Tomorrow Andrea Sutcliffe will publish her plans for overhauling social care regulation – not bad for someone who is just one week into her tenure as the Care Quality Commission’s first chief inspector for the social care.
Sutcliffe has had a bit of a head start as a result of doing “two jobs for two months”, combining work at the CQC with her previous role as chief executive of the Social Care Institute for Excellence.
And tomorrow’s “signposting document” will set out initial thinking ahead of a formal consultation this year. This is probably just as well as Sutcliffe’s agenda is massive.
Over the next year or so she must introduce a new inspection regime that will measure care homes and home care agencies against revised standards; device a system for rating the quality of these providers; recruit teams of specialist social care inspectors from the CQC’s generic band of regulatory staff; and design a system of financial oversight for the biggest providers to ensure continuity of care in the event of a Southern Cross-style collapse.
“If I say it really quickly, it doesn’t sound like as much,” she says.
CQC overhaul post-Winterbourne
The social care plans are part of a wider programme to change the way CQC does business to address the regulatory failures that contributed to the scandals at Winterbourne View and Mid Staffordshire NHS Foundation Trust. Out will go generic inspectors, a pass/fail approach to providers and the 28 existing regulatory standards, to be replaced by specialist staff, rating providers on their quality and asking five core “questions” every service: is it safe, is it caring, it it responsive, is it effective and is it well-led?
The programme is being rolled out first in CQC’s inspections of acute hospitals, reflecting this sector’s political pre-eminence, particularly in the wake of the Francis report into Mid Staffs.
Sutcliffe is aware of the risks that social care becomes just an add on to health in the regulator’s plans. But she says her role – which will be laid down in statute through the Care Bill, alongside those of chief inspector of hospitals and primary care – is testament to the CQC and government’s commitment to the sector.
Sutcliffe’s appointment was hailed across social care’s leadership cadre, reflecting the strong alliances she has forged during her 18-month stint as chief executive of Scie. Provider leaders were particularly fulsome in their praise. However, she will be tasked with delivering a tougher approach to social care services, who will face greater levels of enforcement in future by the CQC if they fall short.
“If services aren’t good enough, then we will need to do something about it, which might involve working with the provider about what they can improve,” she says. “But at the end of the day, if we need to get tough we will.”
She says getting tough with failing providers is “what the sector wants” for the sake of social care’s reputation and attractiveness as potential career.
“Good providers want people to want to work in the sector,” she says. “Every time there’s a problem, nobody distinguishes between the poor provider and the residential home at the end of their street, which may be fantastic. The sector wants us to be a strong regulator on the side of people who use services.”
Specialist inspectors and quality ratings make comeback
A return to specialist inspectors of social care is something providers have been crying out for since the birth of the CQC’s generic model in 2009-10. Sutcliffe and her fellow chief inspectors – Mike Richards (hospitals) and Steve Field (primary care) – will be dividing up the regulator’s staff between them. Those with a background in social care practice, provision or regulation will be welcome on Sutcliffe’s team, she says.
However, she says having the right professional background will not be enough; staff will receive further training and support in identifying good and bad practice through a new “academy” for CQC staff. She says training in dementia care and the Mental Capacity Act 2005 will be particularly important.
Another popular comeback for social care providers will be quality ratings of the work that they do, which were last awarded in 2010. Sutcliffe will now start working with the sector on drawing up the structure for these ratings.
“We want to know what makes a service outstanding, what good looks like and what would stop you ever being considered outstanding. At this stage I don’t have the answers.”
Avoiding repeat of Southern Cross
A less popular move – with providers at least – will be the introduction of a system of financial oversight by the CQC of the biggest providers to ensure continuity of care in the event of one of them collapsing, as Southern Cross did.
Subject to the passage of the Care Bill, the CQC will have the power to require regular financial and relevant performance information from large providers, require the provider to develop a sustainability plan to manage financial risks and commission independent business reviews to help providers return to financial sustainability.
“What we have to do is really think through how we discharge this role,” she says. One key issue will be the skills of CQC staff in financial oversight and whether these are sufficient.
“I think we are going to have to look very carefully at what the skills we require to deliver on this new function, either in terms of training and development needs or indeed bringing new skills into the organisation.”
One of the things inspectors will be looking out for is whether services are sufficiently staffed – an increasing concern in these resource-constrained times that the CQC has agreed to examine more deeply.
Given the diversity of services under regulation, she says she will not be “saying you need to have x numbers of staff on at any given time”. But she adds: “What we are going to be looking at is whether services are responsive to people’s needs, safe and caring, and clearly having the appropriate numbers of staff is a very important aspect of that.”
No return to rating councils
One thing that won’t be added to Sutcliffe’s busy portfolio is a return to regular performance assessments of local authority commissioning of adult care. Though care services minister Norman Lamb mooted this earlier in the year, it has now been ruled out by ministers – something Sutcliffe doesn’t seem too disappointed by.
“We’ve got a big enough job to do in inspecting and regulating the social care provider market,” she says. However, she says she wants to work closely with local authorities on improving quality of provided services and safeguarding – areas in which joint working between regulator and councils has not universally been strong.
“I’m keen to ensure that at a local level inspection teams have a good relationship with their local authorities so that we are clear about the roles and responsibilities we each have. We don’t want service users falling through the gaps but neither do we want duplication of requirements for providers.”