New era for CQC regulation

A lot has changed since the advent of the CQC and there are more changes on the way. David Finney explains what services can expect in the coming months and years.

It’s been three and a half years since the formation of the CQC, this monolithic government body to regulate health and social care, so what has been the impact on the substance misuse sector and what are the implications of the CQC’s change in direction?

To date, I think that our experience has been mixed. Some services have actually had an inspection that gave them a positive report while others have not been so lucky, and services previously rated ‘excellent’ have struggled to make themselves understood to CQC. Others are still awaiting an inspection and unsure what to expect, while Walsingham House was closed as a result of its inspection. So what can we expect in the future?

The national context is interesting, as CQC has been roundly criticised by the press, provider associations and, most significantly, the government’s own health select committee. The criticisms have led to changes in the way CQC operates, with the most significant change being the resignation of chief executive Cynthia Bower and her replacement by David Behan, former director of social care at the Department of Health.

I view this as a positive step, having worked for David Behan at the Commission for Social Care Inspection (CSCI). My experience then was that he was a man of vision and clear thinking and had a passion for quality. For the substance misuse sector it’s also reassuring to know that he has been chair of a DAT – there’s reason to believe that he will ‘get it’ in relation to this sector. Furthermore, CQC chair Dame Jo Williams has also recently resigned, leaving more scope for change.

What is CQC up to at present?

Among other things, it is:
– Focusing on registering GP surgeries – it’s possible that GPs will have to declare in their statement of purpose whether or not they have staff who are substance misuse specialists.
– Implementing the document Improving the way we regulate, which means annual unannounced inspections for all providers and a focus on looking for non-compliance rather than good practice.
– Responding to whistle-blowing as a priority, in the wake of Winterbourne View.
– Recruiting 255 extra inspectors – while this will result in extra staff, there will still be delays in inspections given the necessary induction period, and perhaps less likelihood that your inspector will have experience of inspecting substance misuse services.
– Launching a consultation on its strategy for 2013-16. This includes a risk-based approach to inspection, which means visits according to assessed risk rather than on a routine basis. CQC will also be relying on information from local authority commissioners and Public Health England as well as complaints and notifications. This is a change from the current system, so please visit the CQC website and respond to the consultation if you have strong views.
– Commissioning research into ways to improve regulation, in conjunction with Manchester Business School. This is a long-term project but one to watch in case new thinking emerges.

What are the immediate issues for the substance misuse sector?

– For the rest of this inspection cycle – until March 2013 – the methodology of looking at a few outcomes on a visit still applies. You can expect inspectors to focus on involvement of people in the running of the service, care planning, safeguarding, staff development and quality monitoring. Much of the evidence will be gained through talking with service users and staff as well as looking at your record keeping.
– If you run a residential service expect some puzzlement from inspectors if they see that your service type is ‘care home’ but you don’t deliver ‘personal care’ in terms of practical caring tasks. If this is the case you could ask to be re-designated as a ‘residential substance misuse service’, where the focus is on psychosocial treatment and the need to share rooms can be therapeutically justified.
– Tougher enforcement – CQC has developed a ‘regulatory escalator’ which moves providers much more quickly to statutory warning notices, and just one major concern can trigger this action. There is also the power to publicise the action – and the local press do tend to be interested – so there could be serious consequences for the commissioning of services, as Walsingham House found out to its cost. Advice giving by inspectors is a thing of the past – the emphasis now is on assessing compliance.
– Next year, expect a whole different raft of outcomes to be inspected. CQC says that from April 2013 it will look at one outcome from each heading in the ‘essential standards’ so, for example, they could assess consent under the Mental Capacity Act, nutrition, medication, staff recruitment or complaints, or any outcomes not previously assessed.

My advice, therefore, is don’t leave anything to chance and undertake a thorough audit of your service according to the CQC outcomes. You should also be prepared to explain to an inspector exactly what your service does, as they may have no prior experience of the sector (the document Preparing for CQC inspection on the CQC website offers practical tips). You also need to ensure that staff are fully aware of whistle-blowing arrangements and the role of CQC in safeguarding and complaints management. And finally, keep providing a quality service that thoroughly meets the needs of your service users and fully involves them in the treatment they receive.

David Finney is an independent social care consultant with a specialist interest in the regulation of substance misuse services.