August 15, 2022
Article
The last few years have seen substantial changes in how health and care is regulated. The pandemic forced the CQC to move away from routine inspections, with hastily-prepared alternative models of regulation seeking to identify providers of greatest concern at the expense of broader scrutiny and an up-to-date view of the quality of services across the sector. With those models now gone Carl May-Smith, partner and barrister at Browne Jacobson, shares his thoughts on current trends in inspections.
One of the headlines in the CQC’s strategy for 2021 and beyond was a desire to increase the standards expected for care to be classed as ‘Good’. From our recent experiences, this direction of travel has already begun to affect provider ratings. Inspection reports that would have produced overall ‘Good’ ratings previously are now attracting ratings of ‘Requires Improvement’. 44% of the overall ratings given in the last month were ‘Requires Improvement’ or below, compared to 14% of the most recent ratings over all services. This is something that lenders, insurers and investors will need to bear in mind when comparing more recent ratings with previous expectations.
Are there other factors driving the increased proportion of lower ratings? One key factor is almost certainly the way that the CQC is prioritising inspection activities. It is focusing those activities predominantly on services where there are concerns. This not only means that they are more likely to be inspecting lower-quality services, but also that inspectors’ initial approach is likely to be a sceptical one. Services where there are no concerns, even those with lower ratings that may deserve improved ones, are waiting a very long time for inspections despite the CQC’s aim to address the issue.
Other factors may include the fact that relatively little allowance appears to be being given by the CQC for challenges that arose during more intense periods of the pandemic, particularly where providers are still in the process of addressing staffing shortages, backlogs or the reintroduction of services.
There is also a need for providers to adapt to the CQC’s new priorities. Greater emphasis on people’s experiences of care has not yet been matched with a broader or more methodical approach to collecting feedback. The result is that one negative account can have a disproportionate effect on inspection outcomes. Providers can protect themselves from this by being proactive in collecting feedback from people using the services and their families.
The management of Covid risks has moved on from some of the more detailed national guidance to a period where decisions around management are expected to be much more service-specific. The CQC may identify an additional risk within a service and challenge providers to show that it has been addressed, even where that means considering going beyond the requirements of any national guidance.
Services have innovated, adapting to changes in the care environment and staffing shortages, along with other challenges. Where successful, this has been achieved without any detriment to outcomes. However, the CQC’s aspiration to benchmark providers against other similar services remains just that. For the time being services will still be measured against their own internal aspirations. Where adaptations have been necessary, it is vital that is reflected in written policies and procedures.
Carl May-Smith can be contacted at carl.may-smith@brownejacobson.com, telephone 0115 934 2024. https://www.brownejacobson.com