In the CQC’s board meeting on 16 September 2020 the CQC set out its stall for monitoring activity within the adult social care sector. Whilst all proposals are subject to a formal consultation it seems likely that the position that is to be adopted is likely to be in place for the medium to longer term.
Firstly in respect of adult social care it is confirmed that the physical inspections of providers will be targeted to address areas of concern. There is not likely to be a return to a fixed timetable or frequency-based inspections which may increase the risk of enforcement action for all since an isolated negative experience or incident irrespective of the rating of a service might trigger action from the CQC. The CQC would argue of course that this would likely be the position in the absence of current arrangements but that historical buffer for better performing homes would appear to have been torn up.
The change in the CQC’s approach to really targeting areas of risk which are flagged to it could mean that the consequential action contemplated will hunker down more specifically on those instances than has historically been the case. There is to be a focus on safety, access and leadership when monitoring the providers’ activity which marks a move away from the historical 5 key questions to be addressed at comprehensive inspections; are they: Safe? Effective? Caring? Responsive? Well-Led? The new focus will still encapsulate the 5 key questions and the CQC has stated that it will still be using its key lines of enquiry to support the new focus. Quite how those fit in with the new focus would appear, especially in the case of the ‘access’ line of questioning, to be quite open to the CQC’s own interpretation as to what questions to ask or not. The CQC state that these changes are in order to address the challenges that Covid-19 has brought with it.
Interestingly Kate Terroni, the Director of Adult Social Care at CQC stated that they haven’t yet found a correlation between those providers who recorded an outbreak of Covid-19 and the historic ratings awarded by CQC. This lends itself to the thinking that irrespective of the levels of infection control in place at a provider that an outbreak might occur and that an outbreak in and of itself does not amount to the automatic conclusion that the quality of a provider is not up to the required standard.
The Chief Executive of CQC, Ian Trenholm stated that the job of CQC was to have a set of standards which are unarguable. This was an interesting turn of phrase as it almost elevated the decisions of the regulator beyond reproach. Taking such a position does not necessarily communicate the regulator as being one which is supportive and collaborative but is one of the regulator/regulated. Looking at CQC’s purpose a fundamental part of it is to encourage care services to improve. If the CQC takes the stance that it is beyond challenge and its decisions are final then this doesn’t seem to be following its mandate.
The monitoring of providers is to be information-led and a key part of this is the CQC’s campaign working in conjunction with Healthwatch and other voluntary sector partners to give feedback on a care service. This is an online form which allows anyone connected to a service to provide information to the CQC; good, bad or both; and it will use that information to develop a picture of the quality of care that is offered by a service.
There is currently a trial being conducted in respect of GP services and adult social care with 30 of the former and 60 of the latter taking part in exercises to test the ability for such monitoring to occur remotely. In respect of adult social care this will involve phone calls and video calls to home care services in order to gather information. The CQC will look to see if it is possible to rate each of those services following the pilot and will publish a short inspection report explaining the work that has been done in each sector.
In respect of rating providers the CQC intends to conduct its monitoring activity and if the risk is low it will publish a short statement on the providers’ website and share a short summary with the provider. This development is potentially quite worrying as there doesn’t appear to be a mechanism for challenge although this may just be an oversight. Where the CQC’s activity has indicated the need for an inspection of a service this might not necessarily result in a changing of the rating of a service owing to the more streamlined nature of inspections. This could also mean that there is a move from comprehensive inspections also given that at least 3 of the questions that formed part of a comprehensive inspection historically have been removed from direct consideration. We are aware that this change in approach could prove to be critical to a provider in terms of engagement with both public authorities, many of whom have service level agreements which preclude placing with providers below a rating of good or requires improvement. And indeed the same may be applicable to private individuals who may not be willing to accept a provider with a lower rating from the CQC. Providers who avoid negative concerns being raised may have to live with more negative ratings for longer given the abandoning of the scheduling of inspections with a long-stop date relative to the rating achieved by a provider at a previous inspection.
There is also an assessment by the CQC in its outlook for adult social care in the near future. It is noted within care homes that the fall in occupancy rates across the sector was 10% and that it is likely to take at least a year to return to the position pre-covid-19. The concerns about the impact of the winter flu on deaths in care homes or a second wave is likely to delay this recovery within such services further still. If public funded residents take up a greater proportion of placements in proportion to their privately funded counterparts this is likely to place further costs pressures on the care home sector. The CQC flags within the home care market the risk of clawback from local authorities owing to the difference between the numbers of hours that were actually delivered by providers against the amount of hours which local authorities have paid for. This could stand at around 5% which might not seem proportionally significant but when margins are tight could see home care providers impacted further.