National Care Association chairman Nadra Ahmed has questioned whether the current boundary between a Good and an Outstanding overall CQC rating is consistent, and whether inspectors are deliberately avoiding giving the highest rating.
In the past year, around one in 200 care homes have been awarded the Outstanding overall rating, although the ratio is increasing because CQC began its new inspection regime in November 2014 visiting homes it felt were at greatest risk. As inspectors reach homes deemed less risky, it is expected more will be found Outstanding.
Ms Ahmed told Care Home Professional that she has been in meetings where CQC inspectors have publicly stated that they do not give Outstanding ratings, suggesting that the gold standard is unattainable if certain individuals inspect a service.
Her concerns echo the views of Ed Watkinson, director of care quality at QCS, a consultancy that helps operators comply with CQC regulations. He believes there should be more Outstanding ratings, and fears that the current regime unintentionally discourages inspectors from giving the top rating because an Outstanding report invites much more scrutiny than a Good one.
“An inspector might think that a service could be rated as Outstanding or it could be Good. I know that if I make it Good, I can write my report, maybe get it peer reviewed, and then have it released. Whereas, if I put my head above the parapet and say that a service is Outstanding, I am putting myself in the firing line somewhat. I know it will be checked at the inspector manager level, at the regional and potentially national board level to justify the rating.”
Before joining QCS, Mr Watkinson was regulation manager at Barchester. During his dime there he was seconded to the CQC to work as part of a policy team developing its inspection methodology and standards, so he has intimate knowledge of the inspection regime from both the operator and the regulator’s side.
Ms Ahmed has been through an exercise where colleagues review CQC ratings for different services – some rated Good, others Outstanding. Before being told the actual ratings, the team was asked to guess which were Outstanding and which were Good, just by reading the reports. The team was unable to tell the difference, she said.
Neither Ms Ahmed nor Mr Watkinson are questioning the importance or quality of the current CQC inspection and rating system, but they are both concerned that excellent services are unfairly missing out on the Outstanding rating, which in turn makes the ratings misleading to the public.
“The challenge for the CQC is, having set up the system with the Outstanding rating, they need to be clear about the pathways needed to obtain it,” Ms Ahmed insists.
Responding the concerns, CQC’s chief inspector of adult social care, Andrea Sutcliffe, said: “I make no apology for setting a high standard for Outstanding services to reach. It is not an impossible standard and if services are worthy of being rated as Outstanding, my inspectors will certainly write a report to demonstrate that. I agree we have raised the bar – we were right to do so and providers should be proud of their Good ratings too.
“We have nearly two years’ experience of our new approach to monitoring, inspecting and rating services – an approach we developed jointly and openly with the sector that focuses explicitly on the things that matter to people using services, their families and carers. This allows us to get under the skin of services better than ever before and has been applied with rigorous scrutiny by trained staff to ensure the quality of our judgements is as robust and as fair as possible.
“From visiting some of our Outstanding services, I can confidently say that there is something very special about them. I would love to see more Outstanding services and CQC will continue to raise awareness about their common characteristics so that others can improve – which is what we all want to see.”