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Ratings – the waste product of inspections

October 22, 2018

By Caring Times editor GEOFF HODGSON

A recent report commissioned by the Kings Fund and Alliance Manchester Business School has found that a CQC rating has little or no bearing on the future performance of a provider, which reinforces my long-held belief that ratings are a humbug, and that CQC has no business to be awarding them.

All operators love to have their care homes rated ‘outstanding’ but ratings are not uppermost in people’s minds when they are choosing a care home; in talking to people I have found that price, location and a subjective judgement made on personal inspection are what swings it for most families who are looking for a care home on behalf of their loved one. Many have no idea what their chosen home’s rating is.

Perhaps at the high end, where people can afford to be choosy, an ‘outstanding’ rating might give a luxury provider an intangible marketing edge over their nearby luxury competition, but that’s about as far as it goes.

At the other end, a home rated ‘requires improvement’ is likely to be already struggling. The poor rating certainly isn’t going to help recovery but it’s unlikely to be a causative factor. Whoever awards them, ratings have little practical relevance in the care home arena.

Tell me I’m wrong to see CQC quality ratings as an expensive sideline of dubious utility, and to believe that the regulator could deploy its resources more constructively by adopting a more supportive and collegiate approach to its relationship with care providers.

  • The CT Blog is written in a personal capacity – comments and opinions expressed are not necessarily endorsed or supported by Caring Times.

4 Replies to “Ratings – the waste product of inspections”

  1. We live in a sound bite society that has little time or inclination to carry out any actual research. The consequence is a proliferation of review sites that promise to provide an assessment of a service which demands no more of the user than to glance at the ‘star’ rating, or mark out of ten. CQC were prepared to pander to this trend when they adopted the current rating system. Anyone prepared to read beyond the ‘Good’, ‘Requires Improvement’ etc is a rare beast indeed. It’s sad really. Whilst we must have independent assessments of services these should be far more frequent and provide a much more consistent and objective method of conveying the findings than currently exists. Maybe removing the rating and hence forcing people to read beyond the single/two word summary is one solution.
    What is true however is that in a highly competitive market when occupancy rates are low, however inadequate the current system, a Requires Improvement or, god forbid, an Inadequate rating is a serious setback for the provider and, in some cases, terminal for the business.
    Let’s hope that the changes at CQC start to reconsider these important issues.

  2. I think we all need to be clear what this report does actually say, and just as important, what it does not say.

    As far as any impact on future performance was concerned, adult social care was not analysed:
    “We undertook analyses in three areas – general practice, A&E, and maternity services – to explore whether provider performance changed after inspection, and whether any change in performance was related to the provider’s rating category … We chose areas to study where there was routine data available and some established clinical quality or performance indicators that we could use to explore the association with inspection and rating. This meant, for example, that we were not able to analyse the impact of inspections in social care, where there is little available routine data on performance.”

    As to any impact on choice of care home:
    “… there were differences between sectors. While providers and patient and public groups told us that patients rarely use CQC reports to choose a hospital, we did hear examples of social care users and their families accessing CQC reports to help them when choosing a care home, so they could avoid lower-rated providers … It would be interesting to analyse the impact of poor ratings in other sectors such as social care, where there is arguably more scope for service users and families to exercise choice, especially when entering residential care. Unfortunately, there is no activity data available in social care to enable a similar analysis to be conducted.”

  3. Well written, that editor! At last, do I detect a trickle of serious challenge to CQC and its domineering ignorance about what makes a care home good? Ratings from the national regulator were never a good idea for many reasons, one being that in striving for consistency and fairness, you can give a clear rating only to what you can reliably measure and score.
    I see in the current issue of Caring Times, a trenchant criticism of CQC’s performance by Paul Ridout (Will anyone control the monster?). I have been consistently writing and speaking about the folly of letting the regulator dictate how care homes are run since 2001 (The year I spoke about inspection at the NCA conference – “Let the dog wag its own tail” – and started writing for CT.) I have been an embarrassment to the social care establishment and I’ve been told to get off my hobby-horse. In my view, the “sector” has been supine and complicit in this disaster. Now is the time for change but it will happen only if the people at the top of social care find their long lost courage and insist on inspection that is designed to encourage and support good care, and pick up poor care BEFORE it becomes abuse and neglect. It can be done well and for a lot less money.
    I used to be engaged by care homes and provider organisations that wanted my help to give the very best care in genuinely homely places. I have always refused to have anything to do with preparing for CQC inspections and so, for many years, no work! (However, I do have other ways of remaining closely involved and I continue to work with care homes for other client groups.)

  4. I think the ratings are used by local authorities when they need to search for care providers when the local authority pays for the placement. I assume the number needing someone else to fund their placement will increase as fewer people can afford to buy their own home and are forced to rent instead.

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