As we start a new year, 2023 is already proving to be as challenging for the care sector as 2022 – if not more so. The Care Quality Commission (CQC) has delayed implementation of the Single Assessment Framework for health and social care, with as yet no clear alternative timetable. We do however have the framework’s new quality statements and evidence categories to peruse. Work on the new provider portal is also well underway; the CQC hopes to launch this in the summer.
The new framework is structured around the same five key questions as the previous inspection regime: safe, effective, caring, responsive, and well led. This at least provides some familiarity. But there are red flags to be acknowledged in some of the changes.
There will certainly be a more robust response to any concerns raised from any quarter. This will rightly involve further data requests by the regulator, as well as review of current data held. Initially undertaken off-site, when concerns are supported by a review of the data, the result could be an onsite inspection.
Concerns will routinely be seen as a risk, although it is still unclear how concerns will be assessed, or if there will be a hierarchy of risk ratio to concern. However, we can be sure that the key to any escalation of a concern will be the data already held by the CQC, as well as that which is subsequently gathered. This reliance on data means that providers will need to become savvy with the new portal, which will be the only way of communicating information to the regulator. They must also ensure the data held by the CQC (and thus the data collected by the provider) reflects the current reality of service delivery.
We have been assured that the portal is being tested to its limits to try to ensure a glitch-free launch.
The worry in all of this is that the receipt of a concern will be given undue prominence, due to a lack of counterbalancing positive data. The CQC has always been accused of emphasising negativity in its reports, with little by way of positivity (and that which is there, lost in translation). With the limited information we have available, it seems the new system may risk exacerbating this trend.
Of course, a focus on practice and learning from concerns is no bad thing. But these concerns must be balanced by the full range of factors, if trust is to be built in the new regime.
The timing of the changes – due in no small part to the delayed implementation – means a more challenging period for providers. There are new strike dates issued for March 2023 involving junior doctors, nurses, and teachers. All will add to the ongoing pressure on workforce recruitment issues and the ability of care services, which are so heavily reliant on women, to maintain adequate levels of provision. At the time of writing, there are few, if any, solutions in sight.
Yet care is still being delivered through a dedicated workforce, doing their best, in every type of service. A recognition of that from the regulator would be very welcome. A start could be a change in how reports are written to set concerns in a context that reflects their status within the overall rating of the service.
Margaret Ross-Sands
W&P Assessment and Training
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