Do Care Homes need ‘Experts by Experience’ to Push Up Standards?

Andrea Sutcliffe, the first Chief Inspector of Adult Social Care at the Care Quality Commission (CQC) has announced a number of proposed changes in an attempt to shake up the way the CQC carries out its inspections of Care Homes and also to improve the perception of CQC by Care Sector professionals and the Public.

Amongst a raft of changes, one of the more interesting, or controversial, depending on where you stand, is the proposal to hire 600 members of the public who have had “first hand experience” of care homes to help carry out checks alongside existing inspectors.

Andrea Sutcliffe is quoted as saying of the individuals she is looking to attract: “I am talking about people who maybe have had a mother or father in a care home, and instinctively know the difference between good and bad care.” We want to utilise the knowledge of “experts by experience”.

This is not a new idea, though some care providers may wonder why it is necessary to add yet more layers to an inspection regime that already encompasses inspectors from CQC, Social Services and Healthwatch.

From reading the proposals it is clear the objective is to move experienced inspectors away from a ‘one size fit all’ generic model of inspection techniques towards, as Ms Sutcliffe describes, “ensuring that we’re identifying those people within our inspection team who actually have the skills and experience and the understanding of adult social care that means they’re our experts and they can make a professional judgement.” Some might interpret that statement as an implicit criticism of certain existing CQC inspectors, though CQC’s focus is on matching the particular inspector’s skills to the service being inspected.

By combining existing CQC inspectors with “support” from experienced members of the public, the aim is to broaden the knowledge and approach to the inspection process. In some circumstances the CQC would also utilise a third expert, ‘specialist advisers’, to go into places such as a hospices where particular experience is needed.

These changes, will lead (by a process intended to start in summer 2014) by March 2016 to all adult social care providers being awarded with rankings (outstanding, good, requires improvement, inadequate, echoing the former star ratings), and rated according to the general bands of how safe, effective, caring, responsive to people’s needs, and well-led they are. There are also proposals to base the frequency of inspections mainly on the rating of a care home rather than inspect every care home annually, and to more frequently inspect those establishments which are failing inspections. Don’t hold your breath, but it is encouraging that CQC are at least thinking about allowing providers, albeit at their expense, to call for an extra inspection to upgrade their rating sooner if their service has improved – a key shortcoming in the regime to date which has disadvantaged a number of providers.

The PR problems encountered by the CQC have rumbled on for the last year or so. The failures finally came to a head over the summer after being branded ‘not fit for purpose’ by its own chairman, with the revelations surrounding its  failure to publish the names of those involved in a cover-up of an investigation into deaths at Furness General Hospital in Cumbria.

rhw Solicitors have in the recent past highlighted the likely increase in enforcement activity by CQC.  It is in the main in response to almost continual saturation criticism in the media that Ms Sutcliffe has introduced these changes and re-emphasised CQC’s intention to take tougher enforcement action, such as greater use of fixed penalty notices, when non-compliance is identified.

She gives the example of the basic need for a registered manager in registered homes and that “As of June 2013 we had nearly 4,000 homes that didn’t have one and about a quarter of those hadn’t had one for more than two years. What’s interesting is there is a greater correlation between homes that don’t have a registered manager with rates of non-compliance. So we know how important it is and we have the ability to issue fixed-penalty notices.”

The response to her proposals from the Care Community has, largely, been supportive.

The Chief Executive of the English Community Care Association said the changes offered “an opportunity to ensure that high quality regulation is the foundation of good quality care”.   Ms Sutcliffe says that she wants CQC’s approach to “identify, highlight and celebrate good practice” which will be welcomed by the many good care providers, especially those who have suffered reputational damage due to a disproportionate emphasis on fault finding.

Sandie Keene, President of the Association of Directors of Adult Social Services, commented: “Providing the public with a reliable means of assessing the quality of the experience they can expect to have, when arranging their care, is a fundamental part of the new duties and responsibilities our sector is taking on.”

Norman Lamb said: “We have made it clear that there must be a sharper focus on taking tougher action when things go wrong and holding those responsible to account.  Confidence in the regulation regime has been shaken, but we have turned a corner. I welcome the Chief Inspector’s new commitment to protecting people vulnerable to abuse and neglect, and to delivering better care.”

Certainly the experts by experience initiative offers a very low cost way of bolstering inspector resources, and the volunteers will be trained and DBS checked. If the wonderful example set by our Olympics’ volunteers could to any significant extent be replicated by these volunteers in the social care sector, and in particular help realise CQC’s stated aim of highlighting good practice, it will be quite an achievement.

Currently, though, there are more questions than answers, such as:

  • Will bigger inspection teams mean better inspections?
  • Will these volunteers have a “dampening” influence on over-zealous inspectors?
  • Will this really help to deliver the range of appropriate and effective “professional” inspections that CQC are under pressure to provide?
  • Will care homes be more at risk of unjustifiable investigations, restrictions on new admissions or other penalties as a result?
  • Will these changes really see CQC highlighting and celebrating good practice?
  • How quickly will confidence in the new inspection process be established and confidence in CQC be regained?

Only time will tell what changes will be made and whether or not they will deliver the inspection regime Ms Sutcliffe wants to ensure each care home meets her “is it good enough for my Mum?” test.  In the meantime a formal public consultation on these proposals will be run in spring 2014, with a view to new Regulations coming into force in October 2014.

Giles Gillingham

rhw Solicitors LLP, specialist legal advisers to care providers.

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