Adult social care services would be inspected at least once a year under Care Quality Commission plans to call time on “light-touch” regulation.
The plan, revealed exclusively to Community Care by CQC chief executive Cynthia Bower, comes on the back of a sharp drop in site visits in the past year, because inspectors were diverted into the regulator’s programme of re-registering all providers.
The shift also follows concerns over the CQC’s ability to protect service users given its failure to follow up on a whistleblower in the Winterbourne View abuse case.
Currently, services are inspected at least once every two years.
Bower said that the CQC had favoured a “proportionate, risk-based, light-touch” approach to regulation – in which services were left uninspected for up to two years in the absence of issues coming to light – but service users, providers and staff favoured more inspections.
“What people want, particularly people who use services, is for us to put our boots on the ground,” she said. “Inspections are a really positive quality assurance for providers.”
However, implementing annual inspections of all health and social care services later this year, as planned, would require the Department of Health acceding to CQC’s request for a 10% boost to its budget next year.
This would enable the regulator to increase its complement of inspectors from 855 posts – about 15% of which were lying vacant as of early June – to about 1,000. Bower said she wanted staff to have a “manageable workload”, and also wanted to use more service users and specialist practitioners in inspections.
Bower said the “light-touch” approach sprang from the CQC’s resources – its budget at its inception 2009 was athird less than the three inspectorates it took over from had in 2006 – and the then government’s emphasis on cutting red tape for business.
However, this was compounded by what Bower described as the “dreadful process” of having to re-register 12,000 adult care and independent providers – delivering services from 23,000 locations – under the Health and Social Care Act last year.
Inspection of adult care services plummeted by 70% from October 2009-March 2010 to October 2010-March 2011 due to the impact of registering adult care and independent health providers. There were 518 inspections of adult care services in March 2011, and though this figure has increased in subsequent months, delivering annual inspections would require at least 2,000 monthly site visits.
“It took up a lot of staff time; we did see the number of inspections go down radically as we had to pull the inspectors in to do the work on registration,” she said.
The regulator still has to register some 8,000 GP practices, but it has called on DH for this process to be delayed from April 2012 to April 2013 to allow its annual inspections approach to bed in.
On its bid for more funding, she said: “The [DH is] sympathetic but they will expect us to make a case.”
Bower denied that the CQC’s failure to respond to Winterbourne View whistleblower Terry Bryan reflected its light-touch approach.
Rather, she said, a staff member made the “wrong call” by not triggering an inspection of the learning disability hospital on the basis of Bryan’s testimony.
Learning disability hospitals in general were not inspected at all from October 2010 to January 2011 as a result of registration, but Bower admitted they needed “extra vigilance” compared with other services.
“These are places that are inherently risky and they need to be treated with more vigilance.”
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