1.1 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, 'for profit' and 'not for profit' 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.
Our members are:
- Age Care
- Age Concern England
- Alzheimers Society
- Anchor Trust
- Association of Charity Officers
- Beth Johnson Foundation
- Better Government for Older People
- British Geriatrics Society
- Care Regulators Association (CRA) / NAIRO
- Community Integrated Care Ltd
- Counsel and Care
- Eastwards Trust
- Elizabeth Finn Homes Ltd
- Heart of England Housing Group Ltd
- HICA Specialised Care Homes
- Hunt & Almshouse Charity of the Skinners' Company
- Independent Member; Finbarr Martin
- Independent Member; Judy Downey
- Independent Member; Kina, Lady Avebury
- Independent Member; Paul Ridout
- IndependentAge
- Leaders of Worship & Preachers Homes (LWP Homes)
- Lester Aldridge Solicitors
- National Care Forum
- National Housing Federation
- Relatives & Residents Association
- Salvation Army Social Services
- Servite Houses
- SSAFA Forces Help
- The Brendoncare Foundation/VOICES
- The Royal British Legion
1.2 This submission responds to the proposals to amend the requirements regarding frequency of inspections and quality assurance self-assessment in relation to care homes as set out in the Department of Health's consultation document, dated 14 October 2005. The response submitted here summarises the broad points on which the member organisations of the Coalition as listed above are generally agreed. Some of these organisations are submitting their own detailed responses to the consultation document which will inevitably focus on issues from their own perspectives and therefore opinion within the Coalition may differ on some aspects in some instances.
2. Background to the current position
2.1 The Coalition is concerned that lessons from the past may be forgotten.
Specifically, it is important to recall the situation prior to the Care Standards Act 2000 when care home providers were concerned about redressing what they saw as unfairness in the regulatory system as it prevailed then. They were concerned about inconsistency in inspections, lack of transparency in how inspectors made assessments, and the absence of a level playing field between local authority and 'for profit' and 'not for profit' homes.
2.2 It was generally accepted by the end of the 1990s that regulation needed to be reviewed and that an attempt to reduce inconsistency, redress unfairness and develop a user focus should be made. There was a clear evidence base - developed during the eighties and nineties by academics, practitioners, provider and user organisations - pointing to the way in which this should be done. The Care Standards Act, its Regulations and associated National Minimum Standards (NMS) were the outcome.
3. The current position
3.1 The Care Standards Act 2000 Regulations and NMS have been in operation since 2002. During that time the regulatory regime has already been changed (with the 2004 merger of the NCSC with other bodies to form the Commission for Social Care Inspection and some consequent changes, more recently, in inspection methodology). Now a more wide-reaching review of regulations and standards, within an even broader governmental review of regulation as whole, is underway. This submission is concerned specifically with the proposals in the consultation document to lighten the inspection regime by focusing more attention on poor providers and less attention on the good ones (frequency of inspections) and relying on self-assessment by providers themselves (QA self-assessment).
3.2 The Coalition is concerned about these developments for a number of reasons:
- Coalition members are agreed that there needs to be a balance between regulatory burden on providers and the protection and safeguarding of the interests of care home residents (as stressed in the 2005 OFT report on care home contracts). However as yet there is no published evidence base to support the argument that regulation is currently too onerous and needs to be relaxed.
- The existing system needs to be given time to settle in. The care home sector has already had to adjust to radical changes in the way in which it is regulated. Further change may undermine already excellent developments in quality improvement in the sector.
- It appears that inspection methodology has not so far been given a proper chance to develop and be tested. Many of the weaknesses in the current regulatory regime can be put down to a failure to develop an evidence-gathering approach in assessing care home performance against the regulations and NMS and to the insufficient training of inspectors in undertaking their new roles in a new system.
- The proposals to lighten the regulatory burden ignore the views of service users themselves, as well as the families and organisations that support them. Generally, they want more inspections and more unannounced inspections.
4. The proposals
4.1 Focusing CSCI efforts on where it is needed
The Coalition is concerned that 'proportionality' may in some instances lead to poor practice unintentionally going unnoticed. Members know that the 'regime' in homes can deteriorate almost overnight for a whole variety of reasons (many of them unpredictable) and that such deterioration needs to be speedily identified. They need to be convinced that the triggers that CSCI is developing to alert them to possible cause for concern will actually work. Any failure could put residents in serious jeopardy. Until the CSCI has demonstrated clearly that it has the capacity to identify and respond to instances of poor practice developing, the Coalition urges caution in introducing further regulatory changes - especially if they are to take effect in April. It is important that stakeholders have an opportunity to see and comment on the detail of the proposed changes.
4.2 Self-assessment
Self-assessment is an important tool for quality improvement and many providers are using it to positive effect. However, if regulators rely too heavily on self-assessment - alongside fewer inspections - there is a risk that the inconsistency and variability of the past may return. Reporting procedures will need to be rigorously designed and piloted to ensure that the evidential triggers (to ensure additional inspections take place where necessary) work properly and that the safety of residents is not jeopardised. All homes will presumably need to have IT systems in place to ensure that the reporting procedures work efficiently. CSCI's own IT system will need to be robust to handle the process. If any of these requirements fall down, the new system will fail and older people themselves will be put at risk.
4.3 It is unclear as to how standardised self-assessment systems for annual quality reporting will have to be - if there is no standardisation, inconsistency and variability may present serious risks. Many providers already have excellent self assessment systems. Others have none. There is a danger that the incoherent days of the 1980s and 1990s - with providers working to a wide and variable range of standards - will return. Coalition members think that, while self assessment is valuable for internal use for improving performance, it should not be used as a tool upon which regulation should almost wholly rely.
5. Conclusion
5.1 The Coalition argues for improved inspection. Furthermore, it has some concerns about over-reliance on self-assessment as the dominant way of reducing risk. The general public, and service users in particular, want more inspection, not less. We believe that such views need to be listened to before major change is introduced.
5.2 Overall, the Coalition, representing a wide range of organisations and individuals, would like to see more time given to the current system settling in and being improved incrementally rather than being submitted to yet another 'roots and branches' overhaul. The current proposals are merely the first in a range of changes to regulation to be mooted. We urge caution and careful re-consideration.
policy
