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03rd October 2011

The CQC Annual Accountability Hearing: An Inspector Calls

The House of Common Health Committee recently published their damning report on the progress of the Care Quality Commission, with particular concern raised over the lack of inspections during the 2010-11 period. The balance between registration and compliance activity was found to be unequal and prioritised poorly. Echoing the concerns of the evidence raised, the Committee concluded that: “...the bias in the work of the CQC away from its core function of inspection and towards the essentially administrative task of registration represented a significant distortion of priorities.”

The report focused on numerous aspects of the regulator’s work, which called into question its credibility and fitness to carry out the work it had been tasked to do by statute. Some of this information is particularly revealing for Health and Social Care providers in the UK, as it provides clarity on some of the potential changes we can expect to see regarding inspections and the proposed excellence awards.

The decision by the CQC to focus the vast majority of its resources upon registration, rather than inspection, has led to some worrying statistics being revealed.  In the six month period between October 2009 and the end of March 2010, some 6480 site visits were undertaken to providers however, only 2008 site visits were carried out in the same 6 month period in 2010-11.  This represents a fall of 70%.  The report highlighted that within adult social care 10,856 care home inspections were carried out in the 2009-10 financial year, whilst 2010-11 saw only 3805 inspections take place, a fall of 65%.

Statistics such as these provide ammunition for the critics of the Care Quality Commission to call into questions its credibility as a regulator, whose primary purpose is to promote excellence within Health and Social Care and to ensure that safeguarding measures are always in place and being regularly monitored and scrutinised.  This serious decline in the volume of inspections occurring points towards a fundamental failing in the allocation of their priorities, a view upheld within the Select Committee Report.

The task of increasing the number of inspections has also been hampered by the number of long-term vacancies, as yet unfilled. There are currently 133 vacancies for compliance inspectors/registration assessors. This number appears to be on the increase, which only exacerbates the CQC’s woes in attempting to re-build public confidence in its ability to carry out its statutory duties.

It isn’t however, all bad news, as Dame Jo Williams indicated in her evidence to the Committee that there has been a “step change” since January 2011. It would seem that inspection levels are now rising, with some 600 inspections per month now taking place. This is still considerably fewer inspections that the 13,000 carried out in 2009-10, but the aim is to take this to 1200 per month very soon. This is possible because registration now only accounts for 20% of their time, leaving 80% to be spent on compliance enforcement and follow-up activities.

Whether 1200 inspections per month can be achieved is another matter. Already there are reports coming out of the CQC which suggest that the individual caseload of a CQC Inspector has increased from 50 locations as of 1st April 2010 to 60 locations as of 1st April 2011. Addressing their recruitment needs should go some way towards mitigating this increase.

As is widely know, the current approach of the CQC is to review each provider at least every two years (although it may be far more frequent in cases where a risk-based evaluation suggests that a site visit is required immediately). The problem with this approach is that it doesn’t necessarily imply that an actual visit will be made, but instead could be carried out by the arms-length provider compliance assessment.  The risk to service users is immediately obvious, when one considers that onsite inspections may not happen. This was echoed in the Select Committee Report when they added that:

“ is difficult to see how the CQC can have confidence in a provider meeting standards if it has not visited the organisation for more than two years, no matter how good their record.  Unannounced inspections must form the core of compliance assessment.”

The CQC has already responded to this justifiable concern, with Dame Jo Williams announcing a move towards a regime of unannounced inspections for providers on an annual basis.  This is all subject to a 12 week consultation period, but it is highly unlikely that serious opposition will be mounted towards such a proposal.  This will therefore lead to a huge rise in the number of inspections occurring on a monthly basis, which will in itself present many challenges to not only existing providers, but also to those who have only entered the market place within the last couple of years.

Aside from an increase in the volume of inspections, the other highly pertinent aspect of the Select Committee Report was their findings on the “Excellence Award”, a replacement for the former star ratings system.  The award, which is designed to highlight where providers meet a standard of “excellence” above and beyond the CQC’s essential standards, is due to be launched in April 2012.  Dogged with allegations of a lack of transparency and clarity ever since its inception, the Select Committee bluntly stated that:

“The proposed Adult Social Care Excellence Award has been roundly rejected in evidence submitted to us.  We share these concerns and recommend that the project is dropped”.

Whether this new voluntary ratings system is indeed dropped, is another matter entirely.  Important though the Select Committee undoubtedly is, it is not an arm of the Government and therefore its recommendations can only influence rather than instruct. Looking at what has been said and the all-time low public confidence in the CQC, I suspect that we will indeed see these recommendations coming into fruition in the not too distant future.

For now, Quality Compliance Systems Ltd has pre-empted the likely increase in the volume of inspections, by creating a Mock Inspection Toolkit, which is designed to get an adult social care provider ready and used to inspections. To see how it can help you and your care service, click here for a no obligation FREE TRIAL.

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