Care home operators to face tougher regulatory scrutiny of quality improvement and leadership

The quality regulator of adult social care in England, the Care Quality Commission (CQC), is planning to make a number of important changes to its inspection framework during 2017. The changes are intended to give fresh impetus to quality improvement across the sector.  In particular, the CQC wants to ‘get tough’ on services which are failing to improve between inspections and is looking at how it tackles the significant number of services which it deems to be ‘coasting’ with a Requires Improvement inspection rating.  

The revised approach is also expected to have an increased focus on leadership and safety – with significant implications for larger care home operators whose corporate leadership and quality assurance is likely to face increased attention.  The CQC is also considering the application of an overall rating at provider, in addition to ratings at registered service level – similar the ratings approach used in the NHS.  

Focus on quality improvement

The CQC has already expressed concerns about the significant proportion of care homes which are ‘stuck’ at the Requires Improvement inspection rating.  Indeed, over half of care homes rated as Requires Improvement fail to demonstrate sufficient improvement to improve their rating on re-inspection.  In some cases, the CQC find that services have actually deteriorated. The picture is particularly stark in residential nursing care where approximately 40% of all services are currently rated as requiring improvement.

Whilst the CQC acknowledge financial pressures across the sector and the difficulties with nurse recruitment, they remain unequivocal about their position on care quality – “we are clear that the rating of requires improvement is not good enough, and providers and commissioners must work hard to convert those services rated at this level to good and outstanding.”  

Of course, this isn’t just about inspection ratings and regulatory compliance. It’s also a question of how providers enable the delivery of safe, high quality care to those who receive their services.  Moving services to a level of ‘Good’ or ‘Outstanding’ requires a focus on quality improvement where staff are energised and motivated to do what’s best for residents, and crucially, feel supported and equipped in doing so.  

Improving care quality and CQC ratings – sustainably and with minimal investment

The good news is that most care home businesses already have what it takes to improve the quality of their services.  So why are so many services not improving after inspection?  From our experience,  many providers continue to adopt an improvement approach which is ad hoc and reactive, delivering ‘fixes’ in response to CQC concerns, rather than a strategic approach aimed at sustaining good quality across all services.  

Even where some investment might be required, it is likely to return a financial benefit through improved operational control, lower risk of embargo, reduced burden on management time for ‘fixing’ problems and of course, more satisfied residents, families and commissioners.  

Moving towards and sustaining ‘good’ or ‘outstanding’ quality

Many care home providers are now taking heed of the CQC’s clear expectation that all care homes should be working towards sustaining at least a ‘good’ standard of service.  They already have an idea of the sorts of things which are being identified as requiring improvement, through CQC inspection and their own internal monitoring, but recognise that a more strategic approach to quality improvement is required.   From our experience of working alongside care home providers who’ve embarked upon such a journey, there are a number of ‘high impact’ changes which have enabled a sustained improvement in care quality – which have also led to better CQC ratings.  

In our next blog, we will discuss some of the key strategies which care homes operators have used to successfully deliver sustainable quality improvement across their services.   We will also consider the steps which operators should think about taking in anticipation of organisation level CQC ratings, including the expected focus on leadership at senior management level.


John Morris |  Director
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