In 2017, I started monitoring published CQC inspections and the ratings they handed out to care homes for older people, taking a snapshot at the end of each quarter to analyse the results of those published during those three months.
I had noticed that the share of Requires Improvement and Inadequate ‘non-compliant’ ratings was much higher than those given in total to all inspected homes across the country, and I was concerned about why this was happening.
I continued with my analysis each quarter until the end of 2019, and each time I was seeing higher than normal shares across the bottom two ratings.
Then COVID-19 arrived and all care homes went into lockdown, so my analysis paused, as did the majority of CQC inspections. But, with a new CQC strategy recently introduced, to which I refer later, I thought it would be a good idea to provide an update on the situation and so publish here a full analysis of my findings since the start of 2017.
- Out of 20,000 inspections undertaken and published between January 2017 and June 2021, 1,426 (7% or one in 14) were given an Inadequate rating, despite only 1.7% (one in 58) of all homes currently tarnished with that rating.
- Around 38% of ratings were Requires Improvement, which was twice as high as the 19% of homes currently rated this way.
The analysis covers 20,000 inspections against around a total of 9,800 care homes in England, which means that, on average, every care home should have been inspected twice over that period.
Chart 1 shows how different the ratings handed out over the last 18 quarters are to those currently displayed across all inspected care homes. Whilst around three quarters of all care homes can boast a Good rating, only just over half of all ratings since the beginning of 2017 attained that level. Requires Improvement ratings all but doubled their share and, most worryingly, the dreaded Inadequate ratings have been more than four times that of their 1.7% overall share.
During the COVID-19 period between April 2020 and June 2021, the ‘non-compliant shares’ were even higher – Requires Improvement at around 50% and Inadequate at around 16% – but one can understand this because the CQC focused on those homes with which it had concerns. It would have been wrong for the CQC to enter a care home it was happy with and risk introducing the dreaded virus just to go through protocol.
Quite rightly, the average number of quarterly inspections dropped from around 1,400 pre-COVID to 460 during the pandemic, so during this period the CQC was `fire-fighting’.
But has it also been fire fighting over the last four and a half years?
The results over the period since the start of 2017 suggest one or more of three rationales:
1. Care standards are getting poorer.
2. The CQC is getting stricter with the ratings it is handing out.
3. The CQC has been primarily focusing on its inspections on those with lower ratings.
The first rationale is doubtful, as the CQC has stated in its State of Care 2019/20 report that, ‘while quality was largely maintained compared with the previous year, there was no improvement overall.’ And, in fact, overall, the shares of each rating have not changed that much between 2017 and now, despite the fact that we have seen a repeated drop in ratings since. I imagine that care homes would definitely cite the second rationale as being the reason why they have not received the Good (or even Outstanding) rating they were striving for or had hoped to maintain.
Rationale three was certainly the case during COVID-19, but was this also the CQC’s strategy over the three previous years?
A good indicator as to the choice of homes to inspect depending on their existing rating, is shown when we compare the published dates of the last inspection for both Good and Requires Improvement care homes.
I understand that the higher the rating, the less the frequency of re-inspection, so where on the same day a home is rated Good and another is rated Requires Improvement, the latter home can expect the CQC knocking on its door earlier than the former.
This in itself makes sense, as the home needing improvement will want another chance to prove that it is Good, whereas a Good home should be allowed to get on with its work without further interruption for a longer period – save for the CQC picking up something negative on its radar.
However, we can see from Chart 2 that there is a massive variance in the last inspection dates between the two categories.
All existing Requires Improvements have been handed out within the last two and a half years – a quarter in the first six months of this year – whereas nearly 40% of homes currently rated Good have not been re-inspected since 2018, which predates all Requires Improvement ratings.
Another interesting statistic, and one of my key outtakes, is with regard to Inadequates, where the CQC has handed out 1,426 such ratings. Obviously, these will not all be to 1,426 different homes, as a number of these will be to the same homes that are trying but failing to get out of the predicament. However, currently there are just 163 that still have this rating.
Care home closures
So, perhaps there were massive closures within all those Inadequate homes, hence they don’t appear anymore?
No, during that time only 296 have closed, so that means that quite a number of homes that had this burden have managed to get out of that dubious situation and have subsequently received a better rating and kept closure at bay. Well done to them. The CQC has recently outlined its new strategy which includes accelerating improvement, stating: ‘We’ll empower services to help themselves, while retaining our strong regulatory role. The key to this is by collaborating and strengthening our relationships with services, the people who use them and our partners across health and care’.
If the CQC is, in fact, going to accelerate improvement, then its strategy on whom it inspects and how those inspections will help to meet that objective will need to change drastically from what has been happening over the last four years. Will it?
I will be keeping my quarterly eye on the situation and will let you know.