CQC ‘failing to protect adults abused or neglected in hospital’

The Care Quality Commission is failing to protect adults experiencing abuse or neglect in hospitals, Action on Elder Abuse has claimed in a damning report.

The regulator stands accused of failing to follow up on individual incidents of maltreatment identified in inspections to ensure that patients are safeguarded. In response, the CQC said it welcomed the report but that it “offers views about CQC’s role that we don’t necessarily agree with”.

The findings were based on an Action on Elder Abuse analysis of CQC’s inspection of 100 hospitals against dignity and nutrition standards, an overview report of which was published last week.

CQC found one in five hospitals were not compliant with either the dignity or the nutrition standard. Failings included curtains not being closed when people were receiving personal care, call buttons being left out of patients’ reach and staff speaking to patients in a condescending or dismissive way. Some patients were also not given the help they needed to eat or interrupted during meals.

Action on Elder Abuse said many of the incidents met the definition of neglect in the No Secrets guidance, which includes “ignoring medical or physical care needs”, while repeated cases of poor care constituted “institutional abuse” under No Secrets.

The Nursing and Midwifery Council said it had initiated fitness-to-practice investigations into nurses whose practice was called into question by the CQC.

However, Action on Elder Abuse found:

• CQC made no adult safeguarding referrals on the back of the inspections.

• Serious issues of abuse or neglect did not result in hospitals being deemed non-compliant with the standards, because the CQC judged overall performance rather than individual incidents.

• Hospitals were given 14 to 28 days to respond to issues that should have warranted an adult safeguarding referral.

• Hospitals with more serious issues were given longer to address them.

AEA showed its findings to an experienced council adult safeguarding manager, who said: “Some of the examples quoted could be deemed criminal acts of abuse, as defined in the Mental Capacity Act. Additional to this there are referenced breaches of the Human Rights Act, which again appear to have gone unchallenged. Had these been appropriately referred via established and agreed safeguarding procedures, it is almost certain that different outcomes would have been achieved.”

The CQC has a protocol on safeguarding, under which it pledges to share information, proportionately, to help protect people at risk.

However, the AEA report said: “These inspections suggest CQC has little or no sense or urgency in terms of its regulatory activity, often leaving very vulnerable people in neglectful or abusive settings while waiting for ‘action plans’ to be delivered by a care provider,” said the AEA report. “In our view this is a major failing in its ‘duty of care’.”

Action on Elder Abuse said suspicions and or evidence of abuse and neglect identified by CQC needed to be reported as adult safeguarding referrals, with any decision not to do so explained in the relevant inspection report.

In response, a CQC spokesperson said: “The analysis suggests we may not have followed up on safeguarding issues in the right way. We take these matters very seriously, as CQC’s national report made clear, and are confident we picked up on these during the inspections.”

He said that an the CQC had discussed its approach to safeguarding during the inspection process with an advisory group – of which Action on Elder Abuse was a member – and stressed that the advisory group as a whole had supported its findings. The group also included Age UK, the Equality and Human Rights Commission, the NMC, the NHS Confederation and the Social Care Institute for Excellence.

Community Care understands that the CQC’s approach was to refer safeguarding issues to the trusts and follow up subsequently on actions taken on the basis that it sees making safeguarding referrals as primarily a responsibility for the trusts.

However, the AEA report said that CQC inspectors needed comprehensive training in the Mental Capacity Act and Human Rights Act to identify cases of these pieces of legislation being breached.

It also called for the Department of Health to “urgently consider” an independent inquiry into the operation and management of the CQC to establish whether it was “fit for purpose”.

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