Registering the Right Support is the Care Quality Commission’s (CQC’s) policy on registration for providers supporting people with learning disabilities and autism.
I support the overall direction of the policy – the scandal at Winterbourne View in 2011 demonstrated just what can happen in poor-quality, institutionalised services. However, I question the lack of flexibility in its implementation.
There are occasions when failing to take account of the specific circumstances may lead to worse outcomes for the vulnerable people concerned.
The quality of the manager and the ethos of the organisation is often more important than the exact size of a service. A service supporting eight people with good values and strong management is likely to provide better outcomes for individuals than a service for six people with poor-quality leadership. Overall bed numbers should be an aspiration, not a hard and fast rule that is blindly adhered to.
Interestingly, CQC’s own data on the quality of residential homes for people with learning disabilities indicates that providers are more likely to be rated Outstanding if their service has more than six beds. As CQC moves towards a more data-driven inspection regime, perhaps it is time the policies more closely represent the data already being generated.
Whilst Registering the Right Support aims to promote high-quality care, a potential consequence of the policy appears to have been a marked reduction in the development of new residential services.
Affordability of supported living accommodation can be difficult, particularly for people with complex and challenging behaviour, due to the capital cost of the building compared to the rent level achieved through housing benefit – even at an enhanced rate.
This issue is particularly pronounced in the South East, where property prices are high. It may well be the case that, in the medium- to long-term, CQC’s policy results in a lack of provision for some of the most vulnerable people, leaving them trapped in inappropriate hospital settings.
Whilst I support the values-led approach taken by CQC, I do feel that time could be better spent ensuring existing supported living services are operating at the expected standard.
In recent years, supported living services have been accommodating people with complex needs requiring high levels of staff support. I believe these services require the same level of scrutiny as care homes and care homes with nursing, if we are to provide these individuals with the appropriate provision needed to thrive.
The challenge with the current arrangement is that supported living is treated like domiciliary care. As some providers are registering domiciliary care offices overseeing a large number of supported living services, only the office and a selection of services are inspected.
As a result, a significant and growing number of supported living services are going completely unregulated. This risks a large group of very vulnerable people being supported in an environment which is not receiving regulatory scrutiny – worsened by local government cuts leading to insufficient numbers of support staff.
There appears to be a myth in our sector that supported living automatically means good quality. Most often it does, however, I have seen some extremely poor quality, institutionalised supported living services. In most cases, where we have taken over supported living services from other providers, we find they are of mediocre quality. The individuals being supported have their basic needs met, but these services are rarely helping people to fulfil their potential – a goal which should be at the forefront of all providers’ objectives.
By focusing to such a large extent on Registering the Right Support, the industry is at times losing sight of the real duty of care, and due to poorly regulated services, the safety and wellbeing of thousands of individuals is being put at risk.
Just as providers must rightly deliver a person-centred approach to care, regulation should apply a more flexible and tailored approach to registration. Instead, CQC’s current approach is potentially leading to fewer vulnerable people accessing the very best care, whilst poor-quality services slip through the cracks. CQC should reconsider, if it is to truly protect and uphold the rights of the most vulnerable people in society.
Peter Kinsey is Chief Executive of Care Management Group. Email: firstname.lastname@example.org Twitter: @CMGCare_Support