Inspections and the CQC


Orchardville Care Home. Loving care is given t...

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I was interested to see that Mark Easton in his BBC blog, touched on the issue of residential care and the confusion in the regulatory system.

He talks about a man, Dave, who needed to place his mother in a care home and looked to the CQC ratings and saw two stars (good) and his mother found herself in an awful care home.

She moved to a better place but the post goes on to say how

Ministers are pushing ahead with plans to replace regular national inspection with a “localism” model, relying on residents and their families alerting the authorities to problems.

Whoah. So now care home regulation is going the way of volunteers and ‘big society’. This is frightening stuff. I know the CQC has been being wound down, in effect, for years. There are fewer inspectors and they inspect less frequently.

Local authorities ‘quality assurance’ teams who may have picked up the slack are being disbanded in the face of enormous cuts in local authority funding from the central government. Our teams are being decimated (or if you want to take the term literally – more than decimated).

Easton has a telling – and chilling quote from the CQC

As the CQC explains: “We rely on people who use services and those who care for and treat them to tell us about the quality and safety of services. This feedback is a vital part of our dynamic system of regulation which places the views, experiences, health and wellbeing of people who use services at its centre.

Again. A little stunned and frankly horrified silence on my part when I read this. It felt as if I was being punched in the stomach and that the people who rely on a decent and human system of care homes are being kicked in the stomach by the government and the death of the regulatory system as well.

Feedback is very far from ‘dynamic’. I’ve tried to raise issues myself with the CQC about concerns in residential homes that I’ve visited and when you finally track down the officer responsible, you might get a sympathetic mumble but little has actually been done – oh, except in one instance where I managed to trigger a massive safeguarding alert which encompassed ALL the residents of said home.  Maybe a regular inspection could have highlighted these issues before a social worker who only happened to be visiting by chance raised the alert (when I spoke to the inspector, she admitted she had never actually physically visited that home).  Is this really the best way to proactively improve the quality of care homes? Is this what the ‘Excellence’ scheme is about? To encourage the CQC to be let off the hook as larger care homes tick more boxes.

This is a scandal. This is NOT as expectation that should be on residents and families who often feel incredibly vulnerable leaving their loved ones in a care home to pick up.

It isn’t easy to find the correct CQC number to make a complaint. Their website was actually redesigned to be far worse and far more user-unfriendly that I expect it was done by a work-experience student or the child of one of the higher tier managers who said ‘I know about computers.. I can do it’.

I really hope they didn’t spend public funds on that redesign.. information is much more difficult to find now – or perhaps that was the purpose (I’m saying that tongue-in-cheek – I’m don’t really believe in conspiracy theories – incompetence is usually the more obvious answer!).

Easton goes on to explain that

English councils are expected to improve their monitoring of care home standards just as they make cuts to adult social services, squeezing commissioning budgets and looking to find efficiencies in backroom quality assurance operations. The head of CQC, Dame Jo Williams, recently made the point herself: “The providers will be asking themselves: what can I do to cut corners?”

It is not just central government inspection of care homes which is being cut back. Ministers have also scrapped official assessments of how well local authorities commission care services. In future, councils’ responsibility to ensure good standards will be monitored by a new local consumer champion HealthWatch, which itself relies on local authority funding. The NHS Confederation has warned of “inherent conflicts of interest” with a council funded body scrutinising its paymasters.

So just when you thought things couldn’t get any worse.

This demonstrates that the ‘so-called’ Excellence scheme is a sham by a body that is not fit for purpose (namely the CQC).

We need to protect and provide support to vulnerable adults but no tools are being provided to support this and gradually the tools we had are being stripped away.

This is more difficult to stomach as Ofsted have a new inspection regime that demands that childrens’ homes are inspected twice a year and all inspections will be unannounced.

Why is the same system not introduced for vulnerable adults?

That is the question we should all be asking. Why does our society allow adults who are dependent on us to suffer so much in comparison and to be subject to second-rate, third-rate services and regulation of care homes?

We should be clamouring and demanding the same inspection mechanisms as given to children.

But people need to know about the changes in order to protest against them. Too many of these changes have happened stealthily and without much debate.

So slowly we are seeing the ‘big society’ that Cameron envisaged. It isn’t about community networking and organisation. It isn’t about volunteering and ‘making the community a better place’. It is about absolving the government of responsibilities.

Would we allow ‘friends and families’ to provide the base of inspections in childrens’ services or in hospitals? No. Why could and should we allow it in adult social care?

7 thoughts on “Inspections and the CQC

  1. Pingback: Inspections and the CQC - Fighting Monsters - Member blogs - Social Work Blog - Carespace from Community Care

  2. I used to work for one of CQC predecessor organisations and believe me the system was better when local authorities did the inspections. Anyone remember John Major’s “lighter touch” inspections? A minority of cowboy providers lobbied the government for lighter touch inspections, saying that local authority inspection units were “heavy handed” (equals doing their job properly — no reputable provider wants lighter touch regulation in any field – this is a political myth). So the job was eventually carried out by anonymous national bodies that didn’t even prosecute when people died in homes for example as a result of inappropriate restraint techniques being used by untrained staff. Statistics show that the number of cases brought to court has declined since the 90s, when NCSC, CSCI, CQC etc took over. If anyone believes that this is because inspection has been so effective, then they need a reality transplant. CQC is now a regular feature in Private Eye, with good reason, and not just because of the over inflated salaries of its managers.
    By way of presenting an analogy I once stayed in a hotel near the Menai straits which had an RAC five star rating. It was the worst hotel I have ever stayed in, but it presumably ticked the boxes for the RAC checklist. Tripadvisor is a far more effective way of assessing quality. The fact that CQC has wiped out the historical assessments on all its providers shows that it has no faith in its own assessments, so why bother? I have visited hundreds of homes where the inspection reports were so anodyne as to be meaningless. We should either go back to the local inspection units, either run by the council or by a suitable voluntary organisation, or ditch CQC and set up “Careadvisor.com” to do the job.

  3. Anyone with a passing acquaintance with the residential care system will know that it’s not an area where you can ease off the regulatory pedal, especially as you mention the fact that budgets will be getting tighter. I mean even in the good times, a few years back, my old employers only raised the maximum funding level by 1% for two consequtive years. The care homes were of course outraged, but for the bulk that relied on local authourity funded redsidents there was little they could do.

    And like you say, where will these savings come from? Cutting the wages of the workforce – already in one of the lowest paid sectors of the economy. What does this do for recruitment, retention, and motivation. Or maybe it’s as in a case I’ve recently been told about, things like not getting a broken plug socket fixed, maybe it’s only little, but a health and safety issue nonetheless. Could it be not purchasing equipment like riser/recliner chairs, hospital beds and other equipment needed to reduce risks for residents and staff? Yep, probably that too.

    The phrase ‘perfect storm’ comes to mind.

  4. Maybe this isn’t going to go away into the long grass as some (CQC’s Chief Exec, for instance) might be hoping.
    I sense that I lived through a ‘golden age’ but only realised it as the second national regulator lost interest in inspection and then handed on ‘damaged goods’ to the next lot.
    Just been speaking to a national newspaper journalist who’s planning to run a piece on the case for going local again…..
    Keep up your good work drawing ‘stuff’ to people’s attention and we’ll all go on reading it, commenting and drawing on the blog when we comment elsewhere….this is what a campaign is made of…diverse bits and pieces, not one big bang!

  5. Thanks for the comments all – it is really appreciated as I am trying to get my head around how best to continue this campaign.
    I spoke to a CQC inspector (who is a friend of mine) today and we spoke about the national v local (she used to work for the local authority and has been through a few different ‘incarnations’ as inspector).
    She had no doubt that while the general standards had improved, the system by which she was ‘closer to the ground’ was a better one for the home residents and that the tick box method had served our older adults poorly as good management is measured and good outcomes and care for users is the most important thing.

    I hope the press keep coming back to this issue.

  6. Yes, it seems the media – radio, TV and press – are on to CQC. This seems like a make or break moment. Although I agree that inspection must go local again because inspectors must really know homes and be accessible to the public (and deal with complaints), the old local authority inspection units varied. Some inspectors were expected to cover 60 or more homes but 20 was a more realistic number. And some units colluded with neglect and abuse while others rooted out bad practice. We then ended up with NCSC which went down the bureaucratic road with a vengeance. CSCI was ever so grand(iose) and self-important but ineffectual. And CQC (Currently Quite Confusing) has ditched inspection all together.
    We must prevent the powerful lobby groups and the social care elite from creating another bureaucracy in their own image.
    Inspection must be LOCAL. Inspections must be unannounced, at LEAST once a year, and must concentrate on what actually happens in the home. Inspectors must be accessible to the public and must follow up complaints, and sort things out on the spot. We can keep CQC as the national licensing body but the resources must go into local inspection – possibly through Healthwatch. Government MUST take a lead and not be pushed off course by all the vested interests that there are in making inspection into opportunities for everyone to make money out of care homes. Put the resources into the homes themselves.

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