In the coming year the CQC will be embarking on its new single regulatory model based upon ‘quality statements’. Signalling a new drive to improve the quality of care in social care services. This is at a time when a report about the work of the CQC shows a dramatic fall in the number of inspections.
Evidence of a fall in CQC inspections
The number of inspections in the UK’s care sector have fallen dramatically in the last seven years, as the Care Quality Commission (CQC) continues to evolve its regulatory model, accelerated by the coronavirus pandemic.
From 2015 to this year, the number of inspections undertaken by the CQC has dropped by around 97% – from a peak of almost 23,000 to just over 8,000 to date in 2022.
Understandably, there was a significant reduction across all types of inspections during 2020 as a result of the pandemic, with the CQC temporarily ceasing all physical inspections from 16 March.
The figures obtained through a Freedom of Information (FOI) request to the CQC – conducted by Pannone Corporate – also shows that announced inspections fell from a peak figure 6,684 in 2019 to 3,593, with unannounced inspections also decreasing, from 19,586 in 2016 to 4,663 to date in 2022.
Exploring the reasons behind the decline
Bill Dunkerley, regulatory lawyer and associate partner at law firm, Pannone Corporate, commented: “It’s very clear that the coronavirus pandemic had a profound effect on the CQC’s ability to carry out inspections, despite a number of inspections taking place by means of its Emergency Support Framework.
“However, what is clear from the figures is that inspections have been progressively declining over a number of years, from their peak in 2016.
“The reason for this decline is unclear, given that inspections are the primary way the CQC monitors compliance. Anecdotally, there may have been an initial backlog from when the new legislation came into force, with the CQC reviewing every application for re-registration.
Change in strategy
The CQC has adopted a compliance to standards approach to inspection. It is relying more on providers completing documentation and inspectors reviewing for compliance.
Services rated good will receive fewer inspections with the focus on those who are not up to standard receiving more frequent visits.
The new single regulatory model and quality statements is much less specific than the former Key Lines of Enquiry which were based on inspectors prompts whereas the ‘quality statements’ are underpinned by a more regulatory approach. This makes it far easier for CQC to take legal action against providers who do not comply to specific regulations.
As the Commission continues to capture information and rate providers in accordance with the new standards, there is less need for unannounced inspections, with Inspectors proceeding instead by way of ongoing monitoring and announced follow-up visits in response to specific concerns received.
Mr Dunkerley explained that this reflects the CQC’s revised and evolving regulatory model, which emphasises targeted inspections in response to specific concerns received. He continued: “Moving forward, this risk-based approach is likely to continue as part of the Commission’s move towards a ‘single inspection framework’ and programme of rolling multi-point assessments.”
“What is evident from the CQC figures is that in terms of enforcement, notices remain by far the single most commonly used regulatory action by the Commission, accounting for more than half of its enforcement activity.”
“The changing landscape and evolving position of the CQC cannot detract from the fact that the Commission is still eager to impose conditions, cancel registrations and vary conditions of care providers,” Dunkerley explained.
He says it’s imperative that service providers review their procedures, systems and address risk areas in anticipation of inspection or intervention. The most effective management, however, is to avoid the initial set of circumstances that bring about regulatory intervention or investigation.”
Summary
Evidence from the freedom of information request confirms the dramatic decline in the number of inspections of social care services carried out by the CQC. The focus in future will be on those services who fail to reach compliance to standards. Taking enforcement action against those providers who do not meet specific regulations.
Reviewing documentation by inspection teams has its place but is secondary to site visits were quality of the service being provided can be observed, and the views people who use the service listened to and taken into account.
Albert Cook BA, MA & Fellow Charted Quality Institute Managing Director Bettal Quality Consultancy