Observers of the national inspection regimes for residential and care home providers will have watched, over the past three decades, the old purpose-built, local authority arm’s length units change beyond recognition. First we had Ann Parker and the National Care Standards Authority, morphing rapidly under Denise Platt and David Behan into the Commission for Social Care Inspection, until finally coming to a rest in its present incarnation within the Care Quality Commission.
Each time it has changed it has got bigger, without necessarily getting richer. Each time it has taken on different functions, and produced different turbulences. Forgotten now, maybe, the annual lists of `failing authorities’, the threats of Special Measures, arguments about star ratings, threatened and actual court cases between authorities and Inspectorate: these were rigours that beset the statutory authorities.
As the role of private and voluntary care providers expanded over the same time, so did similar, although less well-publicised, debates over home inspections multiply. The efficacy of `mystery shopping’, the cost of inspection as a factor within the licensing process, concerns about national inspectorate inspections for quality duplicating local authorities’ contract compliance inspections. And recently there have emerged further concerns. The CQC has had its own budgetary and staffing contractions to worry about – a recruitment freeze has effectively reduced its staffing by about 20 per cent over the past year or so.
However amongst all this gloom one bright light for the public has been the quality rating systems for providers. Introduced under CSCI and continued until recently under CQC, it provided a well recognised easy to understand judgement about care homes and care agencies and if you asked an ordinary member of the public what CSCI / CQC did, this was the one thing they would recognise and value
However, the quality ratings systems has gone and, for care providers a new method of judging standards has been proposed. All within a context in which the Ombudsman has raised some fundamental questions about the way older people are cared for within the NHS, and a number of incidents and reports have raised further anxieties about the quality of care in some care homes.
It has been reported, for example, that spot inspections of a significant number of care institutions carried out fairly recently revealed less than ideal conditions in over a third of cases. Some reviews resulted in the possibility of the CQC withdrawing licences to operate. And one review led to the immediate closure of a nursing home.
This is not good news when set against the context of the imminent and profound reductions in local authority expenditure we are facing; rising demographics; a policy trend which continues to see departments of adult social services rightly concentrating on providing care at home rather than in institutions, and one in which clearly some care providers are facing a short term (rather than long term) loss of financial confidence.
Actually, directors of adult social services should in theory welcome the proposals by the CQC to introduce a new `Excellent’ category based on a number of criteria and charged for separately from the registration process. Since the demise of the old quality ratings last year we have been pressing for a replacement and if the replacement genuinely draws upon the experience and views of people who use services then it will once again provide very useful information to those needing services. But there are some concerns we have, and will be raising, over the coming weeks.
Clearly, it’s hard not to sympathise with care home providers who suddenly find themselves having to pay again for something they thought they’d already paid for. Certainly until now they would have been forgiven for believing that the price of the evaluation mark would have been part and parcel of the fee paid to apply for and receive their licence to operate.
That situation could only be made worse if whoever gets the contract to inspect and award the mark – it is being outsourced from the CQC – isn’t able to establish and maintain the same sort of high credibility with the sector and the public that nationally funded inspectorates can and do inspire.
Although there has been some confusion over exactly what standards will need to be obtained before the Excellent rating will be bestowed, there can be little doubt that it will tend to drive costs up at a time when the overall direction of travel is to try to drive them down. Unhelpful, then, and something directors of adult social services will be paying particularly close attention to – especially if it leads to some smaller enterprises not applying for the Excellence award. Local authorities will be inevitably drawn towards Excellent institutions at a time when, equally inevitably, we simply shan’t be able to afford them.
Undeniably the difficult two years ahead will be painful. But they will be endured. And survived. And both surviving and enduring them will be substantially helped if commissioners, providers and regulators can sit down together in the same room, take an adult view of the relationships between the standards required, the resource input available and the cost savings that can be made across the entire operation. We can factor in some of the benefits what will accrue from NHS integration, but not potential gains/losses that could flow from NHS reorganisation. It’s hard to say whether or not, come this summer, the Dilnot Commission on care funding will provide a magical formula to open up promptly new sources of revenue. But don’t hold your breath…
Sarah Norman is joint chair of the Association of Directors of Adult Social Services’ Standards and Performance Policy Network
