When is an up-to-date CQC rating not up-to-date? When it’s awarded under the new inspection regime

23rd May 2024

Healthcare staff members reviewing a phone

We all know by now that the Care Quality Commission (CQC) wants ratings of providers to be dynamic. It wants to provide “up-to-date and high-quality information and ratings”. Last month, I asked you, on LinkedIn, what period of time you considered a rating would remain contemporary. The majority of people said 6 -12 months.

Even if we take the outer measure of 12 months, this means that, as at 1 January 2024, 11,958 care homes do not have an up-to-date rating Or if we flip this 3171, or 2.2%, do.

2.2%. Let that sink in

On the basis of my poll, 2.2% of care homes have a rating that would be considered to be contemporary.

However, we now have the new CQC inspection regime slowly being rolled out. This will mean that ratings are more up-to-date. Well, that’s the theory! We’ve seen the publication of two inspection reports (at the time of writing) that have been produced using the new regime.

In both cases the same 5 quality statements were looked at: Safeguarding; Involving people to manage risks; Safe and effective staffing; Independence, choice and control and Equity in experiences and outcomes. This equates to just under 14% of Quality Statements.

To be fair, the CQC does provide the date on which the Quality Statement was considered and also clearly states if a Quality Statement was not looked at during the assessment. However, this sits within the drop-down section of each Key Question. At the top of each page, including the overarching page which sets out the overall rating, it states the date upon which the CQC did its latest assessment.

This is potentially misleading as the majority of people will only review the headline pages and will assume that all ratings listed arise from the latest date. However, we know that for any Quality Statement not reviewed, the CQC will transpose the corresponding previous rating. In respect of the two new inspection reports, that means just over 86% of the rating relates to inspections that were carried out just over and just under 6 years ago.

Whilst the CQC is seemingly still focusing largely on risk in order to put resources to best use, I would suggest that, based on what we have seen so far, that the system being deployed does not achieve “up-to-date” ratings. I accept that there may be nothing positive or negative to suggest there has been a change in the areas not inspected (I am not commenting on the position of the two services inspected, merely using these to highlight possible issues that may arise moving forward as the regime gets rolled out further) however, how useful is a rating that was established in 2013 (this is the earliest publication date for all registered services in the January 2024 CQC data)?

This system may be acceptable to services that currently have a rating of Good or Outstanding, but for the 2722 care homes that currently have a Requires Improvement or Inadequate rating, in some cases dating back to 2016, a regime that only looks at 14% of a service is unlikely to fill them with the hope of achieving an increased rating any time soon. One would hope that as the CQC inspects services with Requires Improvement and Inadequate ratings, they look at more than 5 Quality Statements in order to give them a fighting chance of demonstrating that a higher rating can be awarded.

The way in which the new scoring system works, leaves the CQC open to legal challenge. For example, take Safe. It has eight Quality Statements. If the CQC only looks at some of those Quality Statements and this results in downgrading of the key question, can it say that the remaining Quality Statements, if inspected, would not have resulted in a different rating?

I accept that ratings are never going to be 100% accurate, 100% of the time, that’s impractical. But any system created should follow a process that is fair. Procedural fairness is more likely to lead someone to accept an outcome they don’t agree with, if they consider that the process in reaching it was fair.

I also accept that it’s not an easy task to come up with a rating system and, of course, it’s easy to criticize however, providers pay a lot of money to the CQC to be registered. Ratings play such a huge part of a provider’s and service’s existence. They play a part in determining: whether you receive business, whether you lose business, your reputation, whether you get a loan, whether funding gets withdrawn, whether you can get insurance or if your insurance premium goes up. It’s therefore not a huge ask that it is both up-to-date and determined in a fair way.

Out-dated inspection reports and ratings, without any real ability to influence a re-inspection has been a topic of conversation in the sector for a while. Given the results of the inspections carried out under the new regime it makes me think that it’ll remain a topic of conversation for some time to come.