Some incidents are unavoidable in care settings, but which ones must be reported to the Care Quality Commission? Vern Pitt reports
Last month, the Care Quality Commission threatened provider Castlebeck with legal action for failing to notify the regulator of a series of incidents at Winterbourne View, the Bristol learning disability hospital at the centre of an abuse scandal.
Arguably, reporting these incidents could have led to swifter action to address the alleged abuse at the hospital, though the CQC has been criticised itself for failing to respond to whistleblower Terry Bryan’s reports of problems at Winterbourne.
The CQC’s threat of action, which could lead to Castlebeck being fined, highlighted the duties on care providers to tell the regulator of specific incidents or changes that occur in their services.
The system for notifying the CQC changed last October when the new regulatory regime under the Health and Social Care Act 2008 kicked in, and some providers are struggling to adjust.
“Instead of a single form we have a range for a number of incidents. It’s more complex,” says Ginny Storey, head of governance at housing and care provider Anchor.
She says she can understand how the changed system enables the CQC to collect more relevant and detailed information, but points out that service managers can struggle with the system.
Another issue is that reporting of information is duplicated. Colin Angel, head of policy and communication at the United Kingdom Home Care Association, says some incidents now need to be reported to the Health and Safety Executive and the CQC. It is easy, he says, to see how some providers believe they have already done enough if they have told one of them.
“Some incidents occur infrequently and providers may not remember that it’s reportable,” says Angel, pointing to another reason providers struggle with reporting requirements.
However, Storey argues that it is a cop-out to blame regulatory barriers if providers fail to fulfil their legal duties. Although the system is complex and can be challenging, especially for smaller providers which may lack dedicated staff expertise, it is navigable with the use of the CQC’s own published guidance, she says.
But the CQC’s failure to respond to the whistleblower in the Winterbourne View case may do little to help remove another barrier to providers reporting incidents.
“I expect there’s a lack of understanding about why the regulator would want this information but also a lack of confidence that returned data is analysed adequately by CQC,” says Angel. “The CQC may have systems in place but that’s not necessarily obvious from the provider’s viewpoint.”
● Providers’ reporting duties are set out in the CQC’s Essential Standards of Quality and Safety
THE SEVEN REPORTING REQUIREMENTS
1 Abuse or allegations of abuse
Providers must tell the CQC of any allegations of abuse in their service. This requirement is tied to the need for providers to ensure they are safeguarding their service users.
The regulator’s essential standards of quality and safety say only that allegations must be reported to the “appropriate authority”, so it is possible for providers to erroneously believe a referral to the local authority in its safeguarding capacity may be enough.
However, the CQC has responsibility for ensuring service users’ safety, so it too should be informed.
2 Serious injuries
The CQC defines a serious injury to a service user as one that: permanently impairs their sensory, motor or cognitive functions; or causes prolonged pain; or changes the structure of their body; or shortens their life expectancy. Broken hips are a common injury in care settings, for example, and should be reported.
The requirement to notify the regulator about all accidents was removed under the regulatory framework brought in by the Health and Social Care Act 2008. Now a judgement is required from providers on whether an accident has caused serious injury.
3 Applications to deprive a person of their liberty
Applying to deprive someone of their liberty for care and treatment under the Mental Capacity Act 2005 is complicated enough.
In addition, simply making an application and undergoing the process should provide safeguards for the service user involved. However, it must also be reported to the CQC.
This is one area where the benefits to providers of reporting are not obvious. The gathering of data by the CQC is more oriented towards informing policy development, although this may in turn inform practice in future.
4 Events that prevent or threaten to prevent the registered person from carrying on an activity safely and to an appropriate standard
When handling a flood, fire or financial crisis in a service it is unlikely to be at the forefront of managers’ minds that the CQC must be told, but that is the duty. Importantly, the CQC can play a role in helping to find alternative services or accommodation for the service users.
Recently the CQC has readied itself to play a consultative role in the possible move of people from Southern Cross homes after the company’s collapse.
5 Deaths of service users
Larger providers will almost certainly have their own mechanisms for monitoring the deaths of people in their services, with the aim of picking up any problems. However, all providers must report deaths without delay to the CQC for monitoring. Notifications must not identify the person but refer to each using a unique code, which must be recorded by the provider for future reference.
The information can help providers benchmark themselves against others. They can also provide quality assurance for smaller providers which may not routinely collect this information themselves.
6 Incidents reported to or investigated by the police
This is one area where providers can often think that they are already dealing with the relevant authority. However, the police and Care Quality Commission do not have a system to share details of all incidents reported or investigated by the police. So the onus falls on the provider to forward the information to the CQC.
It is advisable for providers to notify the regulator of all incidents no matter how innocent or small, in order to avoid jeopardising their registered status.
7 Unauthorised absences
Recording absences of people detained under the Mental Health Act is a longstanding duty the CQC inherited from the Mental Health Act Commission. Though it should prove simple for providers, the management at Winterbourne View failed to do so four times. No explanation was given for this specific breach by Castlebeck.
Because unauthorised absences of this kind are most likely in secure settings, providers may see them as failings they are reticent to advertise to the regulator, especially if no harm came to anyone.
Winterbourne View incidents went unreported
Care Quality Commission inspectors descended on Castlebeck’s Winterbourne View hospital in Bristol after BBC Panorama exposed alleged abuse in May. They found that the hospital, which is now closed, was failing to meet 10 of the 28 essential standards of quality and safety.
Inspectors said Castlebeck had “misled” the CQC by failing to notify it of serious incidents it was under a duty to report. These included four separate incidents of people detained under the Mental Health Act absconding and incidents of physical violence.
“Had we been told about these things, we could have acted earlier,” said Amanda Sherlock, CQC’s director of operations, who added that the regulator was considering legal action.
In response, Castlebeck chief executive Lee Reed said: “As soon as the company was made aware of the appalling misconduct of staff at Winterbourne View, we alerted the police and other relevant authorities.
“We then took immediate remedial steps to safeguard the welfare of all our service users. This work is ongoing, and is our absolute priority.”
Inspecting the rest of Castlebeck’s facilities in England the CQC found major governance failings. There was little accountability at senior level for the operation of services and managers were moved from one service to another without notifying the regulator, another requirement.
Reed has initiated an overhaul of Castlebeck’s management, which he said was overstretched. He will bring in more staff and increase lines of reporting to ensure services are operated safely and in compliance with sector regulations.
● Additional research by Daniel Sibthorpe
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This article is published in the 18 August 2011 edition of Community Care under the headline “What you must report to the CQC”