CQC is refusing to register new services, and expand existing ones, in the learning disability and autism sector that fail to meet its strict interpretation of post-Winterbourne View national guidance aimed at moving service users out of in-patient facilities into the community.
To obtain registration, CQC is saying that only one model of care is acceptable: a service that is small in scale (typically no more than six people) situated in a residential area (as part of a community) which is close to where people come from.
This inflexible approach is having a negative impact on the market and will continue to do so as long as CQC applies it. This flawed registration policy is articulated in its document, Registering the Right Support which was published in February 2016 without any prior consultation. However, the national guidance upon which CQC purports to rely only identifies a preferred model of care, allowing for exceptions that depart from it or for models of care which achieve the same outcomes but in a different way.
CQC’s misinterpretation of the national guidance precludes specialist providers from registering services where there may not be a local need or where that need may be limited. It also prevents services from opening in non-residential settings. A provider may wish to develop an excellent care home in a rural or semi-rural setting with links to the community for service users with complex needs, drawing on placements from across the country but will be barred from doing so because of CQC’s inflexible policy underpinned by its flawed interpretation of the national guidance.
CQC’s interpretation of the national guidance also denies service users and families’ choice. By way of example, a family from Newcastle may wish to place their loved one in a planned new service in Lincolnshire but CQC will say that is unacceptable as the placement should be local. CQC has no power to intervene in such a manner. CQC is acting as if it was a super-commissioner, attempting to shape the market, and control the exercise of choice, as it thinks fit.
What CQC should be doing is making registration decisions on the basis of facts and evidence in accordance with the statutory scheme under the Health and Social Care Act 2008. If a proposed model of care is tried and tested and meets the requirements of the Fundamental Standards, and any other applicable legislation, the service should be registered. CQC should not be applying a one size fits all diktat.
At Ridouts, we know of a number of occasions where CQC’s policy has discouraged much needed investment into the LD and Autism sector. CQC has even gone so far as to apply its policy retrospectively, stopping developments in their tracks, including one in Lincolnshire which commissioners, service uses and families would wish to use. The provider intending to open this service – Home from Home Care Limited – operates 11 successful services in that county on the basis of a tried and tested service model which is innovative and family-led. Paul de Savary, the Managing Director of Home from Home Care writes:
“CQC is another example of the metropolitan elite’s divisive thinking that it knows best. The father whose daughter we have supported for nine years and is now funded for the specialist home blocked by CQC, asks ‘What do they know about M, that as a family we don’t know, or that the commissioner doesn’t know? It is the unique nature of these services that is a major factor as there are no other similar services available for M and the alternative could well be an Assessment and Treatment Unit like Winterbourne View’. Person centred care requires a person centred regulator, not a one size fits all technocracy. Particularly one that compounds its errors by refusing to engage meaningfully with providers like us, who working with families and commissioners are redefining specialist care. The outcome of CQC’s institutional arrogance is now matched by the spectacular crash in funding for specialist LD services. As a banker confided, ‘Now only the scrapping of this unlawfully applied guidance will restore confidence and kick start investment’. The message is unambiguous: CQC – you are making victims of the most vulnerable.”
To continue to restrict the expansion of learning disability and autism services outside of CQC’s narrowly drawn parameters will drive investors and service providers away from the sector, impacting negatively on service provision for some of the most vulnerable in our society.
Ridouts have challenged CQC about is its approach to new learning disability and autism services which we say is unlawful. CQC is now proposing to consult on revisions to Registering the Right Support from mid-December 2016. CQC should withdraw its policy and introduce guidance for the sector which promotes innovation, choice, care quality and safety. If it fails to do this, it may well become the problem rather than the solution as far as achieving the outcome of the national guidance is concerned: getting as many of the 2500 + inpatients out of Assessment and Treatment Centres into quality, specialist provision in the community over the next few years. Given the stakes, providers in the sector should participate in the consultation to ensure their views are properly taken into account by CQC in developing a policy that reflects CQC’s legislative base and works for service users, families, commissioners, investors and providers.