Social care ‘star ratings’ set to return after review gives backing

Aggregate ratings of adult social care services delivered by the Care Quality Commission are set to return after winning backing from a government-commissioned review.

The reintroduction of an overall rating for services, scrapped to sector dismay in 2010, would fill a “clear gap” in the provision of trusted information on the quality of individual care services, enhance choice for families and potentially increase performance, found the review by think-tank the Nuffield Trust.

The independent review, which also covered health, was commissioned by health secretary Jeremy Hunt, who publicly supports the reintroduction of ratings, but wanted the costs, benefits and practicalities of doing so investigated. The review’s support, alongside that of Hunt and most of the social care sector, is likely to make the return of quality ratings irresitible.

Major information gap

“There is a major gap in the information available to the public on the quality of care of their local hospitals, GP practices, care homes and other providers; people are left in the dark,” said Nuffield Trust chief executive Dr Jennifer Dixon, who led the review. “One aggregate, comprehensive rating of providers may provide more clarity and simplicity for the public, especially if it came from one ‘official’ trusted source.”

The review found that the reintroduction of ratings would be “most appropriate” in social care, as opposed to health. This was because the range of information available on social care services was more limited, particularly when compared with hospitals, making an overall rating easier to design. Decisions on social care were often made when people and their families were in crisis, making a simple guide to quality, such as that provided by a single rating, particularly useful.

Strong sector support

The review’s consultation process found a “clear overall consensus” in favour of the introduction of an aggregate rating for adult care services, as well as support for the previous quality ratings system, which ran from 2008-10.

Though its short lifespan meant no comprehensive evaluation of its impact could be made, a 2009 review by the outgoing Commission for Social Care Inspection found the ratings aided choice for users, were easy to understand and provided an indication of quality.

Rise of online care ratings sites

The review acknowledged the rise of online consumer ratings and information sites designed to help service users choose social care services. However, it found that use of the web by families to help choose services was low and that the proliferation of such sites may create confusion.

The review was also told that families of people in residential care were deterred from posting negative reviews of care services on these sites for fear of reprisals from providers.

Design of ratings

The review suggested that ratings for services should be updated regularly, possibly every month, to ensure they remained current. The trust also called for frontline staff and service users to be involved in designing the system to ensure it was credible, though it stressed that any system should make use of existing and emerging performance frameworks, such as the National Institute for Health and Clinical Excellence’s quality standards for social care.

The review concluded that the CQC was best placed to deliver any ratings system but warned that it would need more resources and significant support to do so, as it would have to move from assessing providers against essential standards to judging their performance more widely.

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