At Ridouts we advise care providers on CQC inspection reports and ratings on a daily basis. While there have been some positive developments over the last two years at CQC in terms of the exercise of its inspection functions, there is still considerable room for improvement.
What is apparent is that CQC is struggling to meet its performance target to complete all Adult Social Care (ASC) inspections by September 2016. At the CQC Board Meeting on 18 November 2015, brave statements were uttered about good progress being made but as Sir Robert Francis QC pointed out the underlying completed inspection figures had deteriorated since the September board meeting. The Year to Date gap as at November stood at 25%, equating to 1,505 comprehensive inspections that had not been carried out. Furthermore, only 29% of ASC locations had had published ratings by November 2015. It seems highly unlikely that the overall target to inspect all ASC locations by September 2016 will be met although the true position should be clearer by March or April 2016.
In the longer term, CQC will have to move to a more risk-based model given the pressures of having to inspect over 25,000 ASC locations within a reduced state allocated budget. The CQC consultation on the future of regulation due in January 2016 will have to deal with the reality of what is achievable in relation to inspection frequency. That of course will not help providers rated as “requires improvement” who desperately want a re-inspection. CQC should consider reverting to desktop reviews rather than placing its entire emphasis on site inspections. There has to be greater flexibility on the part of CQC in receiving information from providers after inspections to ensure the public is given up-to-date assurance on the quality of care services.
CQC also requires improvement in relation to the publication of inspection reports in a timely fashion. As at November 2015, 59% of final reports were published within 50 working days. However, it should be remembered that the current target of 50 working days is double that which prevailed before ratings were introduced. While the situation appears to be improving there remain a significant proportion of reports that are taking more than 50 working days to publish with some taking more than 100 working days. This is in the context of providers being given 10 working days to submit factual accuracy comments. Even a delay of two and a half months undermines the reliability of CQC’s reporting function.
What is clear is that inspections are taking longer than anticipated with inspectors being required to undertake time consuming enforcement action work alongside the day job. In quarter 2 of 2015/16, 136 providers entered special measures bringing the total to 155 since special measures were introduced in April 2015. A significant amount of enforcement activity is also in progress. As at October 2015, there were 343 enforcement actions in progress comprising 104 warning notices, 18 urgent cancellations, 104 civil actions (undefined) and 117 non-urgent cancellations. It was also noted at the November board meeting that a number of prosecutions were coming to fruition and would be reported on in due course. One can expect more enforcement action given the Board’s concern that there were an increased number of locations that had not met one or more standards compared to the previous quarter.
Figures presented to the November 2015 Board showed that 51.9% of providers either strongly agreed (12.4%) or agreed (39.4%) that their inspection judgements were fair. However a substantial minority either disagreed (16.6%) or strongly disagreed (8.5%). In part this is to be expected given the measure is of the % of providers who are in breach of a fundamental standard, or rated as inadequate or requires improvement. However the fact that 25% do not consider their judgements to be fair makes the need for an effective rating review process all the more important. No information was presented to the November 2015 Board about rating reviews. At Ridouts we have been waiting many months for decisions on rating reviews with no updates on progress. There is a lack of transparency around the statistics and outcomes of rating reviews which is most concerning.
On a more optimistic note some 44% of ASC reinspections result in an improved rating. The picture is even better for services rated inadequate overall where reinspections of 155 services led to 75 (48%) improving to requires improvement and 27 (17%) to good. That left 53 (34%) remaining as inadequate. CQC will no doubt interpret these figures as showing the effectiveness of its actions.
By way of conclusion, if one were to apply an equivalent overall rating to CQC’s performance, it would almost certainly be requires improvement. The challenge for the CQC Board will be to improve performance to a good. It is telling that in their most recent staff survey only 33% felt that morale at CQC was good, an improvement on earlier surveys but hardly a resounding endorsement of the organisation.