Trouble at the CQC

A lot of people working within the social care sector have had misgivings about some of the changes that have been taking place at the CQC (care quality commission). The CQC is responsible for monitoring and registering care services (as well as health services,  but I’m going to concentrate on care services because it’s what I know best) since its inception when it pulled together various previous regulatory bodies and picked up their functions.

There are a lot of lessons to be learnt for the future within the CQC  as we draw to a point where lots of services across health and social care will be merging and we are pushed towards joint management. There is a lot to be wary of.

Private Eye has an expose’ piece in the current issue (dated 29/10-11/1, in the ‘In the Back’ Section p29). Unfortunately the piece doesn’t appear in full on their website so you will all have to go out and buy a copy (seriously, if you are concerned about the CQC it is definitely worth a read and to be honest, I can’t recommend Private Eye highly enough!).

I wanted to draw on some of the issues raised in the piece so forgive the lack of links for the time-being.

The investigation carried out by Private Eye was alongside ‘Compassion in Care’ which is a charity set up to counter abuse in care homes. The organisation was set up by Eileen Chubb, a former care worker who witnessed abuse and who lost her job because she was a ‘whistleblower’. The organisation campaigns for the vulnerable in care homes.

The report highlights a number of concerns related to the CQC particularly how they have either ignored and in one case ‘upgraded’ via the now defunct star-system homes in which proven maltreatment has occurred.

As the Eye says

‘Only last month we reported how – just two months before a hospital nurse described a care home resident as suffering ‘the worst care of neglect’ she had seen, the CQC had wrongly promoted what had been a failing home, run by care home giants Southern Cross, back up to a two-star ‘rating’.

I don’t have the time to relay all of the information and quite unbelievable lack of teeth of the CQC in the face of appalling care services as relayed by the Eye but it makes for frightening although worryingly not surprising reading to me.

Another part of the article refers to the leaked staff survey results published in Community Care and that backs up informal discussions I have with some good friends who currently work in the CQC.

The Eye states that

CQC Insiders were worried that attempts to push through registration for all homes and agencies ahead of the 1 October deadline was compromising safety in the homes themselves’.

This absolutely mirrors the conversations that I have had with CQC friends, including being told that they were told to concentrate on these registrations at the expense of visiting homes where issues may have been arising –much to their own chagrin.

The other concerning conversation I had with said friends was that the CQC seemed to be increasingly reliant on local authorities ‘quality assurance’ teams to check on the local residential, nursing and domiciliary services. We can only guess at what might happen to some of these teams as the local councils make massive cuts. I don’t know if they will be able to provide as strong a service as they might in less frugal times.

The Eye pulls up the report and interviews given by the head of the CQC last month stating that 34 homes and 8 agencies were closed after they took ‘enforcement’ action as a way to prove their ‘strong arm’ regulation as well as 51 other services which had closed after poor ratings.

This is an area that Private Eye has been investigating and has tried to push CQC to provide details of these ‘enforcements’ as there was nothing about them in the CQC’s annual report published in April 2010. Private Eye and Compassion in Care have tried to find details of the deregistered homes b ut the information  has ‘disappeared’ from the CQC website and they have been stalled in their attempts to investigate.

Cynthia Bower, the Chief Executive of the CQC in her previous incarnation was the West Midland Strategic Health Authority which was responsible for overseeing the Mid-Staffordshire Foundation Trust Hospital. It is quite staggering that the responsibility for protecting standard of care for those who are arguably some of the most vulnerable in society should be under her charge.

I’ve railed against ‘desk based’ assessments which were happening prior to the existence of the CQC where inspectors do not actually visit homes that have previously scored ‘well’ in inspectors but rather rely on ‘self-assessments’. It is a national scandal that we have no reliable and functioning way of monitoring care homes and that the CQC itself is relying on local authority quality assurance visits when it should be setting the gold standard itself.

The piece ends with the comment that while the CQC hasn’t responded to the piece, John McDonnell MP will be raising the issue in the House of Commons so hopefully they will respond to him.

I rail where I can but the difficulty I sometimes face is time and that often homes are able to ‘put on their best face’ for social workers when we visit. We have limited roles usually in reference to one particular resident.

I have to say that all the personal contact I have had with CQC inspectors has been exceptional – when I have picked up concerns at a care home and contacted them directly but it is clear that the time is not allowed in the same way that it had been previously.

We are back to penny pinching and cost-cutting.

Thank you to Private Eye and Compassion in Care for investigating these issues. They should be on the front page of every national newspaper rather than tucked away in the pages of Private Eye – but I have a lot of time and faith in Private Eye to be honest. They have some of the better investigative journalism in  my very simplistic terms. Go out and buy this edition, all the editions and subscribe!

We cannot let it lie.

3 thoughts on “Trouble at the CQC

  1. Whilst accepting the arguments you put for CQC’s ineffectiveness in policing care quality, I feel it’s also important to note the other problem side of their operation. They can be extremely dictatorial and dogmatic about care providers ‘ticking the right boxes’ – sometimes regardless of the impact this has on the quality of care. My own experience is with an ‘excellent’ service to which the new registration rules were applied. Their insistence on a ‘one size fits all’ approach made parts of the care package ‘illegal’ to provide for no good reason other than not fitting the categories easily. Cross category, imaginative care became unacceptable. We have eventually got them to backtrack but it’s been traumatic, and has damaged our relationships with care providers – and even getting them to speak to us has been a problem.

  2. It is heartening to see concern about performance – or rather non-performance – of social care’s ‘super regulator’ making it into the pages of Private Eye as the magazine does have a reputation for being “like a dog with a bone”. I think CQC (and its predecessor) has been given a very easy ride by the specialist press, and by that I mean it’s all very well for Community Care to spill the beans on a negative staff survey, it’s quite another thing to adopt a more forensic approach to taking apart some of the claims CQC makes for itself.
    The simple fact is that even before we embarked on the the journey through the age of austerity (to reach the promised land where we’d “all be in it together”?) the budget had been severely cut – that was a clear consequence of the merger which created the CQC. The number of inspectors has reduced, the number of services to be inspected has been increased – something’s got to give, and it’s visits to homes (once the stock-in-trade of inspectors).
    The situation is a shambles and has to change if the confidence of users and their families – and providers too – is to be rebuilt.

  3. The performance of CQC is a disgrace but it is the culmination of nearly ten years of the decline of real inspection since it became national instead of local. I’m sure there are still some good inspectors in CQC but they are not allowed to do their job.
    From the start the national regulators (first NCSC, then CSCI) thought that inspection was about them not about the residents and the homes. They thought they were in charge of homes and that homes had to jump through their hoops. Each one boasted about its work and put themselves above everyone else. They were the worst sort of Quangos – expensive, bureaucratic, ineffective, and grandiose. They have tried to make running a care home into an equally bureaucratic business. The better you are at the paper work and presentation, the better the home is judged to be.
    For all its faults, Ofsted recognises that children’s homes – even the “outstanding” ones – have to be inspected twice a year, yet CQC has actually ditched inspection (as in visiting and seeing for yourself) altogether. Their plan is to do “site visits” only when something has gone drastically wrong – and that is too late.
    All care homes need inspecting at least once a year. Inspection is for the residents, relatives and the public. Inspectors should be local, available, and responsive. They must spend time with residents when they visit. And they MUST respond to and investigate complaints (something which CSCI said was not their job). CQC charge residents more than £100 a year for NOTHING. Look at the CQC website. For that money, inspection can be done properly.
    Good and improving homes like inspection as long as the inspector understands what she or he is looking at (some don’t). Residents and relatives need inspection as a knowledgeable outsider who can put things right if they’ve gone wrong.
    Unfortunately, I don’t think the politicians really understand what is wrong with CQC (apart from knowing that Cynthia Bowyer’s track record with Stafford Hospital should have debarred her from heading it).
    There is hope: the new Healthwatch idea could be the basis for reviving local inspection. But has CQC got the imagination to develop it in that way? Not now – under this regime – but once the overpaid, self-important, hierarchy of CQC departs we just might have someone who understands what is required.
    Thank goodness Eileen Chubb and Private Eye have got onto this. I’ve been banging on about it for years (and even more so in the last year) but I’ve been talking to and banging my head against the CQC brick wall.

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