Two landmark reports have been published in recent weeks analysing the operational effectiveness of the Care Quality Commission (CQC) and its Single Assessment Framework (SAF).
Dr Penny Dash’s review found ‘significant failings’ in the way the CQC operates alongside a substantial loss of credibility in the health and care sectors regarding the CQC’s ability to identify its own poor performance and efforts to improve quality of care.
Meanwhile, Sir Mike Richards found that the CQC has been unable to fulfil its primary purpose “to ensure health and care services provide people with safe, effective, compassionate high-quality care and to encourage these services to improve.”
He also said the SAF is “far too complex and, as currently constituted, does not allow for the huge differences in the size, complexity and range of functions of the services that CQC regulates. One size does not fit all.”
These reports have bought into question whether the CQC can continue to operate in its current form. But what would a good model of social care regulation look like? And how can we ensure this model works for both providers and those they support?
Using evidence provided by learning disability and autism care providers, ARC England has published a vision statement for the future of social care regulation.
From the recommendations set out in the statement, it is clear that care providers want to see changes in how the CQC operates. The research shows that care providers feel ‘strangled’ by red tape and spend more time proving they are doing a decent job than they actually spend doing it.
ARC members say they see an opportunity for a once in a lifetime ‘reset’ of sector regulation, as Clive Parry, ARC England Director, says: “If the CQC were a provider, it would be rated ‘inadequate’… We need to be bold because people who depend on services now require this of us.”
One of these ‘bold’ suggestions is to move away from a standalone national regulator and towards local independent regulation; this would see local authorities become responsible for regulating services thereby reducing the duplication of work that arises when the CQC and local authorities both ask for the same data to review policies and procedures. However, this would need to be properly funded given that many councils are already cash strapped.
If we do retain a standalone regulator, ARC members say we must ensure that all services for people with behaviour that challenges are regulated, not just those which are accommodation-based. They point to the fact that many vulnerable people draw on support from services which are not regulated (i.e. day services) putting them at risk of abuse and severe restrictions.
ARC England members say they would also like to see ‘whole system’ inspections rather than taking a scatter gun approach. This approach would look at Integrated Care Systems (ICSs) as a whole, providing a fuller and more accurate assessment of the system than merely looking at services in isolation.
They would also like to see the CQC take a different approach to inspections by ensuring they are consistent across the board and based on publicly available guidance. Members also suggest creating ‘specialty divisions’ among the inspectorates so that learning disability care providers, for example, are assessed by someone with specialist knowledge of learning disabilities.
Importantly, ARC is also calling on the Single Assessment Framework (SAF) to be ‘abandoned’. In fact, last week the membership organisation announced its withdrawal from the Care Quality Commission’s SAF review citing a lack of consultation.
ARC England says it was invited to participate in Richards’ review, but on 15th October, they discovered the review had been published without their insights. While the review indicated that consultations had taken place with certain membership bodies, ARC England says their views were not included, ultimately leading to its withdrawal from the SAF project.
ARC England members say the SAF is flawed because it only looks at a small number of elements and does so in an overly magnified manner that is focused on identifying issues rather than good practice.
Parry says the SAF does not allow for “proportionality or context regarding a complex environment which faces daily operational challenges that inevitably mean that some things will be secondary.” He also warns that the framework could lead some inspectors to take the SAF findings at face value, failing to differentiate between a fairly minor issue and a more serious concern.
In doing so, he likens the framework to an MOT: “If we can manage to identify serious problems during an MOT that mean the vehicle must not be driven any further, as well as items that are noted on the advisory list, why can we not do this for service inspections?” he asks.
Parry adds that this framework can also lead inspectors to view services through a historical lens, with some inspectors placing too much emphasis on a singular event that happened in the past, rather than maintaining a sense of perspective.
What is the Single Assessment Framework?Historically, the CQC had different frameworks for healthcare and social care services. The Single Assessment Framework (SAF) is a streamlined approach which enables the CQC to assess all health and social care providers using the same framework. The framework emphasises external best practice, evidenced via the CQC quality statements which are mapped out in five key areas following a CQC inspection: safe, effective, caring, responsive and well-led. The quality statements are written in the style of ‘We’ statements to help providers understand what is expected of them. For example, “We listen to concerns about safety, and investigate and report incidents thoroughly”. These statements are also linked to “I statements” written from the perspective of service users to help the provider understand what a good experience of care looks and feels like, i.e. “I am in control of planning my care and support. If I need help with this, people who know and care about me are involved.” The Single Assessment Framework was first brought in November 2023, replacing the old Key Lines of Enquiry (KLOE) with the new topic areas and quality statements. |
ARC England says the most powerful expression of fairness would be the implementation of a ‘just culture’ which focuses on learning from mistakes rather than assigning blame.
If we maintain a standalone regulator, learning disability and autism service providers want to see an organisational culture that values:
“Arguably, the single biggest area for improvement which represents the most powerful opportunity to transform the regulation of social care services is the way we address the issues surrounding the culture of the CQC, both internally and externally. A shift towards a just culture would move us towards this,” Parry said.
The CQC have been contacted for comment.
