Providers need to be alive to the risk of contractors becoming insolvent and how to limit the resulting inevitable disruption.
The report, dated 13 October 2017, looked at most of the CQC's regulatory activities, but focused on how well the regulator was performing regarding its core functions of registration, monitoring, inspecting and rating, as well as responding to concerns, and taking enforcement action.
It also reflects that the number of completed enforcement actions increased over 2015-16 and 2016-17, whilst interestingly, the number of providers entering special measures remained steady.
In short, the report concludes that since NAO’s inspections in 2011 and 2015 the CQC has improved in its effectiveness, but there remain issues that the regulator still needs to address.
Regarding Registration, the NAO reported that the CQC aimed to inspect 100% of all newly registered locations of adult social care (in 2017/18) within specified time limits based on the date of registration. These are as follows:
|Registered||First Inspection Target|
|If registered between 1 October 2014 and 30 September 2015||Within 2 years (max)|
|If registered between 1 October 2015 and 31 March 2016||Within 18 months (max)|
|On or after 1 April 2016||Within 12 months (max)|
In the first quarter of the reporting period, 94% of adult social care providers received a first inspection on target, and so the CQC is already a little behind its target.
The CQC has undertaken 21,176 inspections of adult social care providers in the first quarter of 2017-18, and the outcome is as follows:
It is heartening to see that this clearly shows that the majority of health and social care providers provide good care (despite reports to the contrary in the press). It is also interesting that the same number of providers are noted to be ‘inadequate’ as are found to be ‘outstanding’. We know that providers have complained for some time that “outstanding” ratings appear to be unachievable in some geographical areas and if a provider does achieve “outstanding” ratings they are extremely difficult to maintain, with providers sliding towards “good”.
The NAO found evidence that between 2016-17 and the first quarter of 2017-18 there were 5,750 re-inspections and most providers improved their rating, which indicates that the CQC has encouraged real improvement in the sector. For adult social care 51% improved, 43% remained unchanged, and 7% worsened. However, it should be noted that those that declined include services that had previously achieved an ‘outstanding’ rating.
One of the main points of interest for adult social care providers will be that the audit has revealed concerns raised by providers around CQC’s inconsistency in making regulatory judgements. The NAO received examples of individual inspectors being subjective or inconsistent. Stakeholders questioned the consistency and profile of ratings within and across sectors. This will come as no surprise to our clients who often find that they received different ratings for the same Key Lines of Enquiry when there was a generic approach. To address this, the CQC is implementing specific measures such as training for inspectors. Each inspection directorate is to have its own quality assurance process for the review of reports and findings and a “quality framework supported by a quality sampling process” is to be implemented. It is not entirely clear what this means in practice, but we hope that it will mean more consistency in approach.
The report makes a number of recommendations to the CQC related to these issues. For example, they have asked CQC to assess how inspection staff engage with other local stakeholders, to review the activities it currently uses to test and demonstrate inspection approaches and judgements, and set out how the CQC will obtain assurance that its inspection staff are taking appropriate decisions about regulatory action in response to intelligence.
We hope that this will not mean that professional judgement will not be engaged but that there will be a more slavish approach to investigations and reliance on checklists.
We know that the CQC plans to change the frequency of inspections for adult social care providers; the proposed frequency changes are:
|Outstanding||3 years (max) by 2019-20|
|Good||2.5 years (max) by 2019-20|
|Requires improvement||1 year (max)|
The NAO report also highlights that the CQC needs to address the persistent issues with the timeliness of some of its regulatory activities. It has warned that the CQC’s aim to base more of its activities on intelligence and risk-based information will introduce significant challenges. It is vital that the CQC’s digital technology and systems are up to the job and that it is efficient in its collation and sharing of information whilst at the same time, maintaining a level of flexibility.
In addressing these concerns and adopting the proposed strategies we think that there will be increased pressure placed on adult social care providers in the short term. It is inevitable that if the regulator is criticised for not hitting targets, this will cascade down to providers. We are seeing an increase in the issue of penalty notices with the invitation of acceptance of “fines”. There has also been an increase in requests for large amounts of information to be provided in a format imposed by the CQC. However, responding to submissions about these demands is taking an inordinate amount of time leading to periods of uncertainty for providers.
If the strategies proposed can be implemented and a more consistent approach to investigations and ratings is adopted, adult social care providers should see an improvement in the way they are regulated in the long term. However, with a decrease in its budget and the number of identified shortcomings, it will be interesting to see if the CQC can implement all of its proposed actions and catch up with the remaining work.
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