Jenny Wilde, Partner at Acuity Law, shares her thoughts about inspections under the Care Quality Commission’s (CQC) Single Assessment Framework
The CQC has probably, at the time of writing, performed around 100 inspections using its new, Single Assessment Framework (“SAF”).
Providers have had the opportunity to review the new quality statements and the update guidance on how these inspections are likely to work. But the real-time experiences are rolling in and there is no better way to get a feel for the new regime than the anecdotal experience of other providers.
I have to admit, I was hopeful but sceptical of the new system. An approach that is more remote, more digitised, and only reviews limited aspects of a service at a time felt like a cost-saving exercise that served a regulator in crisis, rather than a solution for an over-stretched sector.
But I am a cynical lawyer.
I had glimmers of hope that the new portal would streamline information sharing, that the additional layers of staff could deliver more support to providers and that dynamic regulation would have a positive impact on those that have not been inspected for years. Whilst these positive outcomes could still apply, the feedback has raised serious questions about our new frontier.
Remote Inspections and the burden of documentation
As part of the new regime, the CQC is going to do more work “off-site”. This means the days of having an inspector holed up in a service’s side room, looking at policies and care plans, are likely gone. Whilst staff and registered managers will breathe a sigh of relief, what this does mean is that documentation has to be provided in a different way.
A client of mine has reported receiving an email from the CQC containing a list of 75 questions and requested documents. The documents are specific, as are the questions. The CQC’s expectation is that all of this information will be promptly uploaded to the portal to enable remote review. Whilst this is a clear benefit to CQC inspectors and assessors (who will have less “digging” to do) it creates a new obligation for Registered Managers and senior staff. This will inevitably be a time-consuming task which will have to sit alongside the stresses and strains of typical managerial duties.
Given the promise that the new regime will lead to “dynamic” regulation, it could mean that these extensive requests come on an ongoing basis. Time will tell what impact this will have on day-to-day duties, but what is clear is that the better organised your evidence is, the more likely you are to be able to comply with requests for documentation at speed.
An online system is obviously more efficient but this cannot be to the detriment of care home staff who simply have the burden shifted to them. They should be focused on delivering excellent care, not making the lives of the CQC easier.
Absence of consistent inspector relationships
The provider / inspector relationship, as we know it, is a thing of the past. Teams with multiple members will now input into social care services.
Whilst those with challenging relationships with their inspectors will be over the moon with this change, many will miss having a single point of contact to ask questions, raise concerns or generally turn to for advice in difficult regulatory scenarios. Whilst the CQC has never been keen to provide any kind of meaningful support to providers, it can be comforting to know that you have a person at CQC who understands your service and could support you with issues involving other stakeholders.
The reason for this change is sensible and the massive staff turnover and sickness figures at the CQC mean that your single point of contact could suddenly disappear or is on leave indefinitely. It therefore helps to have multiple people available to avoid a bottleneck when someone is unavailable, however, does this mean that their knowledge of your service will be diluted or that their understanding will not be as deep (as they have many other services to work with)? The impact of this will become clear in due course.
Available evidence – demonstrating an Outstanding service
The CQC has recently clarified that it wishes to move away from “risk-based” regulation. This had previously seen inspections triggered by adverse incidents, safeguarding issues or complaints. Naturally, this set reviews off on a negative footing whereby the regulator would be looking for evidence to corroborate the adverse report rather than looking for positive evidence.
The CQC intends to revert back to its approach of “looking for Good” during its reviews. Whilst this is a welcome decision, providers need to examine how they are going to evidence the more positive aspects of the care they deliver through a remote inspection. It is easy to upload positive care plans, detailed audits and comprehensive staff rotas into the portal, but where in-person observations of care are likely to reduce, how do you show the CQC how good you really are? Creative thinking should be applied to showing the impact of activities, service users’ feedback and the innovative aspects of your care and environment.
Conclusion
I think we all want the new regime to work, but not to the detriment of staff working in the sector that are inevitably going to have to undertake more administrative tasks on behalf of the CQC. This is not fair or reasonable. Remote regulation can work, but the human side of inspections is crucial and it should not become a tick box exercise where CQC inspectors demand documents, review them in the comfort of their own home (without staff context or answers where there are queries) and simply fire out judgements at will.
The system is evolving but it should benefit everyone, not just the purse of the CQC.
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