Response to the Commission for Social Care Inspection’s proposals on Star Ratings

The Coalition for Quality in Care (CQC) is a grouping of organisations and individuals concerned with the care of frail and vulnerable older people. It includes national charities, independent sector care providers, health and social care practitioners, older people’s representative organisations, concerned individuals and academic researchers. CQC’s main purpose is to promote and improve the quality of care in services for older people, in a range of settings, through campaigning, debate and example. The Coalition has 40 members and the following have endorsed this submission:

At a recent meeting of the Coalition it was resolved to submit a response to CSCI’s proposals on star ratings. Concerns were expressed from all those present that the Commission had given insufficient attention to the implications of its proposals for both (potential) service users and care providers. In particular the meeting expressed the following concerns:

• How will the services be judged and stars awarded - there are inconsistencies and omissions in the KLORA. There is also a lack of standardised comparisons between one level and another.
• According to the consultation document and the KLORA, it appears that a single star can be given to homes that are breaching regulations and national minimum standards (NMS) – i.e. a home that is unsafe and not ‘fit for purpose’ would be given approval to continue operating through the award of one star. There is little evidence so far that improvement plans ‘bite’.
• Stars will be awarded only after a key inspection and will remain for up to three years. This is unfair in two ways: for the person looking for a safe and good quality care home, the assessment may be out of date and belie the actual current standard of the home. For a care home, despite improvements that it may have made, it cannot be re-assessed for stars until the next key inspection.
• There appears to be no right of challenge for providers.
• CSCI argues that star ratings improve choice. This is impossible under prevailing circumstances where it is widely agreed there is no choice for local authority funded residents. Self funders may have to make do with one star because it is all they can afford.
• Care homes are not hotels – and yet people are being encouraged to regard them in the same way. Older people who are frail and in need of high level 24 hour care cannot always pick and choose.
• Star ratings may affect staff morale, positively in high rated homes, but negatively in poor rated homes.

The Coalition urges CSCI to reconsider its proposals and ensure the proposals are properly tested before full implementation.