CQC to inspect services less often as budget falls

Regulator bids to use better intelligence gathering to focus reduced resources on services with greatest risk

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”.

Spotting risk

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.

‘Mindset change’

“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.

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10 Responses to CQC to inspect services less often as budget falls

  1. Mrs woodward January 26, 2016 at 6:28 pm #


  2. Gillian Dalley January 27, 2016 at 1:00 pm #

    Regulators in health and social care have always flirted with risk-based approaches to inspection while at the same time the shocking catalogue of scandals – relating to services (across the sectors) that have been inspected and left to get on with it – has grown. An excellent or outstanding service can deteriorate with astonishing speed triggered by sudden, often unpredictable, things happening – loss of a good manager, change in ownership, ‘last straws that break the camel’s back’ (where the one prop holding up the edifice is withdrawn without notice) and so on. First, let CQC prove that its skill in analysing routine data returns is good enough to forecast and pick up these phenomena. Only then can they safely take the risk they are toying with. And maybe they should raise the issue with Jeremy Hunt before the next time he stands up to apologise for some unpredicted disaster.

  3. John Burton January 27, 2016 at 2:28 pm #

    Here we go again! This regulator, as with its predecessors, is going through the same old cycle of failure, trying to convince itself, its so-called “stakeholders” and the public (who should be the stakeholders) that it can predict the failure of care as well as we can predict the failure of CQC.
    Social care is a local service and should have local inspectors who know what’s going on in the organisations they are responsible and accountable for keeping an eye on. CQC is a large national bureaucracy with a determination to do everything but its core task. It charges fees that are inversely related to the value of its work. (Why should the residents of an outstanding care home be charged several pounds a week for not being inspected?)
    CQC is entering the terminal cycle which precedes the inevitable crisis when enough services that have been deemed good or outstanding and been left uninspected hitting the headlines, and government turning on the poor creature it spawned, blaming it, beating it and . . . starting all over again with a similarly flawed design.

    • Richard January 27, 2016 at 5:23 pm #

      So far John the evidence would appear to support your comments, though I feel an additional challenge for providers is the additional burden of of self regulation for which they are predominantly ill prepared and often distracted by the priorities of the day job of caring for vulnerable people.

  4. norma parkinson-green January 27, 2016 at 3:21 pm #

    Services need to be radically changed for the better, there is too much abuse going on in residential homes, and often care is of poor quality. CQC announce they are inspecting what good is that!! Our elderly didn’t go through wars and pay their due’s to end up being neglected and left to die with no dignity or respect.

  5. dreamwaverider January 27, 2016 at 5:40 pm #

    The majority of care homes recently inspected are now failing e.g. either need improving or inadequate. CQC are beyond inspecting properly anymore. They have come up with so many different initiatives that they constantly change, no one has got a clue what they are doing anymore, while all the time standards continue to fall because funding continues to fall.
    IT IS THAT SIMPLE. If you keep cutting funding, standards WILL KEEP FALLING.
    The only reason failing homes are not closing is because there is nowhere else for the old folk to go.
    This is a complete and utter mess bought about by the public sector who continue to bury its head in the sand. Face reality, fund elderly care properly or close it.
    Maybe less people will get care, but at least those that get it will be looked after properly

  6. jim kennie January 27, 2016 at 9:06 pm #

    So CQC get paid less and merely cut the service endangering old people nationwide.
    Wonder what would happen if care homes followed their example.
    Care Homes get paid paid less and less yet are still expected to deliver.
    This whole fiasco has become the best covered national scandal out there.
    Who says the government don’t silence the press.
    Yeah right.
    Can the last home to close turn off the lights on this sorry mess.
    The public sector at large should be ashamed of itself.

  7. Michael January 28, 2016 at 8:56 am #

    John Burton makes a number of excellent points in his comments above. I would like to pick up on just one of them – Regulation and Inspection was moved out of local authorities back in the 1990s because they were also providers of services that were being inspected and this was seen as not being even-handed.

    However, local authorities continue to monitor providers through their commissioning and contracting arrangements, and much of this is seen as a duplication of what the regulator does. Why not confirm local authorities in the their commissioning and oversight role and let them regulate independent providers?

    • John Burton January 28, 2016 at 5:59 pm #

      When the first national regulator (NCSC) started in 2002 (I think) it started with fairly local offices and local inspectors mostly recruited from the old local authority registration and inspection teams. Unfortunately, the national organisation very soon lost its way and forgot where it was meant to be going (doing). The hierarchy and bureaucracy grew, inspection reports grew, demands on providers grew. Within a year it had been replaced by an even more grandiose outfit. CSCI continued in the same way and then we were given CQC. Just because the new regime at CQC have improved the organisation (it could only improve) and are doing it better, doesn’t mean that they are doing the right thing. No, they are doing the wrong thing righter – still the wrong thing.

      Make the regulator a small national umbrella organisation with very local offices headed by one chief inspector employing freelance inspectors and using local Healthwatch. Each inspector would be individually and personally responsible for their “case load” of services making them accountable to the local community. Give inspectors the authority to do their job. Now they are so constricted by frightened managers and “quality assurance” processes, they have no authority or autonomy. Providers would pay only for their inspection and year-round oversight, not for any national activity of CQC, and the fees would be determined by the actual reasonable cost of inspection. If inspectors don’t do the job properly, don’t re-engage them. Providers would do NOTHING additional for inspection because the inspector’s job is to make a judgement about what is actually happening and how good the care is. And get rid of the absurd ratings which just slow down the whole process. All this could be done without changing the basic legislation and standards. Unfortunately CQC is a constipated organisation – just watch their board meetings – unable to innovate, learn or take risks.

    • Milligan January 29, 2016 at 10:50 pm #

      several of our local councillors own care homes, this could be tricky in terms of oversight/regulation