At the beginning of the Covid-19 Crisis the Care Quality Commission, the English health and social care regulator ceased undertaking all but essential inspections, to maintain the safety of both the public and their own staff.
They instead established a system known as “The Emergency Support Framework”. This was a way in which they could keep in contact with health care providers across England. The focus remained on the five standards used to monitor health care in England: Caring, Safe, Effective, Responsive, and Well Lead.
Despite the emergency support framework telephone calls being documented and a summary being circulated, the evidence gained was not used to re-evaluate grades or allow action to be taken. As well as gathering information from outside sources and from statutory reporting alongside the emergency support framework calls, it seems the inspection process has stopped.
Only where serious concerns were identified was an inspection considered. We believe the inspection process now needs to start again in earnest. As time goes on and no inspections take place the issues care providers face exacerbate day by day. We fully understand that every provider whether they be rated Outstanding or Inadequate, have gone through a period of enormous pressure managing all the various issues surrounding the Covid-19 Crisis, but there is now a need to focus on inspection.
This may be a strange concept for some to grasp, but it is important to understand the picture faced by some care providers. There are several care providers who have suffered high numbers of deaths during the recent crisis. They have come under criticism from the media when the situation was in some instances out of their control. They will need to demonstrate that all standards are being met. A regulatory review of services will give the public reassurance.
The homes however that really do need urgent inspection are those that before lockdown were rated inadequate. The team at Swift Management Services Limited undertake support of care homes who need to improve following an inadequate rating and where enforcement action has been taken or is likely to be taken. Looking at one of our client’s stories may illustrate the situation:
We started working with one of our clients in late October 2019 when they had received their second inadequate inspection report. Since our engagement we have worked with the provider and supported them through a change process. We have provided regular updates for both the local authority and CQC. The improvements are clear to see. Under CQC guidelines a home rated inadequate should be inspected within six months. We contacted CQC to ask that the inspection be brought forward. The inspector advised that they had planned an imminent review, and would be within the six- month timeframe. This meant that our client only had a few weeks to wait. Then lockdown happened and the inspection process did not take place.
The home has been left for an additional three months without an inspection. Given the last inspection was the second inadequate inspection, should they be allowed to operate for a further nine plus months if the care was not safe without enforcement action being taken? Fortunately, this is not the case for our client. We are pleased to say our client has move on substantially, the care they provide is of a high standard and this can be evidenced. The difficulty they have is their published rating shows as inadequate. This is preventing them from admitting to the home, as the CQC ratings are very much taken into consideration by both local authorities and private clients alike.
If they are to continue to improve, they need the support of the regulator to review their grades which will allow them to admit new clients.
Any home that is rated as inadequate faces extreme financial hardship, as admission levels fall and costs of improvements increase, with no way of servicing the expenditure over an extended period. This uncertainty influences both the provider and the staff. There is uncertainty all around. Thankfully in our client’s case, the Swift Management Team, have been there to support them, and both the management and the staff appreciate our support, advice, and encouragement. They say that our team are part of the family, but that they are not receiving the recognition they need to take their business forward. They need a regulatory visit to review their grades.
Once the inspection happens, we will await with interest the grade they are given. In many cases a home will move from inadequate to requires improvement as the provider needs to demonstrate a sustained improvement. Given the delay in inspection we will be watching with interest as the sustained improvements can be evidenced to the regulator, through our regular submission of audits, feedback and record keeping.
Whilst we have only mentioned one specific client in this article, they are not the only client we have in the same position. We therefore welcome the inspection process starting again in earnest.