The rocky road to the right sort of regulation

Posted on December 8th, by geoff in CT blog. 5 comments

By Caring Times editor Geoff Hodgson

Oh dear! The Care Quality Commission has had to apologise to hundreds of GPs for giving incorrect patient safety risk assessments. The British Medical association is fuming and has called for banding system to be scrapped.

This doesn’t augur auspiciously for the new ratings systems for care homes. Could it be that, despite the most earnest of intent, the CQC is still off-piste in terms of its core function as a regulator?

I wonder how alone I am in looking back to the “bad old days” of local authority-based inspection units with a certain fond nostalgia? – not for the local authority link-up; that had to go, but more of a feeling that inspectors had a less fuzzy idea of their role than they do now.

When the inspection units coalesced into a single national body in 2003, greater consistency was a widely hoped-for major benefit. That hasn’t happened, and never will unless we can clear the ethical hurdles surrounding the cloning of inspectors. In the absence of greater consistency I struggle to see any other benefits the various national regulators have bought to wider society and the care sector specifically. without yet again rubbing their noses in their failures – we all know what they are – but what have now is an expensive, ponderous, dissembling bureaucracy seemingly more focused on protecting its own image than upon safeguarding the wellbeing of vulnerable people and actively promoting best practice. We have a body with far too much on its plate and distracted by ancillary functions such as ratings systems.

Perhaps there needs to be yet another rethink.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

5 responses to “The rocky road to the right sort of regulation”

  1. Just to show that views within Caring Times vary as much as they do within the sector, I have to say that I do not agree with Geoff. I think CQC are improved under the new regime. I think the leadership is more engaged and has less of a bunker mentality than previously. I like their new willingness, for example, to offer guidance on where improvement resources for providers can be found without compromising on their commitment not to be an ‘improvement agency’. They are tougher than they used to be unquestionably but that is no bad thing provided they are fair and that is the test which is they must pass.
    I also like the concept of the ratings which were popular with the sector by the time they had got used to them before they were abolished. I think they have not quite got them right yet, though, with the ‘Need to improve’ category needing clarification in terms of compliance.

    Dr Richard Hawkins, Editor-in-Chief, Caring Times

  2. John Burton says:

    Richard is right that CQC is better than it was under the previous regime. It was appalling before – a disgrace. CQC is now doing better, however, it’s still doing the wrong things . . . but better. It has been set, and has enthusiastically accepted, an impossible task. It will never work and it’s only a matter of time before this incarnation of regulation collapses.
    Geoff is right that the way forward is to go back to LOCAL inspection. Inspectors must be publicly accountable for their own work. They must be known to residents, relatives, staff, and the community in which they work. No more of this nonsense about “we” (CQC) in inspection reports when one inspector visited a home. No more incomprehensible, standardised, copied and pasted reports that tell no one anything of interest or use. A relative must be able to contact their inspector directly. An inspector must be able to “drop in” to a home in response to a complaint or tip-off, or, indeed, in response to a glowing comment.
    This can be organised with a minimal central CQC, local offices and heads of inspection, the serious participation of local Healthwatch, and inspectors – whether full-timers or freelancers – with realistic caseloads, accountable to the public, and given the responsibility and authority to be accountable for their own work.
    Consistency and ratings are red herrings that can never be caught but distract attention and divert resources.
    I have been publishing articles and speaking publicly about this for many years. I’m pleased that gradually more people in social care are beginning to understand that CQC is simply on the wrong road but can’t find a way to turn round.

    • Bob Ferguson says:

      I don’t know if John smokes, but his is a pipe dream – pure and simple. In any case, my recollection of LOCAL inspection, albeit under LA control, was far from the Shangri-La he describes.

  3. John Burton says:

    Bob, take your wet blanket off my pipe dreams!
    No, I don’t mean local as in run by the local authorities. I mean localised CQC inspection linked with Healthwatch. Perfectly possible and practical. Much cheaper. Much more responsive. Much less bureaucratic. Much more accessible to the public. Direct communication. Immediate responses to complaints and compliments. Too few staff at weekends says a relative. So the inspector takes a look for themselves the next weekend. The core task of the inspector is to check that the care home is CARING, HOMELY, and proportionately safe. That’s how I used to inspect in a GOOD local authority inspection unit (some were very bad). I could go on . . . and on . . . but I won’t. I don’t think proper inspection is a pipe dream.

    • Bob Ferguson says:

      I believe you said earlier that you have been speaking and writing about your “dream” for years. Nuff said!

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