Exposure and the CQC

Last night, ITV examined the state of residential care and regulation of the sector in Exposure. While I watched the programme through the lens of someone who has had significant experience of the sector, I’ve also followed the birthing pains of the Care Quality Commission avidly so some of the information given wasn’t ‘new’ to me. I probably didn’t approach the programme as an ‘average viewer’ might.

There were a few issues raised that I think useful to explore. The programme seemed to rightly raise the void of inspection that took place through the initial years in which the CQC was established. The organisation was established with less money than it’s predecessor bodies, the Healthcare Commission, the Mental Health Act Commission and the Commission for Social Care Inspection.  While focusing on registering services, the CQC dropped the ball on maintaining inspections and relying on previous ‘good and excellent’ reports to step back on regular on-site checks.

An ‘excellent’ service can fail very quickly if there are changing in funding and personnel in a home, for example and the lack of attention to frequent unannounced inspections was something that was highlighted in this programme.

However while not resolving the organisation of responsibility, this focus has changed and the CQC has stated that regular, unannounced inspections are taking place now.

The website has long been a gripe as far as I’m concerned. There seems to be less information with each iteration and the scope and searchability isn’t as helpful as it used to be. The CQC website remains the only one I have come across at work which has become progressively less user friendly  with each iteration  (and yes, I have always given feedback on the changes when it’s been an option!). The lack of reports from both predecessor organisations (for example, not being able to access CSCI reports or reports when an organisation has changed hands – as was highlighted in the programme) is a big issue. As members of the general public, we can determine how useful or not historic information is but we have to have access to it. More information is better.

Reports need to be very easily understandable and clear about what is expected and what good and bad care look like. They are better than they were. People liked star ratings because they were easy to understand. They were abolished but the star ratings remained on the website for a long time afterward which was poor information in the extreme. While the government excellence scheme was shelved, I think there’s a real desire for people to have an understanding beyond a care home being compliant or non-compliant – people want to know if St Matthew’s Home in Hull is better than St Francis’ Home in Bridlington and a TripAdvisor type comment site won’t always provide an independent and authoritative understanding of that. I’m not sure if it’s the place for the regulator but it was in the past and understanding what good care looks like as well as bad is something that Behan, the new CEO of the CQC has stated he wants to work on.

The footage of Cynthia Bower at the select committee was positively painful and her links with Mid Staffordshire made her a particularly poor choice of CEO initially. They could never establish any credibility in the sector with that background and proved that she was not up to the task. The only concern was how much damage she did in the meantime.

I do have more hope with the new CEO, David Behan and some of the changes that have taken place but the programme showed the need for a strong and authoritative regulator within health and social care.

The problem is that all these cuts happened in the regulator as commissioners like local authorities were hammered by substantial cuts which – certainly in my experience –  have seen monitoring units slashed. You see the monitoring teams – they were the so-called ‘back office’ which were cut but the input that had on day to day care is significant.

The only way forward is for commissioners (local authorities/NHS and yes, private funders), regulators and providers to work very closely regarding responsibilities and tie information in with each other but most important to make that sure those who use the services and local communities, families and advocates can understand and know cohesive lines of communication with organisations responsible for developing and regulating good care.

It doesn’t help for organisations to be siloed when life is more complex and while I would never want to absolve those government bodies like the CQC of their responsibilities, I think the structures and information streams need to be better regarding lines of responsibility.

If the organisation isn’t able to do its job properly due to cuts, it needs to return to the government and tell it.

I have become more hopeful that there will be a change in culture in the regulator with a change in leadership. Use of more and more ‘experts by experience’ and experienced specialist professionals in inspections is also a positive move but it’s not good enough to stand still.

As Barbara Young said in the programme, the CQC needs to the a regulator for people and particularly for people who have their voices quietened by organisations which can display power in terms of delivering care. It isn’t good enough to rely on families complaining as many people in residential services don’t have families who visit. Proactive regulation needs to happen alongside proactive safeguarding investigations by local authorities and proactive monitoring. Organisations which provide care can’t resolve their own responsibilities to provide quality care. If money is cut by local authorities, it has to be challenged and challenged hard before quality slips rather than afterwards as an excuse.

There is room for hope though. I do think the CQC consultation is positive and the move towards regular unannounced visits is a good one. It should never have been otherwise but we can’t change the past.

If we want a regulator that works, it has to be given the tools and the resources to regulate in a way that we want and expect it to. That costs. So be it, it is a necessary cost.

I want a responsive, responsible, proactive and mostly a listening regulator. I’m willing to give them time seeing that some progress has been made, but there really does need to be a change noticed in the reports that feed back to Parliamentary committees and published reports next year.

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5 thoughts on “Exposure and the CQC

  1. Personal experience and conversation with a CQC inspector has been telling. They undertake rather light touch ‘monitoring’. Only 20 out of a possible 600 clients/family interviewed for a care agency with recent ‘history’. It was intimated that they cannot be too critical and close agencies down because there would be not enough people left doing the job! They tend to look at whether the right policies and procedures are in place- we know that says nothing about anything.

    Curiously when sent detailed information about a care agency with a serious negative history resulting in loss of a significant local authority contract / funding, there response was nil.
    This agency made the national press, but managed to keep things quiet; the same director remains- just seem to have changed management committee at the time. Proof is available that the staff of this agency can seriously lie and cannot be trusted- but who cares, neither the CQC or the local authority the agency went for an alternative contract, providing it with replacement significant contract funding. The agency continues to highlight the 3 star rating long abolished on its website which it managed to get inspite of its history, (also seriously misleads on other matters, but CQC ignores).

    No wonder there are problems- these will not go away unless all information known is in the public domain- for them to judge and choose the best managed agencies they can trust.

  2. Hi,

    I work on the CQC website and would like to hear a bit more about your specific experience around search and usability. We’re always keen to make improvements and are in the middle of some work on search right now.

    It might also be of interest that we will shortly be adding deregistered services (and their inspection reports) to the website.

    Thanks.

    Owen.

  3. I made a complaint to cqc about financial abuse. that was proven. after inspection from cqc,
    i was told they would monitor the situation,the abuse was transferd to another client.ive been moved from service to service,the abuse is still going on.im being victomised for reporting abuse.im going through greivence procedure.but the abusers go about there daily duties .cqc
    there a joke

    • You should report it to the local adult social services dept if you are aware of any abuse. They will be in a better position to investigate than the regulator and I would say it’s important you do so.

      Good luck

    • The CQC should keep records of care institutions failing to deal with these issues… but then it too has done some things that were not ethical it seems.

      The local authority too will often not do much with care homes / agencies they pay a pittance too- they need them on side…so it goes and and exposers/ whistle blowers are deemed trouble makers.

      As I have stated before safeguarding work is becoming a cruel joke.

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