CQC relaxes stance on ‘bed limit’ for learning disability services

The Care Quality Commission has relaxed proposals to introduce a cap on the number of beds a learning disability service can have as a condition of registration.

The regulator attracted criticism after publishing draft guidance that appeared to restrict registration to facilities housing six people or fewer, in line with National Institute for Health and Care Excellence (NICE) policy on autism accommodation.

Following a consultation period, the CQC yesterday published an amended version of its document, ‘Registering the right support’, in which the language has been softened. The new guidance says that the CQC “will not adopt ‘six’ as a rigid rule” for providers of any service for people with a learning disability and/or autism.

“We may register providers who have services that are small scale, but accommodate more than six people, where providers are able to demonstrate that they follow all of the principles and values in Building the Right Support guidance, and meet the fundamental standards and other relevant regulations,” it says.

The amended document acknowledges that provision of care to people with learning disabilities and autism “is complex”. It states that the CQC will not consider size in isolation from other factors such as the effectiveness of management and the evidence base for given service models.

A report summarising consultation responses said there were significant concerns over the perceived lack of flexibility in the “six-bed limit” requirement.

Martin Green, chief executive of Care England, the representative body for independent care providers, told Community Care that he welcomed the regulator’s willingness to listen.

“The CQC should make judgements on the quality of the service and not its size,” he said. “It is clear that the CQC has softened its position in light of representations made during the consultation period, and they are to be applauded for listening to the voices of service users, families and providers.”

‘Crashing the market’

But Neil Grant, director at Ridouts solicitors, which specialises in health and social care, said that the CQC’s adherence to a “small-scale” service model that viewed larger settings as “potentially institutional” was a mistake that could prove financially unsustainable.

“While the CQC is registering new services of eight or nine, it is unlikely it will register more than 10,” he said.

“A key issue is whether commissioners will be prepared to pay for the increased costs that go with running small-scale settings, even assuming providers will be able to raise the funding to build the services in the first place.”

Grant added: “The irony of all of this is that CQC has crashed the market for residential care with the result that more people will be kept in hospitals unnecessarily, or placed in unsuitable supported living facilities where there is little or no regulatory oversight – it’s a scandal waiting to happen.”

A spokesperson for Learning Disability England, a membership body for people with learning disabilities, families and professionals, said the organisation welcomes anything that increases the rate of closure of large institutions – but that “the devil will be in the detail”.

The spokesperson said: “It is important to remember that small organisations can also have a poor or abusive culture and steps need to be taken to guard against this.

“A move away from large institutions is positive but the work doesn’t stop there. LDE knows that we cannot rest until people with learning disabilities are living good lives in the homes they want, with the support they need.”

Second consultation

At the same time as publishing its new guidance, the CQC opened a second phase of consultation on proposals affecting health and social care regulation in England.

Among the proposals are plans to further vary the frequency of service inspections depending on that service’s current rating. ‘Inadequate’ adult social care facilities would be inspected at least every six months, and those ‘requiring improvement’ would face annual inspections, as now. However, those rated ‘good’ would have up to two and a half years between planned comprehensive inspections and those with an ‘outstanding’ rating would have a gap of up to three years (up from two years in both cases).

The consultation also includes plans to register corporate providers, rather than just their individual services, so that the regulator can make those providers more accountable for the care delivered in their separate facilities.

The new consultation is open until Tuesday 8 August 2017.