Care Talk Article – December 2018 – Time to get tough or time to get real?

Topics covered: Amina Uddin, care home, care talk, CQC, CQC enforcement, NHS

The CQC has had a little shake up at the top recently with Sir David Behan, CQC’s Chief executive stepping down and Ian Trenholm replacing his place. Mr Trenholm has previously been chief executive of NHS Blood and Transport since 2014 and had started his career in the police service.

During a recent interview, Mr Trenholm has vehemently said he wants to crack down on care providers who are not providing care in line with CQC’s standards. This followed with a threat of increasing the number of prosecutions across the care sector and focussing on strengthening enforcement action against poor providers.

The new chief executive hopes to achieve this objective by recruiting staff with police and military police background. The purpose of this recruitment drive is to ensure that CQC’s evidence review team is effective and robust in its approach so that CQC can prosecute providers more effectively.

Whilst, it is positive to see CQC taking a serious line on providers behaving badly, is the sector currently so bad, that such an approach is warranted?

In CQC’s recent publication the State of Care 2017/18, CQC states that at the end of July 2018, more than four-fifths of adult social care services were rated as good (79%) or outstanding (3%) overall. Seventeen per cent of services were rated as requires improvement and 1% as inadequate.

It is the providers which are rated requires improvement or inadequate that tether on the cusps of potential enforcement action. Mr Trenholm has stated that safety of individuals will not be compromised anymore, this infers that providers who will come under this category, will face a higher level of scrutiny from CQC. Mr Trenholm revealed he has 200 potential  cases in the pipeline.

In terms of CQC’s prosecution powers, it can bring direct prosecution proceedings against a provider for breaching the following regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014:

Regulation 11:                         Need for consent: care and treatment may only be provided with consent.

Regulation 16(3):                    Receiving and acting on complaints

Regulation 17(3)                     Good governance

Regulation 20 (2)(a)                Duty of candour

Regulation 20A                       Requirement as to display of performance assessments

A defence to all the above offences is available where it can be shown that the provider took all reasonable steps and acted with all due diligence. Such evidence will obviously have to be documented, and this is where Mr Trenholm is proposing to focus on, when looking to take enforcement action.

However, is such a tough approach really necessary and does this further CQC’s objective? Whilst it is in everyone’s interest to ensure that people are protected in health and social care settings, if any concerns do arise regarding quality of care, should there not be a balance between scrutiny and support from the regulator? A recent study conducted by The Kings Fund, found that more often than not, care home providers receive limited support from stakeholders to help drive improvement. Of course, where there are serious failings in care, the registered persons should be held accountable and as a regulator, it is CQC’s duty to investigate and take the appropriate enforcement action. However, initiating scaremongering in the sector will do no good, focus should be on ensuring that quality in care is prioritized and to do that, instilling fear is not always the answer; collaboration is. Providers and CQC should work together in enabling a system that will put people at the forefront and not at the periphery.

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