This briefing is focused on residential care providers and explores the key trends in the sector, supported by commentary from experts where appropriate.
A New Approach to Inspecting Social Care Services In this briefing we want to zero in on the future of care. Although the Care Bill will undoubtedly shape the strategies and structures of the health and care sectors, demand will always take the lead in how people are cared for. Certainly, a closer relationship between health and social care will help to meet the demand in a more efficient and effective way but perhaps the biggest impact on providers and practitioners will be created by the way in which their services are regulated. CQC call this ‘A Fresh Start’. This is a fresh view of regulation no doubt encouraged by the fallout from Winterbourne View, Mid Staffs and other alarming scandals, public demand for some sort of rating system and their misguided perception that most of the care sector provides poor care. So, let’s take a look at what is being proposed, what the consultation produced and think about the impact this may have on providers.
The Key Changes The headline change is about developing a rating system which will look at whether a care home is Excellent, Good, Requires Improvement or is Inadequate. In order to develop a robust system, CQC recognise that they will need to be much smarter about intelligence gathering. In their document they say a lot about placing greater store in what other people say about providers. The better the rating the less frequently the provider will be inspected. A specific target of March 2016 has been set for implementing this.
Secondly, they propose bigger inspection teams with specialist knowledge and the use of Experts by Experience.
Thirdly, inspectors will concentrate on the five domains: whether the care provided is safe, effective, caring, responsive and well led, with a bottom rung consideration of the fundamentals of care, as they describe them. Failures in any domain will see much tougher action being taken.
Further down the list are a range of proposals and aspirations which will need much wider and deeper debate:
– monitor the finances of 50-60 care home providers that would be difficult to replace if they were to go out of business (subject to the Care Bill becoming law).
– take tougher action on services that do not meet standards, particularly those that do not have a registered manager in place.
– check that services that are applying to be registered have the right values, motives, ability and experience to provide care to people.
– discuss the risks and potential benefits of mystery shoppers and hidden cameras to monitor care, and whether they could contribute to promoting a culture of safety and quality while respecting people’s privacy and dignity.
– encourage residential homes to get more involved in their local community.
– work with local Healthwatch to get its views on care homes in the community.
What the New Start consultation produced Well, something of a mixed bag from those who participated. Overall, the proposed changes were welcomed, particularly recognising that different specialisations need to be differentiated and inspected by the specialists in those areas. The five domains are seen as softer but more appropriate expectations rather than the harder style seen in the Essential Standards of Quality and Safety. The rating system will be welcomed back after having had a 3 year break but a lot of work will need to be done to define and understand the difference between ‘requires improvement’ and ‘good’. Introducing a duty of candour into the care Bill was also well received.
Participants were less convinced about how the fundamentals of care can be defined in a way that the public can understand and whether they are relevant to all social care provider disciplines. The rating definitions also caused some disquiet and linked to this, the frequency of inspection being reduced, the better the rating.
Finally, participants were concerned that much greater clarification is needed in a number of areas before a considered opinion can be given. These are centred round the weighting given to intelligence gathering against the inspection judgement (this includes feedback from service users and relatives). People noted that commissioners are not subject to regulation and inspection and since they hold the purse strings the link between quality and cost cannot be established.
What is the impact? There is still a long way to go and a massive and wide ranging suite of consultations before any of the above is put into practice. The trick in business terms is about anticipating the inevitable changes to regulation and responding to the planned tougher line on noncompliance by preparing financially for the cost of change. There will definitely be a cost, particularly in the area of adapting quality assurance and audit processes from the compliance based approach towards evidencing how providers meet the 5 key questions about care. Changing cultures in the workforce could add an additional training burden at a time when funding is diminishing. On the other hand, opportunities will arise with the rating system. Not only will this provide a built-in incentive to deliver good quality care but also deliver ‘free’ advertising to attract new customers.
What is the bottom line? We would say that wouldn’t we, but we have a common purpose to improve it. We see the care sector as highly specialised businesses and work hard to make sure we understand its peculiarities so we can support businesses better.