CQC’s function is to inspect health and social care settings, to encourage improvement and take action where failings have been identified. The size of the task that they undertake is large and progress as against its function is predicated on the ability to objectively assess each provider on their merits or otherwise.
The report conducted by the National Audit Office in October 2017 reads well and provides a balanced critique of CQC’s operation. The report commends the Commission on reducing its staffing vacancy rate, taking enforcement action more frequently, encouraging improvement upon re-inspection and working better within a reduced budget. Much like CQC’s own inspections of providers the negative findings do outweigh those positive findings in the report; although interestingly this report focuses on those areas that it might improve- quite unlike some CQC reports which appear to place emphasis on failings.
CQC’s function to encourage improvement is not something which it is actively engaged in at an adult social care level. Its only encouragement for such providers appears to be the stick of low ratings and potential cancellation of registration. NHS Improvement’s support of failing providers where an underperforming provider is paired with a higher performing provider is something which has the potential to bear fruit in the adult social care sector though it is not something which is being mooted at the point of writing.
Returning to the report the most profound failing identified, but not amplified, in the report is the concern that some have around the inconsistency of reports. The report states that: “The majority of stakeholders that we interviewed raised concerns about the inconsistency in the Commission’s regulatory judgements.” It is clear that there are real concerns with the way in which some inspections are carried out and concerns were raised by staff within CQC and providers. Inspection reports are only as good as those that carry out and draft the reports. This is not an issue which affects the entirety of inspections that CQC carries out; it is arguable that it has a disproportionately damaging effect on those providers that find themselves at the end of an unbalanced and unfair inspection.
Looking at a national perspective on providers who have achieved good ratings does little to placate the provider that finds itself with an inspector who requires improvement and places disproportionate emphasis on findings on the day of the inspection. CQC’s safeguards in place to combat the inconsistency of report findings involve inspector team training and reviews of reports; however for adult social care such reviews only take place for homes rated outstanding or inadequate. This leaves those homes rated Requires Improvement or Good with little additional oversight outside of the established factual accuracy response process.
Such great reliance is disproportionately placed on the ratings of inspection reports by all stakeholders in the provision of care that the integrity of those reports where subjectivity and bias is alleged should be rigorously challenged. The key tool in the provider’s toolkit is evidence and accompanying representations to refute and challenge those observations made. Providers should engage with the inspection process and act swiftly on receipt of the draft inspection report to provide robust representations which accurately portray the provider’s position.