At the end of last week the CQC finally issued a statement on its website concerning the recent issue we have reported on, which has led to the withdrawal of inspection reports and ratings, and re-inspection of services in the North and London.
The statement confirms our understanding that this relates to duplicate material in inspection reports which was included from notes or information put forward by individuals within the CQC’s inspection teams. We have seen different numbers reported but the CQC have confirmed in the statement that it relates to three individuals; two “Experts by Experience” and one “Specialist Advisor”. The statement includes a list of the 68 services which will re-inspected.
Experts by Experience have first-hand experience of using certain types of services. They attend services with the CQC’s inspection team to observe practice, speak to service users, families and staff, with a view to providing a first hand, on-the-ground view to inspectors of performance from a service user’s perspective. At least until recently, the CQC used experts employed by two companies; Remploy (North, South and London regions) and Choice Support (Central regions).
Specialist Advisors are people employed by the CQC with a view to bringing current knowledge and expertise of a particular type of service or category of service users to the inspection and assessment process. They are often medical practitioners or individuals with significant professional experience in a particular area of health and/or social care provision.
We welcome the CQC’s, albeit rather late, statement on the issue but remain concerned by its limited transparency. It is disappointing to see the statement is so light on content and provides no real explanation as to how these issues may have arisen, how they were identified or what investigations have been carried out, nor does it explain what “actions [which are necessary] to reduce the risk of this happening again” the CQC are planning. There is also no acknowledgement on the regulator’s part of the effect this has had on Providers.
We are also concerned by the rationale the CQC has put forward to explain why it has only withdrawn 38 inspection reports, despite the Expert by Experience issue affecting at least 78 inspections. They state that:
“Following close analysis and additional peer review, the majority of these reports have been republished without the inclusion of these quotes as they did not affect the rating of the service”
It is our understanding that an inspector is required to make an independent judgment of a service, and rate it accordingly. Indeed, the CQC regularly reiterate this to us in responses to requests for Ratings Reviews. It is concerning if the CQC is indicating that it has selected those unreliable reports based on how far the inclusion of quotes in reports might affect the rating.
We would argue that this does not address the problem. What is important is how much the experts’ input affected the inspector’s judgement.
The CQC appears to acknowledge this point in respect of Specialist Advisors. It accepts that all 30 services involving the Specialist Advisor need to be re-inspected, to ensure that CQC can “be confident in the ratings and findings”. Why it does not treat Experts by Experience the same in this scenario is unclear.
Input by Experts by Experience is not isolated to a list of quotes given to an inspector for the inspector to include (or not) into a report, without any context or discussion. As the CQC’s own website states:
“[Experts by Experience’s] findings are used to support the inspectors’ judgments on services and may be included in inspection reports”
Surely then, an independently minded inspector, will have considered all the input provided to them by all the experts in its team and will have taken all that input into consideration when forming an overall judgment of a service. Simply removing quotes from inspection reports therefore cannot “undo” decisions an inspector has made, which will (or should have) have taken into account all input provided to them, including that from Experts by Experience.
Presumably only those inspection reports where the inspector, in exercising their discretion, gave no consideration or weight whatsoever to the expert(s) in question can truly be considered sound. If that were the case for the 40 services whose reports have been deemed sound, then the CQC’s use of Experts by Experience should surely be reconsidered as inefficient and ineffective. If inspectors do not take their input into account in over half of the inspections they are involved with, then what is the point in having them at all?
Further, if the inspectors of these 40 services genuinely did not give any weight to input provided by the Experts by Experience in reaching their own judgment about a service, this raises a wider concern about the regulator’s practices. It would indicate a startling inconsistency in the treatment of Experts by Experience’s input by different inspectors. Providers would be right to be concerned by any regulator acting inconsistently in its decision making, without very good reason to do so.
On the one hand, some Providers will no doubt be pleased to know that their rating has been deemed sound without having to go through the stress and inconvenience of re-inspection well before they would have otherwise expected.
On the other hand, Providers cannot yet be sure that affected reports and ratings which have been re-published are indeed sound and a true reflection of the service they provide. Nor can Providers be confident that CQC is acting consistently in its decision making. This could seriously undermine the public’s confidence in the regulator, and the sector generally.
Even if the CQC has adequately resolved the issue, Providers and the wider public cannot be comfortable that is the case without further transparency from the regulator.
If Providers require any legal advice in relation to this issue or on CQC matters more generally, please contact Ridouts on 0207 317 0340.