Ridout Report – May 2019 – Registering the Right Support Revisited. CQC announces plans to change its controversial LD Registration guidance

CQC has announced that there is to be a review of the Registering the Right Support guidance “to ensure that its principles are clear and its aims are achieved.”

This is welcome news for the sector and will hopefully lead to increased clarity for all concerned. However, it will be too little too late for those Providers who have had to contend with CQC’s frustrating approach to applications which have included delay, failure to appropriately consider evidence of good outcomes and, more worryingly from a legal perspective, the issuing and re-issuing Notices of Proposal in response to representations instead of following the usual process of issuing a Notice of Decision. These tactics have denied or delayed Providers’ recourse to the Tribunal and an ultimate final decision on their application and have delayed the registration of much needed provision.

Registering the Right Support is CQC’s policy on registration and variations to registration for providers supporting people with learning disabilities and autism. It has caused controversy within the sector for Providers seeking to register new places due to CQC’s extremely rigid approach to its application.  Despite the guidance recognising that care for people with learning disabilities and autism is complex and that there is no “one size fits all” approach when it comes to accommodation options, Providers tell us that CQC simply are not granting applications that fall outwith their prescriptive model.

This has led to an increase in Providers being left with no option but to bring registration appeals to the Care Standards Tribunal. CQC are clearly mindful of this and it seems to be no coincidence that CQC are now seeking to amend the guidance.

The review of the guidance will begin with a scoping exercise which is presently underway with stakeholders. CQC say they want to hear about stakeholders experiences of reading and using the guidance and any ideas they have for how it may be improved.

Their scoping exercise seeks feedback on the following “issues” which they have identified with the current guidance:

  • Service Setting Definitions – the definitions of ‘campus’ and ‘congregate’ settings require further clarification’;
  • Size and Scale of Services – clarification of how the size and scale of a service may impact on CQC’s registration and inspection judgments;
  • Statutory Guidance – CQC consider Registering the Right Support to be Statutory Guidance but want to make that clearer within the guidance to ‘avoid future confusion’;
  • Title of the Guidance – CQC would like stakeholders to agree a name change to makes it clear that the guidance is relevant beyond simply registration;
  • Supported Living – CQC want to improve how the guidance sets out what is expected of supported living services; and
  • NICE guidelines – CQC need to review new NICE guidance and ensure it is reflected in their policy.

The first three issues identified for review have been of particular concern for Providers since the guidance was issued (and re-issued after consultation). They are often the matters that are central to the disputes in registration cases including appeals before the Tribunal.

The issues of size and scale of services is especially problematic. The current guidance states that CQC do not want to be overly prescriptive and “will not adopt ‘six as a rigid rule”. They say that they “may register services that are small scale, but accommodate more than six people, where providers are able to demonstrate that they follow all of the principles of Registering the Right Support….” However, there is no clarity at all around what might be considered to be small scale. Absurdly, services with seven or eight beds have been deemed not to be small scale. In addition, little credence is given to evidence that Providers of services larger than six can and do achieve good outcomes for their service users.

Providers and Stakeholders have until the end of May to provide their feedback on the scoping exercise. CQC want to know whether they have identified the correct issues and what other issues they should consider and why.

Providers and Stakeholders should take this opportunity to feed into this exercise as further consultation is not guaranteed. CQC state that consultation on any changes will be subject to the findings of this review.

In the meantime, CQC has updated its online guidance about the application process, specifically in relation to service for people with a learning disability and/or autism

It now states:

We recognise that providers need to make investment decisions around developing or expanding their services. These are taken far in advance of registering a service, but the likelihood of securing registration is a key factor in these decisions”

They are encouraging Providers to contact CQC to discuss their ideas before applying to register a service for people with a learning disability and/or autism and offering to  provide specialist advice and to help Providers with interpreting the requirements.

On the face of it, this seems like a step forward from the previous system where only extremely limited (or conflicting advice was available) to Providers pre-application stage. Although of course. at the moment they can provide no certainty until an application is submitted.

Also, Providers ought to treat this pre-application “specialist advice” with caution. It will be coming from the body with the ultimate power to grant or refuse the application, and therefore the potential for conflict of interest is very real.

To avoid this we would encourage Providers seek independent advice on their proposals and whether they will meet the requirements for registration.

Providers can take part in the scoping exercise to share their views on Registering the Right Support by following this link https://cqc.citizenlab.co/en-GB/. The deadline to do so is the 31 May 2019.