Following a recent inspection we were unhappy with our CQC report. We felt that the person conducting the inspection did not have adequate experience of the substance misuse treatment sector and that the specialised nature of our service was not taken into account. Can we challenge our inspection on these grounds or ask for a second opinion from someone with more understanding of residential drug and alcohol services?
This is a scenario we at Ridouts recognise all too well from our regular interactions with substance misuse providers. It is not unique to the sector but is certainly a greater problem here than in some others.
This is because, due in part to the relative youth of the sector in terms of distinct CQC regulation, inspection teams often include no Specialist Advisors (SAs) with expertise in the independent substance misuse field; instead, teams may include SAs with NHS-only experience, contrary to CQC’s published guidance emphasising the important role of SAs in inspections.
CQC’s SA recruitment advert stated that the ‘Job purpose’ of an SA was ‘to provide specialist advice and input into the CQC’s regulatory inspection and investigation activity. This advice ensures that CQC’s judgements are informed by up to date and credible clinical and professional knowledge and experience’.
CQC consistently insists that inspection teams attend inspections equipped with individuals skilled and experienced in that specific environment. In the case of substance misuse sector providers, therefore, the appropriate SAs would without exception have substance misuse expertise relevant to that provider. As readers know, the NHS environment is wholly distinct from the independent sector and should rarely be compared.
In the absence of appropriate SAs, inspection teams necessarily lack the judgement required for the job; inevitably, mistakes, misinterpretations and simply factual inaccuracies will occur.
Providers should not be afraid to challenge either the conduct or experience-level of the inspection team where this has clearly had an unfair impact on the draft report or seems otherwise inappropriate. This is best done through the factual accuracy process, where providers can comment on anything in the draft report they deem to be factually inaccurate. Factual accuracy and the judgements of the inspection team are inextricably linked.
Providers should also consider making a formal complaint on conclusion of the inspection, rather than on receipt of the draft report. This stops CQC from alleging that complaints are only raised when providers are unhappy with inspection results.
Inspection teams must be held accountable. They are obligated to provide impartial, balanced and proportionate conclusions. All information gathered must reflect the norms and standards of that sector; must be robust, reliable and corroborated.
As said before within this column, challenging factually inaccurate reports and submitting detailed, evidenced complaints are necessary steps all providers must take to safeguard their reputations. All reports should reflect the reality of the service, rather than the prejudice and/or inexperience of the inspection team. Providers must always remember that prospective service users and their families will use the finalised CQC report, as will commissioners, to inform decisions about admission.
I also echo David Finney’s article and encourage all providers to actively engage with the new CQC consultation. Providers can help CQC to appreciate the importance of expertise, and indeed the financial, resource and time costs of the legal appeals required to remedy the absence of such expertise. Providers can be the change they want to see, but if they stay silent they will only perpetuate the status quo.