News and Comment from Roy Lilley.
Write about the CQC (them again) and I have to prepare. I need to reinforce my inbox. I have never known an organisation to incite so much ire.
The inspected, the inspectors and the expectant all take to their keyboards. Tales of woe, tales of the expected and unexpected.
For the moment, I’m going to park the ‘futility of inspection’. We all know it doesn’t work. You either get it or you don’t.
If the CQC are to warrant a place at the table and their huge budget, they have to do something useful. They are not useful… and it may be be there fault.
Earlier this week I referred to the Competition and Markets Authority and their report on care-homes. Pretty grim reading.
Finding a care home for yer-granny, untangling entitlements and getting a feel for what is a good home and what isn’t, is, as the report says ‘overwhelming’. A situation made worse by contracts that vary from home to home.
Once in a home; it’s difficult to change a poor choice and there’s always the fear that complaining with result in subtle reprisals.
Rip-off pricing means the private sector is subsiding the skint, public sector. Sometime paying double for identical care.
Service users and their families find themselves in the Bermuda Triangle of Local Authorities as the commissioners and purchasers, consumer law (clunky and dense) and the aloof CQC.
Looking more widely at the landscape; funding is down by 8%, costs are up. The CMA report tells us 75% of care home residents are LA funded and on average they are paying 10% less than their actual costs; a total deficit of £300m.
The consequence; care homes will reduce the number of LA clients they will take-on and the NHS will have to build bigger A&Es.
Is it any wonder the Times is reporting the care home giant, Four Seasons, is on the brink of collapse. I wonder if the DH has a Plan B?
Is there a way out of this mess? Yes; give the CQC more powers. I bet you’d never expected me to say that!
Their quest to ‘inspect’ quality into care homes is futile. Turning them into a proper regulator makes much more sense.
The CQC should have total powers over the sector. Clear accountability and someone to nail if it goes wrong.
I can think of a dozen new powers:
- Develop and publish an annual, independent, strategic assessment of the sector, with recommendations for government on the realistic cost of care and funding levels.
- Provide national model-contracts for care home providers, so the public know what to expect and where they stand.
- New powers to decline any home registration that does not have a CQC recommended safe staffing and skill-mix.
- End the difference between care homes and nursing homes.
- Develop accredited training for the care-home sector workforce.
- Publish clearer ‘Which’ style reports on care homes, making it easier for families to chose through an improved, user friendly website and help line.
- Publish ‘advisories’ on the viability of care home operators and prepare contingency plans for failure.
- Create a centre of excellence making it easy to find and share best practice.
- Provide an easy to navigate complaints and dispute resolution service.
- Create an identifiable, accessible local presence, that includes elected members, to improve public confidence in the CQC and democratic accountability.
- New powers to prevent differential charging between the LA and private sector clients.
- Powers to require care-home providers to post a performance bond to guard against the cost of failure.
Focussing these functions, in one place, makes one organisation accountable for the care home market, its conduct and it gives the CQC something useful to do…
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