The Care Quality Commission plans to inspect adult social care services less often and concentrate on providers of greatest risk ahead of an anticipated cut in its budget.
In a draft strategy for 2016-21 released yesterday for consultation, the CQC proposed a “risk-based” approach where it would focus on inspecting services deemed to be more of a risk to the public, based on better intelligence gathering about service quality.
The CQC’s annual budget is due to fall from £249m in this financial year to £217m in 2019-20, driven by cuts in Department of Health grant funding. It said that the resource reduction meant that it had to develop new ways of working in order to “stay sustainable”.
To identify who to inspect and when, the CQC said it planned to strengthen its ability to analyse the quantitative and qualitative information it collects about providers so that it could spot potential risks more effectively.
The CQC proposed to enhance the data it collected by sharing more information with local authorities about the quality of services and encouraging providers to monitor their work using its regulatory framework and then share the findings with inspectors. The document stressed that while the information from providers would help inform the CQC’s decisions about what services to inspect, it would not rely on information from providers alone.
In relation to adult social care, the CQC said that proposals were “likely to reduce the frequency with which we inspect services and the size of inspection teams overall”, so that resources were targeted where risk was greatest.
Martin Green, chief executive of provider association Care England, said a risk-based approach to inspection was legitimate but its success depended on how well the CQC could analyse the information it gathered.
“It has to rely on a good deal of very good quality and also real-time information,” he said. “I think it’s going to be quite difficult to do and it is going to require a complete mindset change in the organisation and require the organisation to significantly increase its competence not only in the collection of data but also in the use of it. They will have to become much more focused on triggers in the informatics.”
However, Gary FitzGerald, chief executive of Action on Elder Abuse, said a risk-based approach amounted to “inspection on the cheap”.
“This goes back to what the CQC did in its worst days of criticism when they were attempting to make the same argument about a risk-based approach,” he said. “You cannot have a risk-based approach to inspection and regulation simply because the variables are too great.
‘From excellence to danger’
“You do get excellent care provision services but very often that’s because of strong, positive and good leadership at the top. It just takes something to upset that balance and very quickly a care environment that was deemed excellent becomes a care environment in danger. They have never yet been able to demonstrate a system that can move fast enough to take account of those variables.”
The CQC stressed that its proposals would not compromise on the core aspects of its role and that it would:
- Continue to fulfil its full range of statutory duties in relation to all the providers and services it regulates;
- Continue to carry out responsive inspections of services triggered by information that identifies risk;
- Not make a judgement about the quality of a service without evidence from an inspection;
- Not make a decision about how often to inspect a service based solely on information from the provider.
The draft strategy also said the CQC intended to raise the fees it charged care providers as a way of mitigating against the loss of central government funding. Green said this could be a significant cost to services and would alter the relationship between the CQC and providers.
Changed relationship with providers
“Increasingly when we’re paying for it we will expect them – just as they expect us to deliver on quality – to deliver on quality,” he said.
The CQC has already taken steps towards a risk-based approach to care inspections. In October 2014 it ended annual inspections for the highest rated providers in favour of inspecting good ones at least once within 18 months and those deemed outstanding within 2 years.
The consultation on the new strategy ends on 14 March with a final version of the strategy due to be published in May.