The CQC is now the independent regulator of all health and adult social care in England and their aim is to make sure better care is provided for everyone, whether that’s in hospital, in care homes, in people’s own homes, or elsewhere.

The CQC has wider powers than its predecessor the CSCI and the new care regulator will be independently checking the services provided by the NHS, local authorities, private companies or voluntary organisations. The CQC also protect the rights of people detained under the Mental Health Act.

The CQC is there to make sure that essential common quality standards are being met where care is being provided and they have said that they intend to work towards improving care services. The CQC is there to help promote the rights and interests of people using care services and where there is cause for concern or standards are not being met or the service being provided is “unacceptably poor”, they have a wide range of enforcement powers to take action, up to and including closing down the offending service provider.

A link to the Care Quality Commission (CQC) website can be found here

Alternatively they can be contacted as follows:

CQC Telephone: 03000 616161
Email: enquiries@cqc.org.uk
Care Quality Commission
St Nicholas Building
St Nicholas Street
Newcastle upon Tyne
NE1 1NB

During a reading of the Health and Social Care Bill on 1 July 2008, Baroness Thornton indicated that the Government will seek the next opportunity to extend the Local Government Ombudsman’s remit.

Dame Denise Platt, Chair of the Commission for Social Care Inspection, said:

“We welcome this intention to level the playing field for all those who use care services, and hope that the Government will find an opportunity in the next parliamentary session to do so. This will set the minds at rest of all those who will in future be able to access an external review of their complaint.”

“We have long argued that self-funders should receive the same independent resolution of complaints, and are pleased that Government has acknowledged this. The proposal will make a real difference to those who fund their own care.”

News reported by The CSCI

CSCI has published a new bulletin which aims to address the needs of black and minority ethnic people using care services.

The bulletin calls for black and minority ethnic people to have their cultural and social needs addressed on a more personal level. This will help to ensure that their specific needs are adequately considered during assessments by care homes and providers.

The bulletin is aimed at care providers – people who run care homes – to help them address the new government agenda, Putting People First.

“Black and minority ethnic people should feel that their individual needs are being met, rather than providers making assumptions about their cultural requirements.

“People can only make choices if they are given the opportunity to direct their own care. Providers can help people by asking about their cultural requirements and work with them to achieve this.”

News reported by The CSCI

Cynthia Bower is currently Chief Executive of NHS West Midlands. She has previously held posts as chief executive of a community health trust and a primary care trust.

CQC will come into being in April 2009 and will be the new health and social care regulator replacing the work done by the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission.

News reported by The CSCI

A questionnaire of staff from the Commission for Social Care Inspection (CSCI) also raised worries that residents are at greater risk.

The questionnaire was organised by BBC Radio 4’s Today programme.

A CSCI spokesman said that the organisation was taking more action against poor providers than before.

The spokesman added that the watchdog, which oversees 18,500 care homes in England, believed that services were improving.

“To be honest, I would not leave my dog in 90% of our care homes” Anonymous respondent

An anonymous questionnaire was distributed to more than half of CSCI’s employees via unions Unison, the Royal College of Nursing and Prospect.

In all, 30% were returned and more than 200 inspectors took part.

Some replies did not pull any punches.

“To be honest, I would not leave my dog in 90% of our care homes,” one inspector wrote.

Another respondent said: “I do feel CSCI is trying to get it right in terms of making the best use of available resources but given the reduced budgets and political agenda, it seems inevitable the system of inspections will become more arbitrary and less responsive to the needs of those who live in care homes.”

‘Less protected’

The BBC sent out the questionnaire after receiving concerns from a small number of inspectors. One contact told reporter Jon Manel:

“Homes aren’t inspected as frequently as they were before. We rely a lot on information given to us by the providers of a service to say how good that service is. When we actually go out to visit the homes they are completely different to what the proprietors have actually told us in their feedback to us.”

The contact added that at one time, all homes would be inspected a minimum of twice a year.

“That’s now changed and we’ll be inspecting homes anything from what could be a weekly or monthly process for very poor homes right up to a maximum of one inspection in three years.

“Services can change – even excellent services have been seen to go down to poor in the last year.”

Care homes now also carry out self-assessments.

Complaints raised by families about homes are no longer looked into by the watchdog. Instead, the complaint is passed to the care home owner or the local authority which funds the individual.

The CSCI says the new system helps the organisation focus on improving the performance of below-standard homes.

The questionnaire suggested inspectors were not doing enough inspecting

‘Huge pressure’

The BBC was also told that an inspector had been forced by a CSCI manager to change the outcome of an inspection.

The contact said: “For me the issue was the care is poor and if it is poor, we need to say it is.

“However the pressure I was under was huge and so against my own judgement, I made the rating adequate.”

The contact said that a poor-performing home required a lot of extra work. The contact said:

“As soon as a poor home comes on the radar, then an inspector’s time and a manager’s time is focused on that home.

“Managers don’t want that but inspectors do because that’s what we’re there for.”

Another questionnaire respondent said care homes were now effectively policing themselves.

“All people using care services regulated by CSCI are in effect less protected than previously because we are inspecting them less on the basis care services will police themselves.”

“The home was poor throughout and needed enforcement action to be taken but the regulation manager did not want this to happen – too many poor homes this year” Anonymous inspector

‘Improving services’

A CSCI spokesperson said that the organisation had consulted widely and received widespread support for the way it was carrying out inspections.

“Our new way of inspecting allows us to be much tougher with poorer providers than before.

“The evidence is clear. Services are improving. And we are taking more action against the poorest providers than ever before.

“Our new quality ratings for all providers will also give them a further incentive to improve. With better information people are likely to choose the best services, which will thrive.

“The poorest services will face closure by us unless they improve.”

News reported by BBC

“It is a watchdog without any teeth or even a will to act.”

John Matthews’ condemnation of the Commission for Social Care Inspection (CSCI), which oversees 18,500 care homes in England, is strong.

While complaints about standards of elderly care are not unusual, what makes Mr Matthews’ view important is that he is the coroner for the Isle of Wight.

Last year, he recorded a verdict of accidental death contributed by neglect after a 93-year-old man died following a fall.

He was found in a road, half-a-mile away from the care home where he lived. He had a tendency to wander off and on this occasion, he had wandered off unnoticed.

Compliance check

What came to light during the inquest was that eight months prior to his death, a CSCI inspector had discovered there were no risk assessments in residents’ files.

This was supposed to be rectified by July 2006 but according to the coroner “nothing was done at all”.

Mr Matthews condemned the CSCI as “toothless” and “worse than useless”.

“I used those words quite deliberately because it was being dressed up as though there was some institution which had this role when in reality it wasn’t doing anything,” he said.

“If we were to check that every requirement for every inspection has been delivered it would not be feasible given the scale of the task and the resources we’ve got” Mike Rourke, CSCI

“The public was misled into thinking there was protection which existed which in fact didn’t.”

In April 2004, the CSCI replaced the National Care Standards Commission, which itself had been formed to take over inspections from local authorities.

“In my view what would have happened in the past is the council or National Care Standards Commission would have inspected the home again shortly after the deadline to make sure it was now in compliance,” said Mr Matthews.

Resources available

Mike Rourke from CSCI said: “Our view is that we made it very clear to the provider what they needed to do and we would look to them to deliver their responsibilities.

“And if we were to check that every requirement for every inspection has been delivered it would not be feasible given the scale of the task and the resources we’ve got.”

“Unless they (CSCI) follow up what they have told owners to do, then they don’t seem to serve an effective purpose in protecting the most vulnerable members of society” Harry Montague’s daughter

The watchdog says it is now taking action to enforce the law more often. But next year, CSCI will cease to exist.

Following two re-organisations in six years, care home regulation is to be re-organised again. CSCI is to merge with the Healthcare Commission, which inspects hospitals, and the Mental Health Act Commission.

The CSCI’s duties include inspecting homes against national minimum standards, set by the government, and publishing a report after each inspection.

It sets out what the home did well and what it needs to improve, and according to the watchdog’s website its inspectors will work with the service to make sure improvements happen quickly.

But for the family of Henry Montague, the changes came too late.

Proper enforcement

In March 2006, Mr Montague was admitted to Eastbourne District General Hospital, south-east England, with severe facial burns.

His face was “grossly swollen” and “beyond recognition” according to a doctor who treated him.

Henry Montague spent 10 months in hospital

Mr Montague, then 80, had fallen out of his bed at the Farmstead Nursing Home, in Hellingly, and onto the hot water pipe which lay exposed on the wall.

It was a risk which the home had been made aware of some three months earlier.

A CSCI inspector had visited in December 2005.

“The hot and cold water pipes in some bathrooms and residents’ rooms were not covered. The expectation is that they are boxed in to protect residents,” she wrote.

But by March, in Mr Montague’s room at least, that had not happened.

His daughter said: “We were shocked that the matter had been brought to the owner’s attention and nothing had been done and that nobody had thought it was a sufficiently serious matter to remedy straight away.”

‘Action plan’

The CSCI did not impose a legal requirement for the pipes to be covered and a CSCI spokesman said there would have been “a clear expectation that the provider would have taken action to rectify issues identified in the inspection”.

But care home owner Ernie Graham says the CSCI had agreed an “action plan” for the work to be carried out by the end of March. He stressed that the inspector had not seen the specific pipe in Mr Montague’s room.

Mr Montague, who suffered from dementia, spent 10 months in hospital and died four months later.

Mr Montague’s daughter believes if the CSCI’s recommendations had been properly enforced, then their father’s accident would not have happened.

She said: “I would have expected CSCI to have told the owners that unless they make sure these matters were remedied immediately, within the next 24 to 48 hours, that the home would not be able to continue operating.

“What you have is a toothless organisation because unless they follow up what they have told owners to do, then they don’t seem to serve an effective purpose in protecting the most vulnerable members of society.”

News reported by BBC