The findings from the Focus on Enforcement review of the adult care sector have been published together with an interim response from the lead regulator: the Care Quality Commission (CQC), and the Department of Health (DH).
The review was carried out in Autumn 2012 and involved engagement with key industry stakeholders including providers, trade associations, membership groups, professional bodies and other interested parties.
The report sets out the findings in full – however the key findings include:
- Duplication of activities by CQC and local authorities – providers told us this is a widespread problem, placing a heavy ‘paperwork’ burden on them which can take them away from the critical role of caring for residents
- Lack of co-ordination between CQC and commissioners of places in homes – the sector told us this particularly applied to information sharing and inspections – adding to existing burdens
- Speed of re-assessment – providers told us that re-assessment often does not occur before the next scheduled inspection, leaving some homes publicly tarred as non-compliant for considerably longer than is necessary
- Crude compliance assessments – the sector told us that the current pass/fail approach to assessing and reporting compliance has serious limitations and does not incentivise quality beyond basic compliance
- Crude public reporting – providers reported insufficient distinction in CQC’s handling of major and minor non-compliance issues when publicly naming non-compliant homes
- Inconsistency and capability – we heard reports of varied capability amongst inspectors, inconsistency in decisions and a lack of an independent appeals mechanism.
In response, CQC and DH have produced an interim set of proposals for addressing these findings. Much of this response reflects a wider programme of work, and announcements that CQC have already made on how they intend to improve the delivery of regulation and inspections in the adult social care sector.
Currently, the response proposes that CQC will:
- Improve information sharing at local level
- Investigate IT solutions and digital platforms that can assist with the information sharing process
- Move to specialist teams of inspectors (away from current generalists)
- Move away from the current pass/fail model of compliance, developing a system with greater gradation and descriptive ratings
- Apply greater expert judgement and a more rounded assessment of performance – such as talking more to residents – moving away from an assessment of compliance against standards and paperwork.
CQC and DH have committed to publish a full, “point by point” plan early in 2014 setting out the final detail of reforms that will respond to each of the Focus on Enforcement review findings.