In a timely moment (although possibly not for the CQC), the National Audit Office today publish a report into the workings of the Care Quality Commission (CQC). Yesterday the Public Inquiry in Mid Staffordshire wound up and before looking at the NAO (National Audit Office) report, it’s worth pulling a few quotes from the summing up in the inquiry as they make pertinent points.
The issue of what counts as an ‘inspection’ of a service
Right, so an inspection doesn’t mean what members of the public might think of as an inspection. It may simply mean looking at the systems and the paperwork; is that right?
”Answer: It may.”
This should be borne in mind when the CQC parade their ‘inspection’ figures around. An ‘inspection’ can be a form that is sent out to the provider for them to complete themselves.
It was also stated by the CQC that
“Firstly, I would say that, given the scope of
organisations that the CQC regulates, it’s simply not possible with the resources available to have sufficient inspectors who are experts in each type of organisation.However, the inspectors are professional regulators.”
So there we have it. The people inspecting services aren’t necessarily experts in those services. Is that really too much to ask? While the use of ‘experts by experience’ is useful, wouldn’t you demand that a nurse or trained medical professional inspects a hospital? Or that a social worker or care professional or registered home manager inspects a care home? As an aside, I looked at the last job adverts issued by the CQC because I was curious and no professional qualification was demanded. It looked like they wanted more financial auditors than professionals with hands on experience of care or health settings.
But back to the NAO report and at this point, I’m just going to look at the headline points in the introduction due to my own time constraints but I will read the report in full over the weekend to see if I can find more hidden nuggets!
The summary points provided in the introduction explain that the CQC is the third regulator of both health and social care services but the first to cover the two jointly. This chopping and changing is – as I know from bitter experience – is both unsettling to staff and confusing to the public and users of these services.
- More services are going to be brought into the remit of the CQC when really, it can’t manage the work it is currently doing. But I guess as it is appointing professional ‘regulators’ rather than professionals with specialist knowledge of the sectors, it will just provide a couple of e-learning modules and whoosh, your inspector is suddenly an expert.
- The public do not know what the CQC is supposed to deliver. I suspect the CQC does not know what the CQC to deliver. What do I want the CQC to deliver? Effective regulation which does not need to rely on BBC Panorama programmes.
- Budgets fell. The CQC has a smaller budget than the ‘predecessor’ bodies. The problem is that the leadership in the CQC were too heavily in the pockets of the government that they accepted what was thrown at them rather than admitting they just couldn’t do the job. BUT the CQC also underspent its budget in the past two years due to staff vacancies. Why so many vacancies? I would guess that there’s a reasonable amount of staff discontent and roles being left that cannot be filled. Interesting in the light of the evidence to the Mid Staffordshire Inquiry which explores the internal discontent in the organisation.
- The CQC had to prioritise registration over compliance and figures for compliance visits were down to 47% completed. Compliance – that’s when the providers are re-checked. That wasn’t prioritised. The CQC is spread too thin. It is unable to do its job and it pretended it could.
The report states that
‘although regulation is being delivered more cheaply, the Commission has not so far achieved value for money in regulating the quality and safety of health and adult social care’.
Some suggestions are given in the report but for me the issues are as follows
- The CQC and her leadership over-promised
- Staff shortages possibly led by more people leaving than posts that could be recruited into
- Focus on ‘professional inspectors’ rather than ‘professionals with experience of the area that they are inspecting’.
- a sheer lack of knowledge and understanding of the sector
- not inspecting the ‘important’ things – too many desk-based inspections and checking paperwork and filling in forms which some provider organisations can become very good at – at the expense of face-to-face meetings, using appropriate communication skills to gain feedback from particular user groups, digging deep to find out what is happening in a service rather than basing inspections on superficial information handed to them.
- Lack of inspections ‘on the ground’
- Reactive responses – yes, the CQC say, NOW they are going to get better and do more. I still want those responsible for not doing what they should have been doing and taking misdirected managerial decisions over the last two years to be absolutely held to account.
And one personal plea
The website – oh the website. It is an inaccessible mess. I want whoever is responsible to think – if I were placing my parent in a residential home, what information would I need and how would I want it presented.
The website seems to be becoming more difficult to find the necessary information on each time it changes. Yes, I’ve sent feedback but – true to form – they only ask for feedback AFTER they have made the changes!
I’d like the inspections to have stronger links with localities. I used to know the inspectors of the services in our areas. We could phone them up in their offices. All inspectors are now home-based and it can be more difficult to make contact and raise concerns. If one inspector isn’t available there is rarely someone else who knows the service.
The last time I rang an inspector to discuss a service I had concerns about it was one they had never actually visited.
Perhaps I expect too much from them but it’s worth remembering that much of the local authority monitoring teams have been decimated by cuts – no one is checking these services in lieu of the regulatory bodies and in a dog eat dog world of private sector companies biting for pieces of the financial pot – it is important there is someone ‘on the ground’ to check they are doing a good job – for those who are not able to shout loudly for themselves. Now, that doesn’t need to be the CQC – it could be a strengthening of those local authority monitoring teams but it seems to have been passed between the two so we, as the public, need to know what the minimum standards are and how they are enforced and checked and by whom. That has not happened.
As for blame, the CQC leadership and management is where I place it – not with the employees and the inspections. The leadership who over promised and tried to paper over cracks. I want things to get better and all these reports and attention will ensure that is it although I am still very uncomfortable with ‘professional regulators’ as a group rather than those with recognised substantial experience or a professional qualification in the area that they are inspecting.
Where do we go from here? I expect an over-defensive and reactive response from the CQC will be available shortly. I would prefer an honest endeavour to make things better in the future and an acknowledgement of mistakes made in the past. Honesty helps. It feels as if we have had no honesty from this organisation to date.
Zarathustra
December 2, 2011
If they’re having trouble working out who to recruit, might I suggest the following interview technique?
Ask them to repeat the words “desk-based inspection”. If they can say it without rolling on the floor laughing, don’t hire them.
Joanna
December 2, 2011
Good grief it’s not for purpose.
Hungary are criminalising being homeless now, perhaps we won’t be far behind in any complaint of abuse/neglect of patients made by patients/relatives/professionals being an offence. How little human life is worth
Joanna
December 2, 2011
Have they been bought off but without the money, everywhere else appears to be:
http://www.guardian.co.uk/society/joepublic/2011/nov/30/mental-health-discrimination-campaign
Claude Gillespie
December 2, 2011
We need someone to unleash an angry walrus on them. Something has to be done. We are not protecting the vulnerable
guiltycommissioner
December 8, 2011
Don’t blame the inspectors. The ones I know were deeply upset about the shift from inspection to ‘compliance’ – never quite got that, myself. Quite a few older experienced ones took early retirement. I hear that recently there has been a shift back to hands on inspection – sadly it took Winterbourne to wake up CQC senior management and realise that superficial.
Compliance/paperbased regulation is largely useless. Local authority contract compliance is the same – heavily policy and procedures based – when it is not unusual for a home with fairly minimal paperwork to provide superb care whilst ones with highly elaborate combinations of checklists and audits to have the worst. The truth being that such hyper managerialist solutions have been brought in to counter the inevitable effects of hiring minimum wage staff and working them into the ground. Local authorities and finally central government are to blame for paying pitiful inadequate ‘base rates’ for 24 hours skilled care placements that amount to less than a Travelodge room. I predict we will soon see a return to the bad old days that many will be familiar with, of avoiding sending sheets to the laundry, poor cheap food and staff doing double shifts to make a living wage. If, that is, it is not here already.