Report recommends significant shake up to CQC inspections and policies on registration of services for people with learning disabilities and/or autism

The CQC yesterday published the Report it commissioned in summer 2019, in response to the Whorlton Hall scandal. Professor Glynis Murphy’s report makes very interesting reading, but disappointingly is it a little lack-lustre in identifying where the CQC might have done things better.

The Report does accept “in hindsight” that things could have been done differently and alludes to a number of actions which, if not missed, might have resulted in earlier identification of or intervention into the issues at Whorlton Hall. However, there is little direct acknowledgement that these might have led to any different an outcome, or that the CQC might have failed the sector in any way.

The Report makes 6 recommendations:

  • CQC should gather more data, and use data better and in ways which will help the early identification of abuse, or of red flags of an environment where abuse may be more likely;
  • CQC should consider adopting (only) unannounced inspections in high risk settings, increase night time and weekend inspections, request Provider Information more regularly, and not accept action plans as a sufficient reason for upping a rating to good which would otherwise be “requires improvement”;
  • CQC should take abuse, safeguarding alerts and whistleblowing events more seriously and expect these to be only the tip of the iceberg;
  • CQC should speak to more carers, and conduct more in-depth, in private, service user interviews, and make better efforts to understand the true nature of a service during inspections;
  • CQC should consider more wide-ranging, “Level 2” inspections where there is any indication that a service might be at risk of failing;
  • CQC should not register services which are isolated, in unsuitable buildings, or which have out-dated models of care, and should restrict or alter those which have already been registered

Of course, any improvements which can be made to services for adults with learning disabilities and/or autism, and particularly those with very complex needs or challenging behaviours is a positive thing and we support the CQC in its aims on this front. However, at the same time, providers of these services, who may well be doing a very good job will be understandably concerned and uncertain as to how the future will look for CQC inspections and registration procedures.

We do not doubt that unannounced inspections – and more wide ranging ones – might be more likely to catch bad providers unawares, and therefore enable the regulator to better identify any signs of failing services, red flags of abuse or sub-standard care. However, this does not take away from the fact that providers and their staff, and perhaps more critically service users and their families, can find the inspection process to be an incredibly daunting and stressful time. The prospect of the CQC turning up totally unannounced, at night or on weekends, particularly when there have been no concerns raised about a service or any indication that standards might be slipping, will pose a significant burden on providers and their staff. We encourage the CQC to work with the sector and think carefully about how it approaches these changes to ensure that they do not alienate those they are there to support.

The sixth recommendation is perhaps the most concerning to providers. No one is suggesting that CQC should be registering services “like” Whorlton Hall and if the CQC learn nothing else, the Report correctly highlights that they should pay close attention to services which provide care for some of the most vulnerable people. However, it appears to pre-suppose that the CQC will become much narrower-minded about what services they will register. The recommendation implies, for example, that no service in an “isolated” setting should ever be registered, or be able to expand capacity, or that services providing care which happen to be in more remote locations, will now have a black mark against them, even where they are able to provide good or outstanding, person-centred care, which meets an identified need.

Surely if the CQC does adopt the other recommendations, then there should be no need to take a blanket approach to registration of services of this nature. To ensure that all people’s needs can be met, it is imperative that CQC does not use the recommendations as an excuse to take an overly prescriptive approach to registration of new, or existing, services. To do so is likely to prevent some particularly vulnerable individuals from having access to the services they want, and in which their specific, individual needs can be best met.

The Report goes on to explain that the CQC already consider that they are addressing this recommendation in its work on new guidance for the sector, namely the proposed guidance entitled “Right Care, Right Staff, Right Culture” which the CQC say is a revised version of the much debated “Registering the Right Support”. However, as our regular readers will know, we have significant concerns with the status of this new guidance, and the way the CQC have consulted the sector on it. CQC will need to do much more work to get this right.

Providers of services to people with learning disabilities and/or autism can expect changes in CQC inspection practices and registration decisions in future, and these are likely to be wide-ranging. We strongly recommend that all providers watch this space and engage with the sector and the CQC, to ensure they are properly informed and proper dialogue can take place about how the CQC might do things better. We need to work together to get this right for all concerned.