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RESEARCH: Are CQC inspections becoming more negative?

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According to data from multiple sources, including Statista, there are over 15,000 care homes in England.

This makes quite a task for the Care Quality Commission which is entrusted with the inspection and regulation not only of these care homes, but of all health and adult social care services, including hospitals, GP surgeries, dentists, ambulance services and mental health services, as well as home care providers.

There have been several criticisms of the CQC since its began operating in early 2009, among them a “lack of strategic focus and leadership, inconsistency of its inspection regime, failure to strike the right balance between registration and inspection, and the lack of measures of performance or impact of its own work,” think tank The King’s Fund said back in 2012.

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While many of these issues have been addressed in the decade since, one that The King’s Fund did not pick up on, and that is very much still talked about, is that the CQC is ‘too negative’ in its reports. Many on the care provider side of the fence believe that the CQC’s reports can do irreparable damage to a home or service.

A third-party report prepared for the CQC itself back in 2013 reads: “Negative inspections from CQC can have significant implications for an organisation’s reputation and survival; providers could potentially lose funding, commissioning, public confidence, patients and customers, or at worst, be closed down.”

For this reason, some feel it should opt for an approach that aims a little more for constructive criticism rather than just plain criticism.

Here Care Home Professional has analysed data from the CQC, taken from the body’s own website, detailing the number of care homes it has rated, and how it rated them, over the last five years.

It is unclear whether the findings for 2017 indicate that the CQC was not doing as many inspections then, or whether body’s records for pre-2018 are not complete.

Either way, the records from 2018 onwards show that the number of ‘requires improvement’ and ‘inadequate’ ratings have grown enormously over the last few years.

While the number of positive ratings (either ‘outstanding’ or ‘good’) went up in 2018 and 2019 and took a dip during the pandemic (presumably due to the difficulty of inspecting during lockdowns), negative ratings have only continued to rise.

While the total number of ratings more than halved from around 4,500 in 2019, pre-pandemic, to around 2,000 in 2020 and 2021, negative responses went from 476 in 2019 to 423 in 2020 and a huge 852 in 2021.

The decline in ‘outstanding’ ratings during that time was likewise disproportional to the overall slow in inspections. The CQC dished out the highest rating 256 times in 2019, but only 128 times in 2020 and 20 times in 2021.

To be fair to the CQC, there could be multiple reasons for this – one being that they were operating during the pandemic. Care home services could well have seen a dip in quality during this period due to the effects of the pandemic itself, with staffing becoming an even more significant problem and infection control suddenly becoming priority number one.

Another reason could be that, with the CQC operating in a limited format, it was only inspecting the homes that most required it – in other words, the homes that were most likely to garner a ‘requires improvement’ or ‘inadequate’ rating.

Furthermore, there is another criticism of the CQC not yet mentioned here, and one that flies in the face of the idea that the body is too negative in the way it conducts its inspections and in the way it writes its reports.

While there are some who call the CQC too negative, there are also those who make the contradicting claim that it does not do a good job at sniffing out the poorly performing homes.

There are a thankfully small number of nevertheless high-profile cases where ‘good’- or ‘outstanding’-rated homes went on to soon after be the scene of negligence or abuse, which some use as evidence that the CQC does not go far enough in its inspections.

This all goes to say that the CQC is a relatively young organisation, still finding its way, and is the subject of judgement from both sides.

When you are receiving contradictory criticisms like this there is little one can do but accept that you are never going to please everyone and settle for finding the balance of upsetting both sides as little as possible. Here’s to helping the CQC be better so that it can help us.

Tags : Care Quality CommissionCQC
Sam Lewis

The author Sam Lewis

1 Comment

  1. I am beginning to question of the relevance of the CQC? The LA’s all have good QA teams which know their local services and have a far better auditing system, not to mention are far more supportive (in Norfolk at least) so why do we need a double inspection regime that is not really fit for purpose and is inconsistent in its approach and in effective in driving improvements.

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