CQC has increased enforcement action through new powers

CQC have used new powers that have resulted in an increase in enforcement action by 75% according to its 2016/17 annual report. Enforcement actions rose 75% in the year to 1,910 compared with 1,090 in the previous year after the CQC received new powers to prosecute in April 2015. The CQC carried out its first four prosecutions under its new powers. There were 1,271 enforcement actions in progress as of 31 March 2017, the majority of actions were warning notices (1,352). Given the number of warning notices and the small number of prosecutions that actually took place, there appears to be a reluctance on the part of CQC to prosecute unless it involves the most serious of offences.

View of the Chief Inspector The CQC Chief Inspector of Adult Social Care, Andrea Sutcliffe, has said: “This is not about creating a climate of fear – I would much prefer providers to deliver great care and improve when they don’t. “But good providers and the public need to feel confident that when poor care is exposed, those responsible are held accountable so we can restore confidence in this vital sector and demonstrate quality does matter.” A total of 740 providers were placed in Special Measures with 657 coming out, 470 of those did so because they had made substantial improvement.

Complaints The number of complaints received by CQC about the quality of care is quite alarming. There is evidence in this report that the major concern that leads people to complain in caring for service users is the safeguarding of their health and wellbeing. The regulator received 76,634 contacts from people with concerns compared with 80,567 in 2015/16. Of these, 42% (31,826) related to safeguarding concerns, 0.2% (158) were safeguarding alerts, 49% (37,217) were complaints about providers and 10% (7,433) were whistleblowing. Given that 10% of complaints came through the whistleblowing process suggests the there is evidence that those who have a concern are aware of how and to whom they should make a complaint. There were 2,353 Mental Health Act complaints with 7,413 total contacts (including new complaints, enquiries and follow-ups to complaints).

Complaints about the CQC service The regulator received a further 413 complaints about its service, down from 441 in the previous year. These included the tone and attitude of inspection staff during visits, the general competency of the inspection team around evidence collection, and potential bias and pre-conceived ideas of the service and looking for negatives, as well as administration and the handling of information about registered services. The report suggests that there is hardly any improvement with a drop of only 28 complaints against the regulator during the year. The CQC commented: “We encourage staff to learn from complaints and in some cases, we offer additional training and guidance.”

Oversight of the market In its market oversight capacity, the CQC continued to monitor the financial sustainability of large, hard to replace adult social care providers. As of 31 March 2017, there were 51 providers in the scheme. The CQC said care home providers were more resilient than domiciliary care providers but still experienced an overall decline in profit margins. It highlighted increased staff costs and the National Living Wage as the main pressures on providers. The CQC’s revenue expenditure amounted to £226.2m in the year, representing a £12.4m decline on the previous year. Income rose by £40.6m to £149.6m following a fees consultation that will see most providers paying the full costs of regulation.

Summary The CQC annual report hardly makes good reading for providers of social care services given the large number of complaints to the Care Quality Commission. However, the report provides no evidence of substantiation or satisfactory resolution to the complaints. The use of the CQC new powers as a means of effective enforcement action has resulted in an increase in enforcement actions, but limited use of prosecutions. Is it a case that CQC have to let providers know that where they are seriously concerned about a service they will use their powers to prosecute? Safeguarding remains the central issue of complaints against providers of social care services, and there is evidence in this report that people are prepared to whistle- blow if they are concerned about the health and wellbeing of service users. Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy