The Care Quality Commission (CQC) is asking us to tell it what we think about its proposals for the next phase of regulation and inspection. It wants our thoughts by Valentine’s Day.
Its proposals run to 60 pages of “key lines of enquiry” and “ratings characteristics”. It says it has simplified the process, adding a bit here, cutting a bit there, re-ordering and planning to inspect less but charge more.
To me, it’s like asking someone who’s been waiting for a Southern commuter train to arrive whether they would like to comment on next year’s timetable, higher fares and a different colour scheme for the carriages.
In this new phase, someone living in a small care home will have to wait for two or three years between inspections to discover whether it’s inadequate, in need of improvement, good or outstanding and, as providers add CQC fees to residents’ charges, they’ll have to pay up to £627 for the privilege. Sounds a bit steep to me, especially for stating blindingly obvious old news, written in special CQC gobbledegook, delivered about three months after an inspection by an anonymous official who can’t be contacted to ask for your money back. Try the CQC call centre in Newcastle – it will pass the message on.
A couple of years ago, I suggested in this blog that the CQC rarely improves social care. I was too kind: the CQC never improves social care. Of course it’s not really the regulator’s job to improve the services it inspects; that’s the job of the provider. However, at the very least, you might expect the regulator to pick up poor, unsafe or abusive practice and to demand improvement or close services down, and that’s what the CQC claims it does. The only trouble is, it doesn’t!
David Hogarth, a regular challenger of the regulator at its board meetings, has kept track of 52 cases of abuse, none of which was picked up by the CQC, and in many cases the regulator’s most recent report before the event found the service was good or at least “compliant”.
When a resident or relative (or a member of staff) suspects neglect or abuse, and may have tried to take it up with the home, or been too frightened to do so, who do you think they should go to? No, not the inspector, because the CQC doesn’t investigate complaints.
If your care is to any extent publicly funded, you can go to the local authority, but if you’re a “self-funder” you have nowhere to go.
So, why don’t we start with the real purpose of inspection? Design, build and operate the organisation around its core task? Let’s have a local team of inspectors who do respond to complaints; who are on the end of the telephone or email; who, when alerted to a problem, will go and check it out and nip it in the bud before it gets worse. We can keep the standards as they are – they’re perfectly serviceable if used sensibly – and we can even keep a small national body to support and guide the operation of local teams, but above all let’s keep it simple.
The Care Quality Commission is a public service. The best care homes are run for and with – and some even by – their residents. They are communities or big families. They are good places to live and work in, and their neighbourhoods are proud of them. The worst care homes are run for profit only and will pay what it takes to comply with regulations, and get “good” ratings from the CQC because all their records, policies and procedures are “in place”.
Inspectors need to be able to tell the difference and to know whose side they’re on. Local inspectors must be known and accessible to the public because theirs is a vital job in our society.
When the CQC goes local and truly serves the public, let’s all send it a Valentine.
- John Burton is an independent social care consultant and author of the Centre for Welfare Reform report What’s Wrong with CQC? (pdf)
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