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By Debbie le Quesne

CQC special measures – too heavy handed

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The Care Quality Commission intends that special measures for failing adult social care providers will be introduced in April this year.

An online feedback for the proposals closed on January 30. A draft special measures policy will be issued in this month (February), with the final policy being rolled in March 2015.

Doubtless, the proposals will have a significant impact for all registered providers.

My biggest fear is that it will be all too easy to enter special measures and risk cancellation of registration.

LesterAldridge LLP last month issued a healthcare alter warning providers of what’s to come.

The keys points are – stick with it – I know it’s a long read, but it’s important:

  • Entry point of special measures: When CQC carries out a comprehensive inspection against the five “key questions” (i.e. is the service safe, caring, responsive, effective and well led?) and two of those key questions are rated as Inadequate, CQC states that not only will the entire service be rated as Inadequate but this will also result in immediate entry into the special measures process.
  •  Special measures can be entered even if a comprehensive inspection results in only one of the key questions being rated Inadequate. For example, a service might well have an overall Requires Improvement rating following a comprehensive inspection but have a rating of inadequate against just one of the key questions. Where this happens, CQC will carry out a further focused inspection after six months and if this shows the key question to be still rated Inadequate then special measures will automatically follow.
  •  What are the immediate consequences of special measures? CQC state that it will “signpost providers to potential improvement agency support (where they exist) and monitor progress against their plans. The onus is on the service to resolve the issues of concern”. CQC is silent on what exactly “potential improvement agency support” is. Will CQC for example have an approved list of potential care home consultants, lawyers and other specialists or will this be left to the individual discretion of inspectors?
  •  It is significant that CQC state that when a service is placed into special measures CQC will “liaise with the local authority and the CCG so that they can begin planning for service continuity (if they are not doing so already)”. Such notification will almost certainly result in a contractual embargo which might make improvements that much more difficult to achieve.
  • How long will special measures last? CQC states that the process will usually be limited to a period of six months, following which there will be a further comprehensive inspection. At this stage there will be three possible options: (a) If there are no inadequate ratings remaining, the provider comes out of special measures. (b) If there is sufficient improvement made, the provider “may be given an additional six months to improve”. (c) If there is insufficient improvement, CQC will issue a Notice of Proposal to Cancel Registration.

 

In the light of these ‘big stick’ approaches, I would like to see some proper dialogue between CQC and associations like mine. There have been talks about a Provider Improvement Agency and clearly local associations need to be at the table if these plans press ahead.

I’m also concerned that there appears to be an awful lot of importance being placed by inspectors on the Mental Capacity Act and Deprivation of Liberty Safeguards. Being quizzed about such legalities immediately sparks panic amongst my members.

Like so many, they too struggle with the bigger issues of the law, but are perfectly capable of operating within the legislation they know. I suppose a parallel can be drawn if I was to ask you about knowledge of the Road Traffic Act. Not knowing every chapter and verse does not stop a person from adhering to the sections of the Act that allows them to drive safely.

I wonder too about the ability for providers to improve once they are in special measures. Inundated with inspectors, from the Local Authority, CCG, infection prevention, pharmacy, Health and Safety etc – all seeking their improvement as priority – is this a good atmosphere for betterment? I think not.

Inspectors who wish to be heavy handed in these circumstances can expect little co-operation. Micro management of someone’s personal investments by a third-party regulator is never going to be easy.

It clearly erodes already battered confidence and would stop providers recovering in a way they feel part of.

A lighter touch all round please . . . and some dialogue would not go amiss.

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