Top-rated services to go up to two years without inspection under CQC reform plans

Top-rated care services will be inspected half as frequently as they are now under Care Quality Commission plans to take a more “risk-based” approach to regulation from October 2014.

The commission plans to ditch annual inspections and introduce a system under which services judged ‘outstanding’ under the new performance rating system are generally reinspected within two years and ‘good’ services revisited within 18 months.

Services judged to be ‘requiring improvement’ will be seen within a year of their previous inspection and those rated ‘inadequate’ reinspected within six months. The CQC will also carry out responsive inspections where there are concerns and inspect 10% of ‘good’ and ‘outstanding’ each year to ensure its ratings system remains valid.

The proposals were set out in a consultation on the CQC’s new regulatory approach published this week.

Annual inspections ditched after two years

Annual inspections were only introduced in 2012 following significant concerns over the CQC’s previous use of risk-based, proportionate inspections, which left services uninspected for up to two years in the absence of concerns coming to light.

These concerns were compounded by a 70% fall in inspections from 2009-10 to 2010-11 as the CQC shifted resources into its programme to re-register 12,000 social care providers under the regulatory regime introduced by the Health and Social Care Act 2008.

While marking a return to a previous approach in terms of inspection frequency, the CQC said its latest reforms as a whole would strengthen the regulation of adult care services. The key aspects of the reforms are:

• Setting a higher bar for registration, including ensuring that directors of providers meet a “fit and proper persons test” before their services can be registered;
• The introduction of a four-point ratings system, with all adult care providers rated by 31 March 2016;
• Focusing assessment on five questions – whether the service is safe, effective, caring, responsive and well-led;
• Ensuring inspectors specialise in adult social care, rather than cover health services as well, and increasing the numbers of service users and carers involved in inspection teams;
• Taking tougher action against poorer performers, including being able to prosecute providers for serious care breaches without issuing a warning notice first.

The CQC said it also wanted to improve its use of data and intelligence to monitor the quality of services and help detect problems.

Focus on Mental Capacity Act compliance

As part of the consultation, the CQC has set out how its proposed reforms will impact on different sectors, including specialist mental health services, residential adult social care services and community adult social care.

Across all of these areas, the CQC is planning to increase its focus on how well providers are complying with the Mental Capacity Act 2005 and, where relevant, the Deprivation of Liberty Safeguards (Dols).

As part of this it is seeking views on whether providers’ ratings should be limited if they fail to comply with the MCA or Dols.

The CQC has also set out how it plans to ensure mental health services for adults with learning disabilities or autism meet the requirements of the government’s programme to end institutionalised care in the wake of Winterbourne View.

Tackling institutionalised care post-Winterbourne

It listed the following as characteristics of a good service, supporting this client group:

• People are supported to access the local community, to be involved in it, have a role where they feel valued and a part of it;
• People who have behaviours viewed as challenging are supported using positive behaviour support;
• Friends and family are welcomed by the provider and involved in care decisions;
• Providers work with commissioners to ensure people can be discharged from inpatient settings quickly and safely, and people are involved in planning their discharge from the point of admission;
• The service invests time and attention in giving people choice and control and provides resources for advocacy or self-advocacy.

Addressing short home care visits

The CQC’s standards also seek to address concerns about the quality of home care, in relation to service users receiving frequent changes of carer and short visits to deliver personal care.

It proposed that, among the characteristics of an ‘inadequate service’, are that carers are often changed at short notice or no notice; staff may have insufficient time to give people the care they need and be expected to cover a wide area with little consideration for travel time; and the service may arrange short visits (for example, 15 minutes) to arrange care that requires more time than this.

• Providers are likely to see such standards as highlighting the role played by council commissioners in determining the delivery of home care, including the prevalence of short visits.
• From April 2015, the CQC will no longer have a duty to routinely inspect councils on their adults’ social services functions under changes made through the Care Bill, though this duty has not been enforced since 2010.
• However, ministers have said that they would allow the regulator to inspect councils if it found poor delivery of care was linked to poor commissioning, including in relation to rushed home care visits.

Concurrent consultations on regulatory reforms

The CQC’s consultation runs until 4 June and people can respond through an online form, post or email. It is one of several live or recently concluded consultations on reforms to social care regulation in England, all due to come into force in October:

• The Department of Health is consulting until 25 April on draft regulations requiring providers to ensure that their directors are “fit and proper persons” to lead registered services;
• The DH is consulting, also until 25 April, on separate regulations to introduce a ‘duty of candour’ requiring providers to tell service users or their families about safety incidents that have resulted in death, impairment or prolonged harm;
• The DH has also just finished consulting on draft regulations to replace the existing 16 essential standards against which services are assessed with 11 ‘fundamental standards’.
• The CQC is also due to consult later this year on its approach to taking enforcement action against providers and on guidance for providers on complying with the new regulations. The latter is likely to include more specific requirements on how providers should support their workforce, said the CQC.