Is it just me…?

Editor in Chief, Robert Chamberlain gives thought to the new Care Quality Commission (CQC) quality ratings and reflects on the lessons of the past.

By the time that you read this article, the CQC will have launched its new quality ratings for social care providers and the inspections to grade providers will have begun.

In an article from The Telegraph (12th October 2014) the CQC’s Chief Inspector Andrea Sutcliffe stated, ‘From October we will be starting to rate every adult social care service to be clear whether they are safe, caring, effective, responsive and well-led. We will identify the good and the outstanding, but we will also highlight where services require improvement or are inadequate. My first priority is to get services to improve. They need to do the job they are getting paid to do, and they need to show our inspectors that they are effectively tackling the problems. But if they don’t improve – I will make sure that CQC uses its powers to force change or take action that will lead to services closing and managers and directors being properly held to account.’

Personally, I believe that the ratings are to be welcomed but they must be well-executed. There must be universal confidence in the methodology and outcomes to avoid the pitfalls of the Commission for Social Care Inspection (CSCI) star ratings. In particular, local authority commissioners must embrace the regulator’s new system to prevent history repeating itself. I’ve chosen a couple of examples from the past to demonstrate my point.

Local authority confidence

I recall conversations with numerous commissioning teams where there was a lack of confidence in the robustness of the CSCI’s ratings. This stemmed from questioning the approach adopted by the former regulator, especially the frequency of inspection. Many felt that the (up to) three-year gap between inspections was too long and that the quality of care in an establishment could change dramatically in such a period, thus undermining the credibility of the ratings. As commissioners, they felt that they had a duty to the public to ensure that the care they purchased was of an appropriate quality and several councils set up their own inspection programmes to do so – many of which still exist.

Interestingly, it was common to see the contradictory outcomes when comparing the star ratings with a council’s own system. A provider rated three stars by the CSCI might be viewed as low quality following a council inspection and vice versa. As well as being confusing for care seekers, this disparity gave providers an unwelcome headache.

The CQC must gain local authority confidence if they are to see an end to this confusing duplication of effort. The planned annual CQC inspections for all providers have now been changed to every two years for those ranked ‘outstanding’ and 18 months for those awarded ‘good’. I do wonder how commissioners will receive this approach and if it eases their original concerns.

Affordable quality

At our CMM conference in May, Malcolm Bower-Brown, the CQC’s Deputy Chief Inspector (Central Region) stated a belief that the new ratings would help commissioners to purchase better quality care. This was not the case during the CSCI’s reign and I remember writing to the contrary in my column many years ago.

After the introduction of star ratings in 2008 a pattern emerged that showed councils were purchasing from one star and even zero stars providers. Commissioners openly admitted that their reducing budgets could not afford two and three star services. Therefore, only those individuals who ‘topped-up’ or self-funded could access the better quality care.

Moving forward to now, local authority budgets are even tighter than before and, with the impending funding reform, the State will be purchasing greater amounts of care than previously. The conclusion I came to in my previous column is that it will be the private contributions of the public that drive up the quality of care while cash-strapped councils reward those at the poorer end of the quality scale. Can we expect commissioning practices to be any different this time around?

Do you agree with Robert? What are your thoughts? Add to the debate in the comments below. Subscription required.

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