Have your say on care provider inspection frequency

The Care Quality Commission (CQC), the English health and care regulator, is currently running a public consultation on how providers of services are assessed during an inspection in order to award their ratings of Outstanding, Good, Requires Improvement or Inadequate.

We will be submitting an organisational response, based on the suggested changes and their impact on the people we support, with the input of our Lived Experience Group. The consultation covers many topics, such as training for inspection teams, moving to sector-specific frameworks, and using ratings characteristics.

There are some positive changes suggested, such as making inspections for care homes unannounced by default, which we have been calling for for many years, including in Our Vision for Social Care.

However, we have significant concerns about the proposal in the consultation that routine inspections generally occur every 3-5 years. The consultation also mentions that there will be rapid response inspections, but without detail of how these will be triggered, we still think this will leave a significant gap in oversight that could allow poor care to go unregulated.

The consultation also suggests that the they would not expect to look comprehensively at every area of every service or cover every part of the assessment framework every time they inspect a service. This means that some parts of a service may not be assessed for ten years at worst.

Inspections are vitally important for understanding practice on the ground in care settings. The regulator has a vital role to play in providing accountability and a route forward to address poor care, and inspections occurring with several years passing between them will leave people at risk.

CQC will not get a full picture from relying on intelligence being raised, as often there are barriers to reporting information, especially for people in residential care settings. When those settings are small or there is existing complaints or challenging relationships, reporting to the CQC could make the person identifiable and at risk of reprisals. Our research found that 56% of those who had witnessed poor care in a care setting did not report it to the CQC. We support people every week on our adviceline who are facing visiting restrictions or eviction notices as a result of complaining about poor care.

Not looking at every area of a service during an inspection misses one of the only opportunities to ensure a high standard of care that is necessary for promoting safety and wellbeing. Additionally, if care providers are rated based on different areas, there will be no consistency in approach meaning those who are looking to CQC ratings in order to choose a provider, will not be able to make fair comparisons.

We also know that there has been a precedent of inaction despite receiving intelligence about poor care, where we’re told that the information submitted isn’t enough to meet the threshold of concern. These cases often describe systemic issues that are caused by things like staffing pressures, which will affect multiple people. Not everyone will have an advocate in their corner, or may not understand how to report things to the CQC, when many of the loved ones of people in care are also older, or with their own disabilities or communication challenges.

The people who would be most affected by inspections occurring this infrequently are unlikely to be able to engage with a public consultation like this one.

If you share our concerns about this proposal, we would encourage you to respond to the consultation before 5pm on 11th December. You do not need to answer every question. We would suggest you respond to question 6 if you are addressing the proposals described in this article. If you don’t feel confident responding directly, you can contact us and we can include your feedback in our response.