How the Care Quality Commission is changing the way it regulates social care

The inspection and regulation of adult social care services has undergone a radical transformation in the past 12 months. From replacing generic by specialist inspectors to a new quality ratings system, the Care Quality Commission’s revamped regime includes elements from previous approaches to regulation as well as new initiatives.

The next stage of reforms will take effect in April 2015. Social care professionals can find out more about what the changes mean for their organisation from Sally Warren, deputy chief inspector of adult social care, at Community Care’s Safeguarding adults in care homes and hospitals conference on December 2. But first, here’s a round-up of some of the key changes that have been implemented and the main ones to come.

A return to ratings

The CQC’s original four-tier rating system, which saw services rated from zero (poor) to three stars (excellent), was scrapped by the regulator in 2010.

However, ratings were revived last month, with the introduction of a similar system under which services will be rated as inadequate, requires improvement, good or outstanding. This will be based on how providers perform against five key questions: is their service safe, caring, responsive, effective and well-led.

The CQC has published guidance on how the ratings system works and, earlier this month, released the results from their first round of inspections, which saw two-thirds of services rated ‘good’. The aim is to inspect all 25,000 adult care services in England by March 2016.

GUIDE: The new ratings system for adult services

Image Credit: CQC

An end to annual inspections

Also making a return, from October 2014, is an approach under which the highest-rated services will be left up to two years without inspection so that the regulator can concentrate on addressing poor care. This had been replaced in 2012 with annual inspections of all services in response to concerns that the previous “risk-based” approach was leading to poor care being missed.

However, the return to risk-based inspection was vigorously defended by chief inspector for adult social care Andrea Sutcliffe in an interview with Community Care in September to mark her first year in post.

Sutcliffe said that the CQC was better placed than before to pick up on signs of deteriorating care in services rated as good or outstanding, meaning poor care was less likely to be missed.

Specialist inspectors

Sutcliffe has, among other things, spent the past year building up a specialist team to inspect adult social care services, replacing the previous approach in which inspectors covered both health and social care services. This included the appointment of 13 heads of inspection to lead regional teams of adult social care inspectors.

Sharper focus on mental capacity

In October, the CQC issued guidance to providers on how they would be assessed under the new system. This set out that care staff will have to demonstrate an understanding of key requirements of the Mental Capacity Act 2005 in order for a service to be rated good. Inspectors will quiz employees on whether consent to care and treatment is being sought in line with legislation and guidance. This has marked a strengthened approach from the regulator, which had not previously included the MCA as a specific key line of enquiry.

What’s next?

Next April sees the introduction of a host of further reforms to social care inspection. Under new regulations, providers will be replaced against eleven new “fundamental standards”, replacing the current essential standards of quality and safety.

In addition, providers will be required to ensure their directors are “fit and proper persons” to lead a care organisation and be under a “duty of candour” to tell service users and relatives about serious failings in their care.

If that’s not enough, the CQC will introduce a new regime to monitor the financial health of large or specialist provider, a reform ushered in by the Care Act 2014.

Hidden cameras

The regulator is also due to publish guidance on covert surveillance of care home services through hidden cameras by the end of this month. CQC deputy chief inspector Adrian Hughes will be participating in a debate on the use of hidden cameras in care homes at Community Care’s safeguarding in care homes and hospitals conference on 2 December.

The conference will be held at the Holiday Inn in Bloomsbury, London. Register before 28 November to book a discounted place.