On 8 May 2013 the Queen opened Parliament with a speech in which she stated that the government will be introducing a Care Bill that will, among other things, introduce an Ofsted-style rating system for hospitals and care homes.
The new system is intended to present a clearer picture to the public of how care services are performing with the aim of making regulation of care providers more transparent and understandable. CQC announced in their Strategy for 2013-2016 that they will “take forward the recommendations of the Nuffield Review to publish ratings of services, working with people who use services, professionals and providers to develop how we do this.”
The Nuffield Trust, in their review, ‘Rating Providers for Quality: a policy worth Pursuing?’ (March 2013) found that currently there is public confusion with regard to the care sector as in addition to CQC conducting reviews of care services, a number of companies have emerged which provide their own individual versions of star rating systems for care providers. The Trust recommends that there is one single organisation taking on the role of providing a quality rating system. It was decided in the Trust’s report that CQC was the most obvious choice of organisation to deliver this rating system. However CQC would require a system of support from politicians and national stakeholders alongside sufficient time and resources to develop an effective system.
CQC previously used a star-rating system. However this was replaced in 2010 by the current outcomes focused inspection reports. CQC has been criticised for abolishing the old star rating system introduced originally by the previous regulator, the Commission for Social Care Inspection.
There is little information available with regard to the new rating system and it is not yet known how it will be applied – it has been suggested that enough time should be allowed to develop a credible rating system and this should be tested thoroughly before it is fully implemented.
Clearly there are specific considerations that will need to be addressed to ensure that the system is fair and proportionate.
CQC will need to develop a clear rationale behind the rating system in order to provide transparency through the system. The Nuffield Review states that the main purpose of the rating system should be to increase accountability, aid choice by users, help improve provider performance, identify and prevent failures in the quality of care and provide public reassurance as to the quality of care. It is vital that any quality rating system accurately meets these criteria. Any system that appears to be unduly arbitrary will be counter-productive.
CQC stated that they aim to make improvements with regard to the speed of publication of their findings. In the past CQC have been known to publish inspection reports which are out of date and do not reflect the current service at the time of publication. CQC will therefore need to be more proactive in the publication of quality ratings and inspection reports. Reviews will need to be sufficiently regular to ensure that that information provided is truly reflective of the service at the time of reading. If negative reports are published, providers should be given the chance to improve and CQC should be just as responsive in re-inspecting a service and publishing findings of improvements as they are in publishing initial findings. If they are not responsive to this then there is a risk that damning reports can have a negative impact on providers businesses.
Right to make representations on the rating
Under the old quality rating system, providers had a right of appeal to the regulator about their provisional rating, as well as the underlying facts. Although the appeal was to the regulator, at Ridouts we found that it operated effectively as a “check and balance” with the system, ensuring providers a right of challenge if a rating was felt to be unfair, disproportionate or based on flawed evidence. It will be important to ensure that the new quality rating system provides for an appeal process. We will be pressing for this as part of the quality rating system.
Providers will have to become familiar with yet another change in the regime – training will need to be provided to ensure staff understand the quality rating system, what is being tested and how best to evidence compliance. At Ridouts, we will be monitoring the progress of CQC’s development of this system and will be providing further information when available.