Behan: specialist inspectors will help CQC regain credibility with providers

The Care Quality Commission hopes to regain credibility with care providers by ensuring all its staff specialise in inspecting particular health or social care services, chief executive David Behan has said.

Behan acknowledged that the CQC’s generic model of inspection – under which staff have been responsible for inspecting the full range of services covered by the CQC – had raised “issues about credibility” over the quality of inspection, particularly among care providers.

“This is a question, if people are generic rather than specialist, about what their background knowledge is about the organisations they are inspecting. I want to tackle that head-on and say we want inspectors to specialise,” he said.

Generic inspection model scrapped

Behan was talking to Community Care following the publication last week of the CQC’s strategy for 2013-16, under which the regulator would scrap its generic model by getting staff to specialise, inspecting different sectors against different standards and increasingly varying the frequency of inspections of services based on risk.

“How we inspect an international teaching hospital, a three-bedded are home for people with autism and challenging behaviour and a dentist will need to be different, “he said. “To date CQC has had a consistent approach to all three. That’s not going to work in the future.”

Behan added that, while all staff would specialise, some would be specialists who had a professional background in the sector they inspected, particularly where the services in question involved individuals at particular risk.

“People who are judging the difference between a good service for people with autism and a poor one need to have some idea about what good looks like,” he said. “Some people with autism don’t like light; if you didn’t know that you might go into a service and ask why it is in the dark.”

He said the strategy involved significant changes for CQC staff, which would be tackled by establishing a training academy for them and using secondments between the regulator and health and social care services, “so people get to know us and people in CQC get to know services”.

Changes to inspection frequency

While the CQC will continue with its existing model of doing one scheduled inspection of each service in 2013-14, higher-performing services would receive fewer inspections in future on the basis of reduced risk to service users, said Behan. The strategy also promises to increase inspections where there is a higher risk of harm to users or people are vulnerable because of their circumstances, such as in learning disability or mental health services or home care.

However, the CQC will not increase the number of scheduled inspections for these sectors; instead it is likely to carry out more “responsive” inspections that arise from concerns about services, based upon a better use of information to “identify, predict and respond more quickly to services that are failing, or are likely to fail”.

The strategy also heralds the replacement of the CQC’s existing 28 essential standards of quality and safety, against which it inspects all providers, by five “fundamental standards” examining whether services are safe, caring, effective, well-led and responsive to people’s needs. Behan said different sets of standards would be designed for different sectors under these five headings.

“In a hospital there are a number of things that we will need to look at to see if it is safe or effective and the things we need to look at will be slightly different in a care home and different again in a domiciliary care agency.”

Return of care ratings

As announced by government last month, the CQC will also reintroduce quality ratings for social care services, which will assess how far services surpass the fundamental standards. The quality ratings system is likely to have been developed by the autumn and grade services’ performance at one of at least four levels.

Behan said that the ratings would help care providers benchmark themselves against each other, driving up performance, and also enhance choice for families in choosing care services, by enabling them to “sort and sift the best”.

The strategy will also introduce a tougher test for organisations looking to register new services. This is in response to the government’s desire to increase corporate accountability for service quality in the wake of Castlebeck’s management’s failure to exercise effective oversight over Winterbourne View.

In future, providers will be asked to identify a person responsible for quality within an organisation and what they will do to maintain standards, as a condition of registration. Behan said this would enable the CQC to challenge these individuals to make improvements where services fall short of standards, under the threat of enforcement action and being “named and shamed” by the regulator.

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