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Major questions over performance of the Care Quality Commission

If you’re hoping that the Care Quality Commission in England might help you to achieve better care for your family and friends, you may be disappointed.

On the same day that the BBC releases a report showing apparently poor care in many homes across the country, a report from a law firm argues that the CQC is facing challenges that could significantly impact the health and social care sector.

The BBC notes that nearly one in five care homes across England are currently rated as either ‘requiring improvement’ or ‘inadequate’. Common themes in struggling homes included gaps in staff training, mismanagement of medicines, lack of accurate records, facilities not meeting safety and cleanliness standards, residents’ rights to privacy and dignity not being upheld, and poor management oversight.

CQC in turmoil

The care industry is overseen by the Care Quality Commission, which inspects and assesses the provisions of care across the sector, including care homes. The report from Bevan Brittan says that recent events at CQC have highlighted that this is an organisation in turmoil. And that could well mean that assessments are out of date or not available at all – and therefore as good as meaningless for potential service users.

According to the report, the interim CEO has admitted that the way the organisation is working is not working, and it is not consistently keeping people who use services safe.

Furthermore, a report to the Board in May 2024 noted that the CQC was exceeding its tolerance on a number of measures, such as productivity of its workforce and making timely, accurate assesses on quality of care and risk.

Registering new services

Historically CQC has had a guidelines of processing applications of new service providers in 10 weeks. In March 2024 the number of applications taking longer than 10 weeks had risen to 54%, and can be as much as six months, says Bevan Brittan. This is not just an issue for those seeking care, but also represents high costs for care providers who are asked to have all the locations and staff ready to provide services before making applications.

Inspection and assessments

Bevan Brittan has previously expressed concern about the quality of CQC’s new assessments processes under the Single Assessment Framework (SAF). Now it is worried about assessments happening at all. Only 6,970 inspections/assessments took place across the whole sector in 2023/24, and the numbers are falling.

Updating rankings of existing services

One of the aims of moving the SAF was to move to more ‘dynamic’ regulation, with more meaningful ratings giving an up-to-date and accurate picture of quality. Currently though, out of a total of 23,965 locations with published ratings, over 50% had their most recent report published in 2020 or before.

Services stuck in ‘requires improvement’

Because it is taking such a long time to re-inspect services, many are stuck in the ‘requires improvement’ category, despite having long since addressed the issues. There are 3,918 services rating as requiring improvement across all adult social care locations, but over 2,000 of those had rating awarded in 2022 or before.

Assessment of newly registered services

In the adult social care sector alone, there are currently 5, 133 locations that do not yet have a CQC rating, with over 2,000 of those registered in 2022. CQC is also still unclear about how often assessments should take place.

 

The good news is that there is a Cabinet Office review in progress, which may report with positive steps to take to make CQC more effective and supportive of safe care.

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