Social Care Sector & the CQC – A Brief Look at What Service Providers Need to Know
In 2022, the Government mandated a cost of care exercise. Unfortunately, this exercise has bought about little change and has simply proven that the sector is under-funded. This looks set to continue as the Government announced in April 2023 that it was going to halve its commitment to social funding, reducing its pledge from £500 million to £250 million.
Care England research has found that, as of April 2022, the average difference between a) what a local authority pays for residential care fees; and b) the fair cost of care, is £218 per week. The gap in nursing care fees is £231 per week. This is a discrepancy of £2,616 for residential care fees and £2,772 for nursing care fees.
It may also be worth exploring what funding might be available for your service, such as assistance with digitising your systems and/or training your staff through the Skills for Care initiative.
Funding is an area our team often see as an area of dispute. We would recommend that providers ensure they have:
- Compliant service user contracts in place;
- Care fees being guaranteed by a third party in the event of default where possible; and
- Robust credit control processes.
Our team specialises in troubleshooting and crisis management. We have seen a rise in the number of safeguarding matters we are dealing with. Unfortunately, a safeguarding enquiry can either be some troubleshooting or the start of substantial problems for providers.
The way in which a safeguarding incident is dealt with can set the stage for the way it plays out. We would suggest that providers are as engaged as possible from the beginning and seek to handle all the issues early and thoroughly, as well as:
- Keep a detailed chronology.
- When you are summoned to a planning meeting, have a chronology and full file of evidence in hand.
- Anticipate the likely questions that may be asked and be ready with the answers.
- Provide any follow-up answers or information as soon as possible.
- If asked for a section 42 report, do a really good job on it. Get professional help if required. It can often be useful to have a neutral pair of eyes cast over these reports to identify any gaps before a safeguarding team does.
A safeguarding visit often triggers unwanted scrutiny from CQC, which can cause a situation to spiral. If the situation is dealt with competently from the start, it can make the difference between some troubleshooting and crisis management.
Changes at CQC
In 2022, CQC set out its new regulatory approach for health and care providers. Its aim remains to drive improvements across the sector but address the issues they have faced over the years such as:
- Long gaps between inspection and rating updates;
- Writing substantial reports;
- Engaging in a long FAC process; and
- Achieving more consistency in their assessments.
Most recent figures which showed in February 2023, 47% of services were rated as requires improvement or inadequate. This is in part due to ratings not having been updated post-COVID.
CQC plans to create a “single assessment framework” for all types of services (social care, healthcare and local authorities). We have compared the models below:
|Current model||Future model|
|Multiple assessment frameworks for different types of services.
|One assessment framework for all.|
|Risk-based approach with monthly monitoring.
|Ongoing assessments of quality and risk, which may trigger an inspection.
|Snapshot approach to inspections: inspectors gather evidence using the KLOEs at one point in time. The questions asked are the “prompts”.
|CQC gather evidence at multiple points in time, not just during an inspection. The KLOEs remain but questions asked are whittled down to 34 “topic areas” which will be supported by six kinds of evidence such as feedback from partners, people’s experiences and outcomes.
|Ratings are based on ratings characteristics.
|Inspectors give each area a numerical score – from 1 (being significant shortfalls) to 4 (being exceptional).
|Factual Accuracy Check (FAC) – 10 working days (2 weeks).
|It is understood that the response timeframe may be reduced to one week and the process may be changing, but this has not been confirmed.
|Longer form inspection report is published.||Ratings for the service are calculated and updated on CQC’s website and a short statement is published.
The advantage of this new approach is to create a broader view of a service, by updating the evidence they hold at different times, showing a more real-time view of ratings.
To implement these changes, CQC is also changing the way its regulatory and inspection teams are structured. Inspectors will now work as a team with someone called an assessor. An assessor is a sector specialist who leads on maintaining an ongoing view of quality, safety and risk in a service. The assessor will carry out the off-site evidence collection, i.e., the sort of “intelligence-gathering” that CQC is already doing. The assessor will also make the decisions about whether to bring enforcement action.
CQC’s teams are currently transitioning into new more integrated teams. They are also currently testing parts of its new portal with providers.
The next step will be the roll out of its new regulatory platform this summer. This will be done in stages. It will be used first to submit statutory notifications. After that, they say that you will be able to review draft judgments on the portal. Later in 2023, they will start to use the new assessment framework.
We recommend that providers have someone actively managing this new process. There will likely be a need to be more proactive in dealing with CQC as time will be of the essence once information is presented to a provider.
If you require any advice about the topics mentioned in this blog, please do not hesitate to get in touch with a member of our Health and Social Care Team, who would be happy to assist.