Care Provider Alliance calls for “urgent change” to regulator’s single assessment framework

A new Care Provider Alliance (CPA) review into the CQC’s Single Assessment Framework (SAF) has been published. Its review, which was commissioned by the CQC alongside the work of Professor Sir Mike Richards, examined the perspectives of social care providers of SAF and what they want from future regulation. It also raised provider concerns about backlogs and assessments, with many describing the assessment experience as “inconsistent, stressful, and disorientating”.

The CPA project was formed of two stages. The first stage involved an online survey gathering over 1,200 qualifying responses. The second stage involved 100 care providers in five 90-minute workshops. The project also had input of a steering group, comprised of 19 representatives from CPA member organisations and a range of care providers who form part of the CPA membership.

Several issues were raised across both stages of work, with themes covering:

• Quality statements: Need to be more precise, contain more detail and no longer overlap.
  
  
• Experience of assessment: Providers who have been assessed under the SAF describe staff feeling “devasted” and “distressed”, with registered managers leaving their jobs, and organisations considering closing their services. “These experiences were consistent between those who received both good ratings and requires improvement ratings.” Inspection teams have “often not communicated throughout the inspection process” resulting in care providers not knowing what they have been assessed on, or how their assessment has gone. 
  
  
• Challenging outcomes: Providers describe the process as “very difficult, lengthy and frustrating” and “often yields little to no satisfactory outcomes for providers.”
  
  
• Inspection teams: Inspectors did not always have sufficient knowledge of the wide diversity of service types within social care, and the changing context in which they operate, resulting in inappropriate and inaccurate conclusions about services.
  
  
• CQC reports: Reports were often unclear, inaccurate and not timely, meaning ratings were not meaningful to the public, and the inspection process and report do not drive quality improvement for providers.
  
  
• Communication:
  • With the CQC has become “very difficult” for providers, with “no reliable route through online systems” with “often” no acknowledgement or feedback.
  • Within CQC does not appear to reach all inspectors, with inspectors not always aware of recent change.

James Bullion, chief inspector of adult social care and integrated care at CQC, said of the review:

“This report gives us a practical agenda for change which we will incorporate into our urgent improvement work underway in CQC. Professor Vic Rayner, as chair of the CPA, met with me and my executive team colleagues and with the CQC board to discuss the findings of this report. She articulated a powerful message on behalf of providers, including in some cases the distressing impact of approaches to regulation and assessment on their organisations and mental wellbeing. We are grateful for their feedback and acknowledge their experiencw.

We acknowledge too the strength of feeling from providers about the need to improve their experience of inspection. Underlying this report (but not looked at in detail) are the changes needed to improve our computer systems, portal arrangements and communications. CQC colleagues have themselves struggled with the challenges caused by the technology issues and rollout of the assessment framework, including the clarity of how the system worked, training, complexity of the approach, and the consistency of approaches in different care sectors. CQC inspectors are skilled and dedicated to good regulation and have struggled to be effective because of these factors.”

Recommendations

• The review makes 11 recommendations around three core areas:
• Changes required in the functioning of SAF.
• Care providers’ poor experience of assessment.
• What needs to change in terms of culture and communication internally and externally with the CQC.

In brief, the recommendations include:

1. Limit quality statements to under 20.
2. Develop guidance for each service type at the quality statement level.
3. Use the Provider Information Return to plan assessments.
4. Share assessment plans, including evidence requests, with providers and give them advanced notice of inspection.
5. Verify evidence before using it in decision-making to ensure a balanced evaluation of the service.
6. Rewrite provider reports for those published between implementation of SAF and the “stabilisation of the regulatory approach”.
7. Engage in co-production with providers during CQC’s recovery programme.
8. Reintroduce single point of contact/named inspector for providers.
9. Train inspectors to understand the range of provider types.
10. Establish an independent body to mediate all complaints and challenge processes.
11. Ensure changes in regulatory approach are communicated with inspection teams to reduce inconsistencies in implementation.

CQC will now consider the recommendations, with some subject to further discussion, policy change or consultation. Readers will be aware that CQC is developing a handbook which describes what they expect from providers and what providers can expect from CQC.

Our content explained