The CQC has been urged to develop a bespoke approach to regulation that takes into account an organisation’s capacity to respond to recommendations, and the resources available to support improvement.
Researchers say: “Social care is a sector with relatively little infrastructure and support.”
In an evaluation of regulation in adult social care, GP practices, acute care and mental health care, researchers from the King’s Fund found a general consensus that quality regulation is necessary, but that there is “room for improvement in how organisations on both sides of the regulatory relationship, and stakeholders in local systems, work to maximise its value”.
They found that in the care home sector there was little information available to support care homes to understand what best practice looks like, and how they might monitor and evaluate quality: not all authorities have quality improvement teams; commercial competition reduces a provider’s willingness to share learnings from inspections, researchers said.
Among the identified limitations to regulation and negative or unintended consequences are that a care home may feel unable to make the necessary improvements, and will close. Of the four sectors evaluated by the King’s Fund, social care providers and GPs were said to be the least able to adopt CQC quality improvement models internally.
Compared to the other sectors evaluated, the publication of ratings gave more scope for service users and families to exercise choice, particularly affecting providers rated as poor.
Of the 24,000 care homes inspected by the CQC between October 2014 and January 2017, only 2 per cent of homes were rated outstanding and inadequate. Most (77 per cent) were good, and 19 per cent were rated as requires improvement.
This compares to the following ratings in GP practices:
- Outstanding – 4 per cent
- Good – 79 per cent
- Requires improvement – 8 per cent
- Inadequate – 2 per cent
Conducted with the University of Manchester, the evaluation looked at CQC inspections between 2015 and 2018 in six areas of England. The nature of the relationship between regulator and provider, and information about provider performance placed into the public domain were considered to have the most regulatory impact.