In its latest publication on the 21 December 2021 the CQC has announced that it will finally begin to inspect care homes rated ‘Requires Improvement’. This means that up to 14% of care homes in the UK (3,271) care homes will now be subject to inspections once again. As part of a wider amendment to their inspection strategy, the CQC has acknowledged and reflected on the importance to, “recognise the work of everyone in health and social care.” As such, the CQC will begin to inspect the previously rated ‘Requires Improvement’ providers, who have been previously ignored and overlooked. CQC has stated it will inspect with the view to “identify where improvement has taken place and to re-rate where possible”. It is believed that this amendment to strategy is largely driven by the need to create additional capacity within the social care sector amidst the growing concern around Omicron and the difficult winter season ahead. This amendment to inspection strategy will commence immediately beginning in early January 2022.
Inspections and the FAC process
Prior to an inspection report being published by the CQC, the only option a provider has to challenge this is through the Factual Accuracy Comments (“FAC”) procedure. However, the FAC process is reviewed by the same inspector who conducted the inspection. This raises questions over impartiality, with some CQC inspectors sometimes reluctant to concede they have made a mistake without substantial evidence to the contrary to highlight this. It can be difficult for providers who are running a busy social care service, alongside gathering sufficiently robust evidence to balance this. Seeking legal advice at an early stage can assist and take some pressure off providers by helping you to gather the right evidence to negate the regulatory challenges raised by the CQC. This includes, asking the right questions, advising on how to implement the right measures which can assist with ensuring regulatory compliance swiftly. As often with the CQC, the problems providers encounter are often time sensitive with only 10 working days to prepare a response to the CQC for the FAC process. It is advisable to seek advice so that together you can defend your position. This cannot be overstated enough in the current working environment in social care. Providers are already stretched thinly by the strain of Omicron, an ongoing staffing crisis, and managing new admissions from hospitals and local authorities often with insufficient patient information.
What does this mean for Providers currently rated ‘Requires Improvement’ and why is it so important?
This news will be welcomed by some frustrated providers who feel like they have been overlooked since the CQC introduced the ‘Risk’ based strategy. If you are interested in this topic and a more in-depth analysis of the CQC inspection strategy you can read more about it here. This was implemented by the CQC in response to Covid and the limited working capacity and resources the CQC had as a result. However, this meant that those most adversely affected were the providers who were rated ‘Requires Improvement’. This is because prior to the CQC adopting its ‘risk’ based strategy, providers rated ‘Requires Improvement’ should have been re-inspected within 12 months from publication of the ‘Requires Improvement’ report. However this stopped with the CQC prioritising providers who were deemed a risk to safety and not all providers were being routinely inspected. This has meant it is even more critical to respond and conduct FAC to challenge ratings received following an inspection – due to the uncertainty around the length of time providers may have a rating for with no chance of a re-inspection in the foreseeable future to improve this. Fundamentally the issue with the risk-based approach strategy, is that if a provider was rated ‘Requires Improvement’ and had made substantial investment and improvement to the care home following the inspection, this would go unnoticed or unrewarded. Recently providers were slipping through the cracks with 14% of care homes being overlooked for inspection with the CQC choosing to remain only focused on finding faults with providers deemed to be a risk, rather than reward any care homes making a stride for improvement. This meant a large proportion of ‘Requires Improvement’ rated providers were having efforts ignored and the chance to be reviewed and improved to ‘Good’ unlikely with no prospect of a re-inspection. Therefore, there is a risk many providers are currently stuck with outdated ratings which are not a true reflection of the service. The effect of which can have damning commercial consequences which is unfair on providers. Therefore, the long awaited news that the CQC is amending this inspection strategy stance, should be welcomed across the social care sector particularly among providers, even if this is only a temporary measure.
Why is the inspection rating so critical for Providers?
CQC inspection ratings can have a significant commercial impact on a provider’s business. This is because it is one of the most important factors that the public rely on when selecting a provider for a health or care service. The ratings are a clear accessible piece of information available to the public which is meant to be reflective of the provider’s quality of service. This helps the public make an informed decision when selecting a provider and can lead to a loss of business following an unfavourable rating. This can have an impact on a home when members of the public are unlikely to choose a home that is rated ‘Requires Improvement’ as the rating is suggestive of the quality of care provided. Furthermore, commercial problems arise when providers tender for new contracts with commissioners. Ratings can affect the price a local authority will be willing to pay in fees, or even place at all, whilst banks, lenders, and insurers also pay attention to ratings. All of these commercial ramifications can threaten the financial stability of the provider. In addition, the CQC themselves refer back to previous inspection ratings when reviewing a service. For example, if you have two consecutive ‘requires improvement’ inspections, you will be subject to scrutiny from the CQC who view it as not demonstrating the necessary leadership and governance required to assure and improve quality. This could lead to a breach of Regulation 17 ‘good governance’ and therefore risks regulatory action in addition to the commercial impacts. All of these factors should be considered when a provider receives an inspection report they do not agree with, especially when considering conducting the FAC process to challenge this.
To conclude, the CQC are amending their inspection strategy under the guise of ‘recognising the work of everyone in health and social care’. However, the reality is, amidst the current wave of Omicron spreading in the UK there is an emerging pressure on beds and hospitals. Therefore, the change in policy on a temporary basis is motivated by the need to create additional capacity and ease the strain placed on hospitals currently. This is further cemented by the news announced on the 10 January 2022 which has halved the time period in which care homes are unable to admit new patients following a Covid outbreak. Previously, if a care home had 2 or more cases over a 7 day period, they would have to abide by outbreak management rules and isolate for 28 days preventing new admissions. However, this has now been halved to just 14 days. This is another change in policy designed to tackle the increasingly emerging problem with bed capacity in hospitals. The CQC is quick to raise the importance to recognise the work of everyone in health and social care. However, this remains to be seen. Whilst the CQC is currently concentrating on the ‘Requires Improvement’ homes, for homes rated ‘Good’ and looking to achieve ‘Outstanding’, they too are not recognised.
This amendment to inspection strategy is a temporary measure designed to free up bed space in social care and tackle the capacity crisis. There is no guarantee that this will be adopted as a permanent measure, therefore inspection frequency from the CQC remains unknown. This is why providers must take the inspection process seriously especially when factoring in the prospect of using the FAC process. There is no guarantee when you will be next inspected, so if you are unhappy with a rating received it is critical now more than ever to conduct a FAC process to challenge this.
If you require any assistance or advice in relation to CQC inspections, our specialist solicitors can help. Please contact Ridouts Professional Services Ltd by emailing: email@example.com or by calling 0207 317 0340.