Registration is the bedrock of what we do at the Care Quality Commission (CQC). It’s the first quality check we make. The decisions made by registration inspectors – informed by national and best practice guidance – are an important part of how we promote the health, safety and welfare of people who use services.
This is why I’m proud of CQC for standing up for the rights of people who use services when making decisions in line with our policy, Registering the Right Support . Last month, the First-tier Tribunal upheld one of CQC’s decisions to refuse an application submitted by a provider to increase the number of people with a learning disability at one of its services, following an appeal by the provider.
Registering the Right Support guides the assessments that registration inspectors make of providers of services for people with a learning disability and/or autism. It sets out that new services and variations to registrations within a campus or congregate setting should not be developed because this model of care is not in the best interests of people. Consistent with other national policy, it gives a clear message that people with a learning disability have as much right as anyone else to live fulfilling, ordinary lives in their communities.
I acknowledge that, for some, Registering the Right Support has been controversial. There have been myths circulating that there are strict limits on the number of places a service can have (for the avoidance of doubt, there are no rigid rules, just expectations that providers can demonstrate they follow the principles and values in the guidance) and we’ve heard concerns that promoting small services may impact on future capacity. I am very clear that standing by the policy and the principles that underpin it is the right thing to do.
Our focus must be firmly on the rights, welfare and wellbeing of people with autism and learning disabilities as determined by national best practice evidence. This evidence shows that smaller services are best placed to work with people, their families and carers to ensure care is truly person-centred and responsive to individual needs and wishes. Having said that, size is not considered in isolation from the other things that contribute to a service being able to deliver the best outcomes for people. We will always look at service size alongside the skills of staff; effectiveness of management; and the evidence base for the proposed service model. This is set out in Registering the Right Support, alongside clear examples of the types of applications that are likely to be approved and those that are likely to be refused.
CQC has an important role in supporting national policy and best practice guidance. The registration decisions we make today will impact what services exist to support people in the future. We have a responsibility to ensure that those services deliver a model of care that is proven to lead to the best outcomes for people and make a real difference to people’s lives. This means services that create environments where people have access to their local communities, the associated opportunities for independence, jobs and relationships, and the best conditions for a happy and successful life.
Everyone deserves these opportunities. It’s right that at CQC we’re using our position to make this a reality for more people in future.
Andrea Sutcliffe CBE is Chief Inspector of Adult Social Care at the Care Quality Commission. Read the First-tier Tribunal judgements in full and share your thoughts on Registering the Right Support.