right to have a report that reflects its true position?
With shortened reports came problems. It often became more difficult for providers to understand who or what the inspector was referring to. A lack of context meant providers were unable to pinpoint which service user the CQC were referring to so were unable to check it’s factual accuracy. What followed was a bit of a hoo-ha about the disclosure of inspection notes. The CQC moved from often supplying full inspection notes, to only responding to targeted responses. Ridouts could never understand the reluctance to share the documents which contained the information that the CQC sought to rely on to inform the report. Surely the notes would not only reflect what was in the report but also provide exact details of which service user and documents (with dates) the CQC had looked at? Sadly, some of the notes that Ridouts has seen over the years fall far short of the detail one might expect. It shouldn’t be for providers to try and scrabble around in the 10 working days it has to produce factual accuracy comments trying to work out who or what the CQC are referring to before it can even test whether it is accurate or not.
So CQC wanted to say more with less words. If by saying more, it meant leaving statements open to interpretation and giving potentially misleading impressions, then perhaps it succeeded. We’ve all seen the phrases such as “Some people we spoke to said…” or “Some people’s records…” How many readers are going to go to the summary of the report, review that the CQC spoke to 8 service users (of a 70 bed home) and extrapolate that “some” may mean anywhere between one or seven people? You may say that the word “some” has to mean more than one, otherwise surely the CQC would say “a person”? But on occasions when Ridouts has requested the identity of the service users such statements relate to, an individual’s initials have been provided. Context is required, otherwise people may draw the wrong conclusions, and are likely to err on the side of caution, and lean to the conclusion that the comment relates to most people.
Whilst people’s views are important, they cannot stand alone, untested and unchecked. CQC must either triangulate the views with other evidence or provide such detail to allow the provider to test the factual accuracy of the comment. Without either, such comments should not make the report. There was an occasion when I was assisting a client to draft representations to a draft inspection report for a children’s home. There was a statement within the report that a young person told the inspector that they often got restrained in a particular manner. When Ofsted were asked to provide the corroborating evidence, such as the restraint records to verify the statement, they said “It is factually correct that the service user said this”. If this attitude is taken by all regulators then a provider is fighting a losing battle if every comment is taken at face value.
In its move away from timetabled inspections, the CQC’s inspections are now being prompted by risk. As of 9 March 2021 54.93% of CQC inspection’s that were triggered by risk were triggered by “information of concern” – enquiries related to “safeguarding, whistleblowing, concerns and complaints”. It appears that the days of starting an on-site inspection looking for ‘Good’ are gone and inspectors will be looking to see whether they can confirm the perceived risk. Does this mean that the CQC will be trying to triangulate the concerns raised or simply make the statement and let the reader draw their own conclusions?
So there are already “problems” with these shorter form reports yet it would appear that the CQC think they’re still too long. In its January 2021 Consultation on its proposed new strategy, the CQC said “We’ll move away from long reports written after inspections, and instead provide information and data targeted to an audience. Information for the public will be easier to understand and more accessible. We want people to be able to get information in ways that suit them.”
The mind boggles to understand what this will look like. We’ve had classification of Minor, Moderate and Major breaches, we’ve had Ticks and Crosses and Traffic Light Systems. We live in a world of sound bites, where infinite content is jostling for our attention. Will it be easier for the public to understand a 280 character tweet (by the way, the previous wording underlined is 278 characters…) or a single photo, with or without a particular filter, or maybe it can be distilled to a few emojis…
Reports need context. Providers need to understand what the CQC is saying about its business and the basis upon which it is being said. Reports need to be balanced and only contain information that the CQC has been able to verify and not just based on soundings which, let’s face it, tend to be aired when we’ve got something negative to say.
The CQC say that inspection reports are for service users, their families and the public. But what about providers? Perhaps reports cannot be all things to all people – you’re never going to please everyone but the CQC needs to have in place a process whereby providers feel that they have been heard, that is consistent and produces a report that is based on fact. The CQC would probably say that the current system does just that, but for all the reasons mentioned above, providers often feel that they are already on the back–foot by the time they receive the draft report. Yes, providers can challenge the factual accuracy, the lack of context, conclusions and generalisations made and at Ridouts we are often successful in achieving amendments to reports, but it shouldn’t be such a task.
CQC’s consultation on Change for Flexible Regulation does not contain detail on how factual (in)accuracy will be managed. This is an opportunity for the CQC to reassess their approach and maybe such important information should not be dumbed down. Perhaps, when it comes to making decisions about care and where to live and spend the last few years of your life, such matters can’t be boiled down to a snapshot and time needs to be taken to read a carefully balanced report, no matter how long it is.
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