aware that commissioners are being informed of perceived failures in services and
contracts are being affected as a result of this information sharing.
Glancing at the CQC website will often reveal information about enforcement
action being taken against care homes or reports of the failures of NHS trusts, and
there are also regular updates about how CQC is progressing in its urgent review of
all learning disability services following the Winterbourne View investigation. It will
not be surprising if CQC is now more robust in its inspection style.
So what are the implications for substance misuse service providers? My view
is that treatment services for substance misuse registered with CQC will need to
be vigilant rather than complacent in the light of the trends highlighted. Some of
the implications may be:
• Delayed inspections due to the slippage in the CQC timetable and focus on
learning disability services
• New inspectors who may not be familiar with the substance misuse field
• No prior warning of a CQC inspection
• No opportunity to send completed provider compliance assessments to CQC
before an inspection visit
• Highlighted concerns may be communicated to commissioners
• An emphasis on safeguarding and safe recruitment procedures
• A much tougher approach to enforcement, even if you’ve been a good provider
On the positive side, however, experience has shown that CQC inspectors spend
a good deal of time listening to people using services on their visits. This is in line
with their ‘observational tools for inspectors’ documents which suggest that 50
per cent of their time should be spent with service users, and an examination of
inspection reports shows that many people using services are saying very positive
things about the treatment they are receiving, especially in residential services. It
appears that this then guides the inspectors’ thinking as they write their reports.
So, whilst it may be tricky dealing with CQC, an experience akin to dancing on
ice, when one slip could be disastrous, it is possible to succeed and have a
positive inspection report placed in the public domain.
David Finney was the policy lead for substance misuse services in the
Commission for Social Care Inspection (CSCI) and is now an independent social care
consultant specialising in the inspection of substance misuse services.
DDN/FDAP are holding a workshop on 14 March in London looking at the new
inspection regime and how you can be prepared for your next inspection. For more
details email kayleigh@cjwellings.com or call 020 7463 2085.
On the positive side, however,
experience has shown that CQC
inspectors spend a good deal of
time listening to people using
services on their visits.
THERE HAS BEEN MUCH CRITICISM
RECENTLY OF THE CARE QUALITY
COMMISSION (CQC) in the press, on TV, in
government circles and in health and social
care journals. The question is, what implica-
tions will this have for the substance
misuse sector?
Those who watched the BBC’s
Panorama as it investigated the
Winterbourne View hospital for people with learning disabilities couldn’t help but
be shocked by the abuse of vulnerable people. In the aftermath, CQC and the local
authority came in for criticism as they were seen to have delayed their response
to the whistle blower, and questions were asked about an inspection regime that
could allow a three-year gap between visits.
The National Audit Office published a report in December 2011 in which it
outlined that fewer than half of the CQC’s planned reviews were completed in the six
months to April 2011. It also highlighted that by September 2011, 14 per cent of all
CQC posts were unfilled, with a high proportion in registration and inspection activity.
In September 2011 the Health Select Committee pointed out that ‘the bias of
the work of the CQC away from its core function of inspection and towards the
essentially administrative task of registration represented a significant distortion
of priorities’. This partly explained why inspection activity was low initially, and then
in December 2011 the public enquiry into the Mid Staffordshire NHS Trust heard
evidence from a CQC board member, Kay Sheldon, in which she criticised the
leadership and culture of the organisation.
A recent policy initiative, Recognising excellence in adult social care, whereby
outside contractors were to be appointed to award excellence ratings has also
been dropped after criticism from provider associations concerned about the cost
and lack of objectivity of the scheme. Public pronouncements from CQC have
indicated that they are progressing with the appointment of new inspectors and a
revamped inspection regime, and thereby hope to increase the number of
inspections, or reviews, undertaken this year.
A recent consultation document highlighted changes that CQC intends to
introduce including:
• Inspection visits once a year, all unannounced.
• Targeted inspections, focused on a smaller number of outcomes
• Reports that focus only on areas of ‘non-compliance’
• An enforcement regime that offers no extension of timescales
• No reference to a provider’s previous track record
• No encouragement of improvement without enforcement action.
In response to concerns about perceived unresponsiveness to whistleblowing,
CQC has also published a document entitled Raising a concern with CQC – a quick
guide for health and care staff about whistle blowing. This raises the profile of CQC
as a public body concerned about safeguarding issues in regulated services with
the expectation that it will take action.
On the ground, the experience of providers is that CQC is now quick to undertake
inspection visits if concerns have been raised with them by staff members, relatives,
professionals or other members of the public. Behind the scenes, providers are also
February 2012 |
drinkanddrugsnews
| 15
Regulation |
Care Quality Commission
www.drinkanddrugsnews.com
GAME CHANGER
The Care Quality Commission has had its share of bad press
recently, and is toughening its approach as a result. But, says
David Finney, that shouldn’t be cause for despair