Care Quality Commission

CARE-HOMES SECTOR LOOKS FORWARD TO THE CQC WITH BAITED BREATH

Bringing care and health together for the first time, the Care Quality Commission is set to have a major impact on regulation in the care-homes sector. The CQC regulates health and adult social care services in England, whether provided by the NHS, local authorities, private companies or voluntary organisations. And the commission protects the rights of people detained under the Mental Health Act.

The CQC promises tougher standards and enforcement, but improvements in provision must be accompanied by greater consultation within the sector, according to Andrea Rowe, Chief Executive of Sector Skills Council, Skills for Care.

Skills for Care covers training for adult care in England and is supported by nine regional committees, the North East, the North West, Yorkshire and Humber, East Midlands, West Midlands, Eastern, London, South East and South West. The Sector Skills Council covers residential care homes and nursing homes, both private and publicly run, as well as local authority social workers.

The trend is for personalisation of care services, and in future more people will be cared for in the community. This means a shift away from care homes, which will increasingly come to cater for people with more acute needs. Rowe says “People needing care will be funded direct by local authorities. And with people free to employ relatives or agency care workers there is inevitably less regulation.” Skills for Care estimates that there are 90,000 people now commissioning their own welfare.

People who go into residential care homes will have more complex needs, such as older people with dementia or Alzheimer’s or people of all ages with sensory impairment or in need of a hospice for end-of-life care. Linking health and social care will be good for this vulnerable clientele. The greater regulatory powers of the CQC means that care homes can be shut if there is a problem.

CQC’s predecessor body used a more relaxed approach to regulation which led to a few isolated cases of abuse, such as the recent learning-disabilities scandal at children’s residential homes in the South West of England. Rowe remarks “It’s a shift from guidance to compliance. Scandals over abuse at care homes will be easier to detect and lead to swift closure.”

The rules are transparent, and homes have to meet a minimum standard and can be given a star ranking in a similar way to schools and hospitals. This is good for informing consumer choice. Says Rowe, “The new standards make it easier for the public to compare residential care even when services are integrated such as health, social care and housing under one umbrella. This is good if you are using or paying for a service.”

But Skills for Care fears that the new standards will lead to loss of focus on the unique problems faced by care homes. Rowe believes that health will dominate the agenda. From her consultations with managers and owners of care homes many fear the new regime. Quite apart from the greater scrutiny leading to the forced closures of badly run homes, training in care could suffer. Rowe says “Our employers and care home owners believe one size won’t fit. And that they will come off worse in terms of budget and training compared to the health trusts.”

Foundation

Until April 2009 the regulation of health and adult social care used to be carried out by the Commission for Healthcare, Audit and Inspection (known as the Healthcare Commission) and the Commission for Social Care Inspection. The Mental Health Act Commission was responsible for all services coming under the Mental Health Act 1983. These three bodies are replaced by a single, integrated regulator for health and adult social care — the Care Quality Commission.

The Bill defines the new commission’s functions in assuring safety and quality, performance assessment of commissioners and providers, monitoring the operation of the Mental Health Act and ensuring that regulation and inspection activity across health and adult social care is co-ordinated and managed.

A risk-based approach means regulation will be targeted where action is required. The CQC has a wider range of enforcement powers along with flexibility on how and when to use them. This will allow the regulator greater powers to achieve compliance with registration requirements — including requirements relating to infection control. The commission will be able to apply specific conditions to respond to specific risks, such as requiring a ward or service to be closed until safety requirements are met as well as being able to suspend or de-register services where necessary.

The new system will enable a joined-up regulation for health and social care, helping to ensure better outcomes for the people who use services. There are already many good examples of integrated health and social care delivery, so the creation of a single regulatory system will fit with this.

While the result may be greater consistency across both health and adult social care and will be the subject of a forthcoming consultation, concerns remain. Andrea Rowe, Chief Executive of Sector Skills agency Skills for Care, explains that under the old CSCI progress was being made towards a professionally trained care home workforce.

She says, “In the last couple of years the care-home sector has moved from 80 per cent of the workforce not having a qualification to 60 per cent of care-home workers with a level 2 NVQ qualification appropriate to their role.” Training is an ongoing challenge, because an ageing population means that the care workforce is projected to double from just over a million to 2.2 million by 2020. Says Rowe, “The average age of care-home workers is late 30s. We’re trying to get that down, because we need to attract younger workers to our sector.”

Skills for Care does not offer training, but it works closely with awarding bodies and stakeholders across the sector to decide on the most appropriate qualifications.

Most care staff are working towards National Vocational Qualifications NVQs levels 2 and 3, but Skills for Care has encouraged many young people into the social care workforce through modern apprenticeships and the diploma for 14–19 year olds. Qualifications like the Entry to Social Care Induction as well as niche training in specialist skills, such as caring for adults with learning disability or autism or caring for patients with Alzheimer’s, are needed to supplement the current generic suite of NVQ qualifications. Rowe explains “The care-home sector needs to move towards specialist qualifications within the NVQ framework including awards, diplomas and certificates for all age groups not just the government’s target 16–19 age group.”

Leadership and management

Leadership and management is a big issue in the care-home sector and problems arise when it is weak. Andrea Rowe does not want to see care homes play second fiddle to spending on health in primary care trusts. Care homes need a champion and are easily ignored. She says “Care homes are for the most vulnerable. People who go into care are people with the most complex needs and it is the most vulnerable who go into them. The problem is that the focus always tends to be on health and social care gets a raw deal.”

This issue is even more acute for groups like Alzheimer’s patients, most of whom are served by residential care. Neil Hunt, Chief Executive of the Alzheimer's Society, comments “The Care Quality Commission has a crucial role to play in driving up dementia care standards. One in three people over 65 will die with dementia, yet there is widespread failure to provide good-quality care for people with this devastating condition. The Care Quality Commission needs to act fast; ensuring regulation is rigorous with an emphasis on regular review and inspection.”

Two-thirds of people with dementia live in care homes and up to one-quarter of hospital beds are taken up by people with dementia. The recently announced National Dementia Strategy is a huge step forward in the fight against dementia. The Care Quality Commission must provide independent assessment of the strategy's impact and progress to ensure it transforms the lives of people with dementia and their carers.

Rowe explains that health and social care enjoy a different status according to the perception that healthcare is about immediate results gained by drug treatment or surgical intervention while social care is more resource-intensive and involves long-term rehabilitation and results that are harder to quantify. Rowe says “Care homes place an emphasis on social rehabilitation and personal therapies. The culture is so different, and I believe social care will stretch the resources of the CQC.”

Better outcomes

Having one body responsible across the board for health and social care and mental health issues will put in place better outcomes for residents or patients in care homes.

CQC’s role is to ensure that essential, common quality standards are met and where care is provided that services are improved. The commission intends to promote the rights and interests of care-home inmates, and it has wide ranging enforcement powers to take action if services are unacceptably poor.

These powers include:

• Registration of health and social care providers to ensure they are meeting essential, common quality standards
• Monitoring and inspection of all health and adult social care
• Using our enforcement powers, such as fines and public warnings or closures, if standards are not being met
• Improving health and social care services by undertaking regular reviews of how well those who arrange and provide services locally are performing and special reviews on particular care services, pathways of care or themes where there are particular concerns about quality
• Reporting the outcomes of our work so that people who use services have information about the quality of their local health and adult social care services. It helps those who arrange and provide services to see where improvement is needed and learn from each other about what works best.

Reporting health and social care information

CQC provides information on the quality of care services to help people who use those services and their carers to make informed decisions about their care. The information we provide to the public is fair, accurate, easy to get hold of and can be trusted. It helps people using health and adult social care services to find quality care. If you are looking for a care home, for example, you can see how one compares to another and how well it might meet your needs or the needs of someone you care for.

CQC tries to give as much detail as possible so that you know how it arrived at its judgement about a service. Sometimes this means presenting technical information in an easy-to-read format or grouping information in a way which CQC’s research and testing tells us is important to the people who use those services.

CQC reports its findings fairly and truthfully. And it communicates its findings with everyone concerned, from service providers to policy-makers and the public.

The information provided helps commissioners and providers of services to compare their performance with others to see where improvement is needed, and to learn from each other about what works best.