Winterbourne-style services could face more frequent inspections

Winterbourne View-style hospitals and some social care services could face more frequent inspections under Care Quality Commission plans to regulate organisations differently depending on their level of risk.

The CQC said its current approach of inspecting all adult social care, independent healthcare and NHS services a minimum of once a year, which was only formally introduced in April, could be revised to make it better able to identify and respond to failures in quality and safety.

This would mean more frequent scheduled inspections for services deemed to carry inherently higher risks – and less frequent probes for others. 

‘Higher-risk’ services

Services could be deemed higher risk because they are delivered in relatively closed institutions or cater for more vulnerable clients, as was the case with Winterbourne View, or because they receive relatively limited scrutiny from monitoring bodies other than the CQC, such as commissioners, other regulators or internal quality assurance teams.

“We may need to regulate different services in different ways and at different times to make sure we achieve the greatest improvement in quality,” it said in a consultation on its 2013-16 strategy, published today.

Winterbourne View serious case review

The Winterbourne View serious case review, published last month, concluded that hospitals for adults with learning disabilities or autism should be regarded as high-risk services that required “frequent, more thorough unannounced inspections, more probing criminal investigations and exacting safeguarding investigations”.

As part of its own response to its role in the Winterbourne View case, the CQC has already started classifying residential services for people with learning disabilities and challenging behaviours as “higher risk” in the quality and risk profiles it produces for every regulated service. Though this has not increased their minimum inspection frequency, it may have increased the number of “responsive reviews” such services receive as a result of other information received by the CQC, such as safeguarding alerts or complaints.

Boosting staff morale

The CQC said that a critical factor in its success over the next three years would be improving the skills and motivations of its workforce and promoting a “positive culture” among staff. Successive surveys of staff, both by the CQC and trade union Unison, have identified low morale and a lack of confidence in the CQC’s management and strategy.

The consultative strategy also includes proposals to:

• share more information about the quality of services with other monitoring bodies, such as council commissioners;
  
• base its regulatory activity more on the views and experiences of service users and carers, including by increasing their role in inspecting services and through the establishment of user watchdog Healthwatch as a committee of the CQC;
  
• remove unnecessary burdens on providers;
  
• develop its Mental Health Act role to better safeguard the rights of patients on community treatment orders or under guardianship arrangements;
  
• developing measures to assess its impact as a regulator.

The consultation runs until 6 December and people can respond online, by email or post.

Learning from Winterbourne

Lessons for practitioners from the Winterbourne View case will be among the topics discussed at a Community Care conference on safeguarding in care homes on 4 December 2012.

Related articles

CQC’s approach to safeguarding: what providers need to know

Issues for the CQC from Winterbourne View

CQC to double inspections of adult care services