here have been a number of whistle blowers reporting their employers for failing to provide care, with no further action being taken until undercover broadcast journalists go into the institutions to exposure systematic abuse. Thus, CQC is coming under increasing pressure to be seen doing something. There are many organisations and practitioners talking about the Care Quality Commission turning a corner after a tribunal panel upheld CQC’s decision to reject Lifeways application to provide campus-style care consisting of self-contained flats, a care home and some communal facilities. Currently, national guidance says campus-style or congregate services are not in the best interests of people with learning difficulties and autistic people and do not promote their right to choice, independence and inclusion. Whilst, CQC may get it right occasionally, there are some fundamental loopholes and flaws within the inspection regimes.
Supported living services can easily deregister or not register their services if they decide to employ a care agency instead of providing direct care themselves. This loophole leaves it open for supported living services to employ care agencies which are falling very short of the quality of care being provided for their clients. There is no oversight in how supported living providers recruit and monitor social care agencies. Even if the care provider is registered, there is no guarantee that any complaints made by the public will be investigated by CQC.
I am currently reading the CQC reports as part of my Free Our People Now Advocacy Role to gage whether the psychiatric hospitals and assessment and treatment units are likely to provide a caring and therapeutic programme of activities that will enable the patient to secure a safe discharge plan. It is here I start to question the validity and usefulness of the CQC inspection reports, especially when there have been some cover-ups – where very critical inspections reports have been withhold from the public, and advocates like myself by CQC.
My first concern was the numbers of patients that were being interviewed – inspector’s opinions appeared to be informed by no more than a few patients’ views. I have no idea how the patients were selected for interview. So the patients who are most critical of the care services provided, were their views sought? Being on the ward may affect what patients are willing to share with the inspectors, especially if could be some repercussions’ such as loosing hospital leave and home visits. Relationships between care staff and patients are complex, and therefore cannot be judged simply on what can be observed over a short period of time. The same observation can be viewed differently by various inspectors which mean that one does not know whether there is an accurate account of a particular encounter or situation. To really understand and evaluate relationships inspectors need to really understand the patients and care staff and to devolve at a deeper level. So at best I can only get a glance of the patient-care staff relationships which quite frankly tells me nothing about the quality of care provided. Further, the inspections appear to focus on ward staff – there is very little information about the therapeutic relationships between patients and responsible clinicians.
These inspections can go out of date very quickly, especially if there is high turn-over of staff or a change in care management – so how do I know that the inspection ratings actually reflect the quality of care provision? Even if the current CQC inspection ratings reflect the standard of care provided today, I have no idea how inspectors conceptualise a safe, effective, caring, responsive and a well-lead service. Thus, no idea whether there is shared understanding what is meant be good care between inspectors and myself.
The focus on procedural and the quality of written documentation tells me very little about the standard of care provided. A well-written care plan or discharge plan tells me nothing, because this alone does not guarantee any implementation. Whilst I read the inspection reports, nevertheless I am increasingly relying upon the community and patients on-line reviews and ex-patients views to help patient make decisions about whether the next placement.
Increasingly I am wondering to what extent that experts by experience are involved in the care inspections and indeed with any thematic reviews. Currently, there is a big review of seclusion and segregation of inpatients with learning difficulties and autism. And from what I know, there are no experts by experience on the steering committee and only one person was invited to speak at a recent CQC conference. If disabled people are not involved in any strategic work then questions must need to be asked – to what extent can I trust anything being published by the CQC?