Over the years providers of health and social care services have been known to cry in frustration: “Who inspects the inspectors??!” This is particularly common when CQC appear to be being lax in following their own policy and procedure whilst making high demands of providers and their staff. These careless approaches could be in the way the inspectors are inspecting a service, their failure to communicate properly with a provider or delaying the production or publication of an inspection report.
However, there are signs that CQC are beginning to turn the magnifying glass on themselves.
In their Public Board Meeting held on 29 July 2015, CQC addressed a number of issues facing the regulator that mirror concerns already felt by providers. Firstly was David Behan, the Chief Executives, making clear to the meeting that there was a serious need to cut red tape in care homes. Mr Behan referred to the government’s care homes review, launched on 15 July 2015, which focusses on removing “unnecessary duplication and overlap in inspections, visits, paperwork, data requests and in commissioning and contract management, whilst safeguarding standards of care and protection for residents”. This has been a longstanding problem for providers who are subject to almost constant review by either the CQC, local authority safeguarding or contract monitoring teams or the CCG. Each inspecting body has different criteria against which investigations are made and each stakeholder has a different agenda when visiting a service. It is not uncommon; in this firm’s experience, that one inspecting body will come in and find a service to be a good and competent provider of care services and just a matter of days later, another comes in, reviews the same environment and documentation and finds the service to be non-compliant. This can be very confusing and challenging for providers and it is heartening that CQC have acknowledged this strain and the unnecessary duplication it brings. It is not yet known what CQC can or are prepared to do to avoid this, but the fact it has been raised as an issue is a positive step forwards.
At the same meeting the issue of the publication of inspection reports was raised. For the first quarter of the year 44% of inspection reports were published within 50 working days. CQC acknowledge that this figure needs to be improved upon and the publication of reports in a “timely manner” is cited as a “high priority” for the directorate. The matter will be discussed at monthly senior management meetings and at subsequent tiers of management meetings. Again, this is a clear acknowledgement from CQC that they must do better and the issue of publication is something that has had providers tearing their hair out for a number of years. Services are subjected to an intense inspection and will keenly await an inspection report which reflects their service. That report is the home’s opportunity to connect not only with the family members of service users who are obviously keen to see how the service is performing, but also prospective service users. If it takes almost two months to publish a report then final product will surely not be a true reflection of the service at the time the report goes to press. This is clearly a misrepresentation and can cause great stress to providers. It is particularly frustrating when we consider how heavily CQC will fall down on a provider who misses any of its many deadlines, be it for the submission of an action plan, factual accuracy comments or representations on any notices of proposal. It is hoped that this new vigilance at director level will result in the efficient completion of inspection reports.
In April 2015 CQC identified three main concerns that were listed as CQC business priorities for 2015 / 2016. These were:
- Provider risk is not identified and managed systematically
- Data and evidence are not used consistently to inform inspections and judgements
- Cost, quality and timeliness of reports needs to improve
These points all reflect concerns felt by providers nationwide and often form the basis of the kind of work we do on behalf of Clients. The fact that CQC are facing up to these very real issues suggests that they are listening to the plight of the providers who have the courage to stand up to the regulator when an inspection or subsequent provision of a report does not go to plan. This clearly shows the value of putting in responses to CQC at every available opportunity where a provider disagrees with the way an inspection was performed or the wording of a report.
This brief and rare moment of reflection shows that CQC does have a conscience and should indicate to providers that their messages of concern are slowly trickling through to those at “the top”. This is a time to continue to hold CQC to account and to force the creation of a regulator who is fully accountable. Proactivity, we hope, will lead to the change that can be felt by all.