The CQC Provider Profile – a fairer system than the old star ratings?

Provider Profiles were introduced on the CQC website without fanfare towards the end of last year. At first glance, it might appear beneficial that the Profiles can be easily understood, with a green tick denoting compliance, a grey cross non-compliance and a red cross, enforcement action. However, on careful examination, there are genuine concerns about their fairness as a means of informing the public about compliance and non-compliance with standards. This is because a green tick or grey cross is determined by the worst judged standard within each of the 5 outcome Chapters (based on the groupings in the Essential standards of quality and safety).

An outcome “rating” can be misleading if a member of the public only skims the front page of the Provider Profile and does not open up the judgement panel behind each Chapter to look at the particular outcome.  For example, a provider can be fully compliant with 4 out of 5 outcomes under Chapter 3 (Standards of caring for people safely and protecting them from harm) but if there are minor concerns with 1 outcome that will still generate a grey cross.  In comparison, another provider who is non-compliant with all 5 outcomes is given the same grey cross.  That is not a fair and balanced way of representing those two services to the public because it fails to distinguish between two services of profoundly different quality (assuming the CQC ratings are valid).  Additionally, the “rating” on the front page of the Provider Profile does not differentiate as to the seriousness of the non-compliance i.e. a grey cross arises from any breach, minor, moderate or major.

We suspect that the public and commissioners will tend to avoid providers who have any grey crosses on their Provider Profiles. Few readers will carry out a painstaking analysis to determine the real extent of non-compliance when making a judgement on the suitability of a service. Most people simply won’t have the time or the inclination to get into the regulatory detail.  Indeed, CQC would only have implemented this summary system if it considered that stakeholders wouldnot read the full reports.

Although the old quality rating system was not perfect, it at least sought to differentiate between providers on the basis of a rules-based system which led to an overall rating that was clear to the reader. What we have now is a simple “compliant or non-compliant” model which demands of the reader the time and willingness to read the separate judgement panels for each of the 16 outcomes and the Compliance Review Report in order to gain an appreciation of what the regulator is really saying about a particular service.

What all this means is that it is essential to challenge draft Compliance Review Reports in relation to factual inaccuracies, unsupported findings (such as subjective expressions of opinion) and unreasonable judgements.  After all, even a minor concern under one outcome will generate a grey cross in the Chapter it falls under.

After the inspection, it will be important to produce and submit a comprehensive action plan to CQC whenever there are compliance actions that are justified. It should state the date you expect to become compliant. Importantly, when you are compliant you should send CQC evidence to back that up. CQC says on its website that it will review the service within 3 months of a provider declaring the action plan complete.  CQC adds, “If at that time we judge you to be compliant, your profile page will be up-dated when we publish the findings from that review of compliance.”  Provided you send in sufficient information to CQC, that review is likely to be a desktop exercise.  Even if you are challenging aspects of a draft Compliance Review Report, you should still submit an action plan in relation to any outcomes that have valid compliance actions in place.

A word of warning. Until CQC reviews an outcome, the judgement will stay the same on the Provider Profile.  While CQC will be carrying out a lot more inspections in the months to come, it is likely they will look at a smaller number of outcomes, typically no more than five. You need to watch out for outcomes that are missed on re-inspection and therefore remain as non-compliant on the Provider Profile.  Under CQC’s Guidance on how to carry out inspection, you should be told at the beginning of an inspection what areas will be looked at. If inspectors appear to be ignoring an outcome that was judged as non-compliant at the previous inspection, ask them to include this as part of the current inspection. You want a fresh review of that outcome or it could remain in place until CQC next looks at it or you submit evidence of compliance.  The important thing is to take the initiative and check your Provider Profile, following up on any grey crosses.  After all, the reputation and commercial viability of your business may depend on it.

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