Over the last 3 years there has been one significant theme in the many conversations that we have had with care providers. They have not been visited by the CQC in years and have been left stranded with a “Requires Improvement” rating that no longer represents their service.
Their frustration is tangible and their question to us is “How do I make the CQC come out to re-inspect me…?”
Before we discuss what can be done in this scenario, it’s important to explore how we got here.
CQC’s Change In Approach
As a consequence of the pandemic, the CQC decided to abandon its usual timetable for inspections. The Transitional Regulatory Approach replaced the standard method of inspection during and shortly after the pandemic. This meant that infection control inspections took priority and that a new “risk based” focus would drive inspections – meaning that only services that were perceived as having issues (as a consequence of the CQC receiving “information of concern”) or risks associated with them would be inspected. This risk-based approach was adopted on a more permanent basis, leading to negative factors triggering inspections. It remains in place today.
Whilst it is naturally important that the CQC investigate and evaluate services that are having clear issues with allegations of abuse, repeated whistle-blows or family complaints, what becomes of the services that are ticking along nicely without any cause for concern?
The Real Impact
These are the services that are suffering. We were approached by the providers of a care home which was last inspected by the CQC in 2018 and was rated “Requires Improvement”. The staff and management were disappointed by that outcome at the time and put in place a programme of works and action plan to improve the rating as quickly as possible. Significant improvements were made and the provider expected the CQC to return within the year. Unfortunately, the pandemic happened and the aforementioned departure from regular inspections occurred. Given the level of improvement there have been no issues at the service and therefore no “information of concern” has been passed to the CQC, prompting an inspection. The service is now left in limbo – a victim of its own success. Staff are frustrated and demotivated – their hard work having had no real impact on the outward facing aspects of the home. Services being delivered are notably better but until that is fairly assessed and quantified by the CQC the service will still appear to require improvement.
Why Is A Rating Important?
Fair, accurate and contemporary ratings are crucial to care businesses. Firstly, inspection reports and ratings are a service’s biggest marketing tool and where most prospective service users and their families go first for assurance about a service. Secondly, we are seeing an increasing number of commissioning authorities actively electing to do business with services rated as “Good” and above over “Requires Improvement” services. An outdated and irrelevant inspection and rating could limit the commercial success of a business. Finally, staff morale can be directly linked to the outcome of a CQC inspection. Staff members that believe they have done everything to improve, only to never be inspected and have that hard work verified by the regulator are likely to feel demotivated and disengage from the service. A failure to inspect a service in 5 years is absolutely unacceptable.
So How Can I Make The CQC Come Out And Inspect My Home?
Unfortunately, there is no formal mechanism through which a provider can demand an inspection. The CQC will simply plan inspections, placing at risk services towards the top of the list. Whilst there is nothing that can be done to force an inspection, we would always recommend a frank and open letter to the inspection team, detailing the impact that the lack of inspection has had on the service. Open dialogue can sometimes be successful and all aspects of the detrimental effect the lack of inspection is having should be clearly set out. In the absence of formal CQC inspection reports, some providers are engaging the services of independent care consultants to conduct an impartial mock inspection which they then publicise and circulate to relevant stakeholders.
We have had clients suggest to us (we hope in jest) that they would consider raising a fake whistleblowing incident in order to provoke the attendance of the CQC. We would never recommend that a provider do this, as frustrating as waiting in regulatory purgatory might feel. The consequences are likely to be adverse.
Are Things Going To Change?
The good news is that things are slowly changing. This past winter, the CQC embarked on an increased number of inspections of “Requires Improvement” homes in order to ease winter pressures experienced by the NHS and hopefully upgrade ratings (thus making more “Good” care home beds available to patients leaving hospital). This shows that inspections are possible but unfortunately, there still remain a large number of services awaiting inspection.
It is anticipated that the CQC’s new single assessment framework will have a significant impact on the way inspections are done and indeed, their regularity. More remote inspections are expected to increase productivity and the CQC has even indicated that ratings can change as and when new information about a service is received. We have our own concerns about this dynamic system of inspection and what it will mean for providers, but those views deserve their very own article.
Concerns aside, what is clear is that there may be an end in sight for those waiting to show the world that they have improved and be duly rewarded with the appropriate rating. Until then, we will have to patiently wait for that knock on the door.