Since October 2014, providers have been inspected under a new ratings regime. Linked to the new ratings system is the forthcoming requirement under regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which requires providers to display their CQC ratings (of ‘Outstanding’, ‘Good’, ‘Requires Improvement’ or ‘Inadequate’). This is due to come into force from 1 April 2015. CQC recently consulted on displaying ratings. The commentary below, is based on CQC’s current proposals on displaying ratings, which may be revised following the responses to the consultation. However, given the requirement is being introduced in less than one month, the main elements are unlikely to be revised.
Under regulation 20A(2) every website maintained by or on behalf of any service provider which has received a rating by CQC following an assessment of its performance will have to display details of that rating. More particularly, the website will have to display:
- CQC’s website address
- the place on CQC’s website where the most recent assessment of the provider’s overall performance may be accessed and
- the most recent rating by CQC of the service provider’s overall performance and of its performance in relation to particular premises or activities ‘in a way which makes it clear to which activities or premises a particular rating relates’
Therefore, any ratings from October 2014 will need to be displayed, if these are the most up-to-date ratings available.
There is also a requirement under regulation 20A(3) for the provider to display at least one sign showing the most recent CQC rating that relates to the provider’s performance at their premises. This must be displayed ‘at each premises from which the service provider provides regulated activities’. Where a particular premises has not received a rating yet, the provider must display the rating of their overall performance instead (regulation 20(A)(4)).
Similarly, the principal place of business must display
- at least one sign showing the most recent rating of the service provider’s overall performance and
- its performance in relation to particular premises or activities ‘in a way which makes it clear to which activities or premises a particular rating relates’
If the principal place of business is itself subject to a separate performance rating then this rating should be displayed instead.
CQC set out further requirements in their guide on how to display ratings. According to this guide, providers must:
- display ratings ‘where people will be sure to see it’ in a way which is ‘accessible to all of the people who use your services.’ (Failure to do so could lead to a fine or could adversely impact your future inspection ratings). This should be done no later than five working days after it has been published on CQC’s website
- ensure the ratings are legible
- raise awareness of your most recent rating when communicating with people who use your services by letter, email or other means
- display the CQC logo, the name of the rated service, the overall rating and any separate key question ratings which go towards that overall rating
- display the location on CQC’s website where the assessment and ratings can be accessed
- provide the date when the inspection report was published
There are further expectations which differ slightly according to what kind of provider you are. For example, hospitals need to display the ratings for each location at the main entrance to the hospital. If there are several entrances then it should be displayed at each one. They also need to display the information on the main website, in a place where as many people as possible will see it. The overall rating for the Trust and the rating for each of the key questions at the Trust level will normally have to be at the entrance to the Trust’s / provider main offices. It must also be on the Trust’s main website or home page. The overall rating for core services must be on the relevant page of the website and must be conspicuously displayed at the entrance to each core service ward, where as many people will see it as possible.
GP practices need to display the overall rating and the rating for the five key questions on the main home page of the website, where it will be seen by as many people as possible. These must also be prominently displayed in the waiting area.
Care homes will usually need to display their ratings at the main entrance to the home and on the main homepage of their website.
As far as domiciliary care providers are concerned, they must display ratings at any location where a member of the public visits or may visit. It is deemed to be ‘good practice’ for them to send details of ratings to service users using these services, and to keep them in their notes. The ratings must also be kept on the relevant website.
Any providers who have been judged to be inadequate or to require improvement are encouraged to display information about what they are going to do to improve the service alongside their ratings.
There are some exemptions to the duty to display ratings. The following providers do not need to do so:
- prison healthcare services
- children’s services not registered with CQC
For the majority of providers, displaying ratings will, therefore, be a legal requirement from 1 April 2015. It makes it all the more important to challenge ratings that you feel are not a fair representation of your services.
Formal ratings reviews can only be made after the publication of the inspection report, where it can be argued that there has been a flaw in the procedure adopted by CQC (e.g. they have failed to comply with their own rules on how to calculate the overall rating or have failed to abide by fundamental principles set out in CQC’s provider handbooks, such as proportionality or needing to give equal weighting to each of the 5 key questions (is the practice ‘safe, effective, caring, responsive and well led?) If you do disagree with the factual content of a report, this is a separate argument which should be raised as part of your factual accuracy response to the inspection report. Given that the ratings are going to be published, it makes sense to challenge their merits (so far as you are able) at the same time as you submit your factual accuracy response, which you will need to submit within 10 working days of receiving the draft report.
CQC’s response to their consultation on the requirement to display ratings will be published later on this month.
CQC state in their January 2015 consultation on the display of ratings, that they have produced a ‘range of products’ which you can use to help you display ratings at http://www.cqc.org.uk/content/ratings-display-draft-toolkit.
This toolkit will be available once the results from the consultation are published later this month. CQC will also be making a suite of editable templates for displaying ratings available online. We would encourage providers to check the CQC website this month for further developments.
Providers, however, should start to prepare for the change by reviewing the consultation referred to above and making themselves aware of the anticipated practical steps that will need to be taken. There is only going to be a short window between publication of the consultation response and having to get in place the ‘displays’ of ratings from 1 April 2015.
If you are concerned about any ratings you have received we would urge you to seek legal advice as soon as possible. We’re here to help.