Ridout Report – Is CQC’s focus of inspection properly aligned?

Topics covered: CQC, CQC inspections, Nythan Smith, Ridout report

CQC claim to now have a handle on the quality of care provision provided in the UK; however this is on the presumption that the inspections it conducts provide it with accurate conclusions.  I write from the perspective of a trainee solicitor who has sight of what would appear to be those providers CQC views as failing but I cannot help but pause to reflect on this basis on the quality of care provided across the UK.

Much in any given inspection report is hinged on the strength of language that is selected in it.  Blanket statements such as the service is not safe are interpreted by the general public as defining a service which is failing to provide a safe location for users of the service; for what in reality might be as a result of a suspected discrete breach.  The foundation for a finding can be the lack of records in a format deemed acceptable; however that lack of record in and of itself is not wholly determinative of the overall safety or otherwise of a service.  Unlike that which findings may have the reader of the report believe.

The issue with the language and the inferences that are drawn from little more than anecdotal evidence is a symptom of our times.  We often look to find the negatives in life without looking at situations with an even hand.  This approach to inspection with a focus on highlighting poor quality care can disproportionately affect the conclusions that are drawn in relation to the quality of care provided at service overall.  There are instances where providers of care fall below the standard of care required.  Providers have fluctuating levels of capacity and the current model of inspection does not appear to offer all care providers with a fair shake.  There is no doubt that the regulator has good intentions and believes that it is fighting the good fight; however on occasion there are occasions where comments within a report which could reasonably be described as being hypercritical in the way in which they are reported so as to maximise their influence on the picture of care at a location.

Whilst this is not a criticism of CQC the substantive reports themselves are generally skim read by stakeholders and the inclusion of ratings such as ‘good’ ‘requires improvement’ and ‘inadequate’ in isolation can mislead the reader on the true quality of care provided.  There is a fluidity in levels of compliance with the regulations but with reference to ratings that are awarded no such flexibility is afforded.  All providers of care are and will continue to be in a state of transition at any given time and should be continuing to improve.  Ratings can prove unhelpful in presenting an accurate summary of the quality of care provision offered by a service.

One criticism of some inspection reports is the gap in evidence provided in comments made within inspection reports.  Assertions are made at present without documentary evidence to support their observations.  It is likely that the integrity of inspection reports might be more open to scrutiny if the evidence base upon which inspectors have reached their findings was shared with the provider and the public more generally.  In CQC’s response to its first consultation on CQC’s next phase of Regulation CQC stated that it intends to provide evidence online and to the provider which will allow stakeholders to interrogate the inspection findings as against the submissions made.  This was only in relation to NHS Trusts but it would be a step that would be welcomed to improve transparency in findings that CQC determines sector-wide.

CQC’s founding statute, the Health and Social Care Act 2008, enshrines into the raison d’être of the regulator the encouragement of improvement within health and social care services.  CQC has interpreted this to mean that it fulfils this goal through its inspection of services which in turn are read, accepted and actions taken by the provider.  Improvement then follows.  This is a rather limited interpretation of both the letter and spirit of the statute.  A better interpretation would see the regulator seeking to go over and above the current cycle of inspection and sanction as their only means of encouraging improvement.  A strategy I have long thought should be one rolled out across the entirety of the healthcare estate is the one which is in force within Trusts whereby those Trusts that are found to be in need of support are offered it by a high performing provider.  Notwithstanding this should be the intention to work more collaboratively and less in the position of a judge but more in the mould of a supportive friend.  I understand the difficulties in treading such a course; the number one priority should be in increasing the level of care provision across the domestic health and social care sector.  An element of this does involve using the stick, when necessary, but a less adversarial supportive regulator may also have a positive impact on the level of care delivery across the UK.

The end of another year approaches and the challenges that the health and social care sector face continue to grow.  The observation that the focus of some of its inspection report activity can make findings on the overall quality of a service which do not seem to be proportionately considered, is as much a reflection on the current climate of gravitating towards negative aspects of life as it is a critique on CQC itself.  The net effect for stakeholders in the healthcare sector, of which we all form part, is that particular caution should be employed when considering the findings and ratings of CQC inspection reports.


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