Between April and July 2019, CQC suspended 4 providers’ ratings.
“Their rating was suspended? Don’t you mean their registration was suspended?” I hear you ask?
A little known option available to CQC, which has made its way into the Provider Guidance on ‘How CQC monitors, inspects and regulates adult social care services,’ allows CQC to suspend a rating “if [it] identif[ies] significant concerns that lead [CQC] to reconsider [its] previous rating. The rating will be suspended until [CQC] have investigated the concerns and/or re-inspected the service.”
That’s all the Guidance says. No criteria, no process that will be followed, no indicative timescales.
At the CQC’s September 2019 Board meeting, Ian Trenholm stated that the suspension process was “created in order to make sure that we can be clear with the public that something is going on, that we’re carrying out an investigation into something and that the previous rating is something that cannot be relied on until that investigation is complete.”
Now, CQC has made noises before about the fact that it cannot always tell the public about enforcement action that is in the process of being taken. So perhaps the suspension process has been created to get round legislation which does not allow CQC to publish information about certain enforcement action until that action is complete, and where any representations or appeal lodged has not been successful?
Under the Care Quality Commission (Registration) Regulations 2009, there is certain information that CQC ‘may’ publish and ‘must’ publish. Information around matters which ‘may’ be published include warning notices. Providers have the right to make representations about a number of things concerning a warning notice, including why the warning notice should not be published. If CQC accepts these representations then it won’t publish the fact that a warning notice was issued. However, there is some information about enforcement action that CQC ‘must’ publish and this includes action taken to cancel, suspend or vary a provider’s registration. However, such information must not be published where an appeal is brought to the First-Tier Tribunal and the Tribunal orders that the enforcement action taken by CQC either does not take effect or, ceases to have effect.
The effect of this is that no-one should know that action was taken.
With the introduction of suspension of Ratings to let the public know “that something is going on”, it seems that this is not only trying to circumvent the legislation, but also lacks transparency and places the provider in a difficult position – if the provider responds publicly to the suspension to say it is challenging enforcement action being taken by CQC, does it waive its right to have that information kept private? Keep quiet, and it suggests it’s accepting of the action.
This is on the assumption that the Provider is even told about any concerns that CQC has. There have been numerous occasions when clients have been informed that a safeguarding investigation is on-going but they cannot be informed of the detail. OK, so that is a different remit but it’s demonstrative of external stakeholders taking action, to the exclusion of a provider, who is the one party who could actually take action to put things right. That’s assuming that anything has gone wrong in the first place. This is similar to naming people who have been arrested on a matter but not charged. Should people have the right to have their identity protected when action may amount to nothing?
The suspension of a rating could have a huge impact on a provider. They may not get any further placements, they may lose service users, and they may even lose staff members who fear for their jobs. This could result in irreversible damage, which was wholly unnecessary.
Ian Trenholm recognised that CQC has an obligation to providers and that it can only change a provider’s rating when CQC has done a full comprehensive inspection. This suggests that the rating does not even have to be suspended following an inspection. Suspension is a nod and a wink to the gossip-mongers which could have the effect CQC desires on a provider without them actually having to go to the trouble or cost of proving their case.
At the CQC September Board Meeting Ian Trenholm said, in respect of rating suspensions, “I think you’ll see that happening pretty routinely, I don’t think you’ll ever see very very large numbers but it will be a tool that we use in order to make sure that our work is visible and clear to the public”
CQC has tools to take action against providers where there is cause for concern over the service that they are providing. Suspension of ratings should not be used as an interim measure as CQC doesn’t have the resources to carry out an inspection which would ultimately justify a change in rating, nor should it be used to circumvent the legislation which is there for a reason.
I have requested information about CQC’s policies and guidance on ratings suspension by way of a Freedom of Information Act request. At the date of submitting this article I had not had a substantive response but hope to keep readers updated when this information is forthcoming.