Many health and social care providers decide to engage with CQC in the spirit of cooperation and collaboration. They accept the ratings awarded to them by CQC and they accept CQC’s findings and don’t challenge them as they are not confident that their efforts will lead to successfully changing CQC’s position. This lack of challenge is not actually acceptance of CQC’s findings it is a vote of no confidence in CQC’s ability to fairly regulate the sector.
The tried and tested approach we employ is to engage with CQC even if providers are not confident that CQC will accept the challenges that we make on our clients’ behalves. We have often found that CQC’s opinion, contained in an inspection report or in action it may choose to take against you, is not one which would likely be shared by the public if they reviewed the same circumstances and evidence. It must be remembered that CQC does not retain absolute power over the sector, the ultimate decision maker is the courts when effective challenge to CQC’s decisions can formally be made. Strictly speaking everything up until a formal challenge is made in the courts is simply the opinion of CQC officials. This is not to downplay the effect of the interaction providers have with CQC but to place that into context.
If providers fail to challenge they are effectively accepting CQC’s opinions of them. In turn, the CQC’s confidence in its own ability to self-affirm the decisions it makes will continue to rise. CQC sees a lack of challenge as tantamount to acceptance, as indeed would any court if challenges have not been made to CQC previously.
There are at least two sides to every story and if you, as a provider, choose not to challenge CQC you are deemed to be accepting CQC’s version of events. Often there is nuance, there are reasons why that opinion of your service is not wholly accurate. We suggest that you exercise your right as a provider to seek to make challenges to CQC where your opinion differs from that of CQC. The absence of challenge allows CQC to become more resolute in their decision making process. Challenging is important when you have reason to, especially when staff practice is good and is worth defending. Not challenging CQC can have the impact of causing employees to depart as they may interpret not challenging as the provider taking CQC’s side in any interaction.
Engaging in a constructive manner with CQC affords providers with the opportunity to show that they have a voice and that they are invested in CQC’s opinion. Adopting a passive approach to engagement with CQC, such as ineffectively challenging CQC or doing nothing, can lead to CQC developing an opinion that what it says is beyond dispute. This we suggest is not a good place for CQC to be and has resulted in CQC drawing sweeping conclusions based on small amounts of evidence in support.
The issue presently is all too often providers are reluctant to challenge because of the lack of faith they have in CQC to handle their objections fairly. Even though providers are granted the opportunity to challenge CQC’s decisions if that process is not engaged with then the process is deficient. Engaging with the process means providers testing the allegations that are made of them against the evidence that CQC purports to hold.
CQC have recently announced changes which will be coming into force in due course in the way that it assesses services. Headlines from this announcement include a focus on evidence gathering off-site, a departure from on-site inspections and the intention to publish how it reaches its ratings including how it attributes scores to each rating for each piece of evidence it reviews. These all combine to make CQC and its decisions seemingly less open to challenge. CQC is purporting to become more transparent to providers in describing how it reaches its decisions and we suggest this will have the consequent impact of dissuading providers, even more than present, away from challenging CQC. In whatever direction CQC goes it must be remembered that CQC is not the final arbiter – they are not the law. They interpret the law but the scrutinising of its inspection reports is conducted in-house so the independence of such tools is not beyond question.
This new approach by CQC would appear to be more of the same. CQC is geared towards amplifying criticisms and it will continue to be led by risk. Where is the fairness and consistency of interactions that providers need? If the argument is, we at CQC have now reached a shared understanding of what a good provider is, and now we will assess all providers based on this understanding, we submit that this still is not fair. This is because this opinion is based on CQC’s assessment on what a good provider is. Which by extension also extends to what a less than good provider looks like in CQC’s eyes. If those providers who have historically accepted CQC’s opinions on them without question then this has also contributed to CQC’s assessment of what a less than good provider looks like.
We are often contacted by providers who assert that individual inspectors have been dismissive and not open to correction or challenge. There appears to be a redoubling of efforts in CQC announcing its new approach which appears to be leaning towards how it can make its reports and decisions as impenetrable as possible.
Challenging CQC is about changing their perception of you. Such challenges can be disheartening if you don’t receive the outcome that you would have liked to have received. Nevertheless engaging in the process of challenging CQC’s often widely drawn opinions of your service is a worthwhile endeavour. Many positives can be drawn from engaging in the process of challenging CQC and it can be an effective learning exercise for providers in how to evidence the quality of care you offer at your service.
If you don’t challenge and adopt a “Yes CQC” approach this may combine with other things to paint the picture of you as an underperforming provider when this may not be the case. Our advice is to actively engage and in any and all interactions with CQC with a high level of professional curiosity. A failure to engage with concerns that have been raised against you is likely to lead you further along the path towards CQC having the ability to interfere in the running of your service. Challenging CQC can feel as though you are fighting a losing battle, given the obstinate nature of CQC on occasion, but you are not. You are putting CQC to task and not simply accepting CQC’s version of events. The absence of challenge can have the unintended consequence of subjecting your service to excessive intervention and diversion from focusing on providing the best care to users of your service. The responsibility for making your voice heard rests with you as providers and you should engage constructively with CQC. Any such engagements may be a time and intellectually draining process, in respect of responding to each concern with evidence in support, but the cost of not engaging, we suggest, could be of much greater impact.
For advice and support in responding to an inspection report or any enforcement action taken by CQC, contact Ridouts at firstname.lastname@example.org and 0207 317 0340.