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Setting a higher standard


In 2011, England had its own Oakden, which has been followed by ongoing reforms at England’s care regulator and how it assesses quality, writes Nick Albrow.

It was a watershed moment for the country’s care industry six years ago, as an undercover journalist working for the BBC revealed horrific abuse at learning disability service Winterbourne View.

Nick Albrow

The incident sparked public outrage and led to major reforms to England’s care regulator, the Care Quality Commission (CQC).

The fallout from Oakden has followed a similar path, with several inquiries and reviews, and speculation they will result in significant reforms to how aged care services are regulated.

What can the Australian care sector expect if it follows a similar path?

Inspection framework focused on quality

In response to Winterbourne View, the CQC transformed and simplified its inspection framework and further strengthened it with a second series of reforms in 2015. Inspectors now judge a service against five key criteria:

  • Is it safe?
  • Is it well-led?
  • Is it effective?
  • Is it responsive? and,
  • Is it caring?

For each category, inspectors rate a service as either outstanding, good, requires improvement or inadequate. Based on these five judgements, services are given an overall rating.

The new framework was intended to make the inspection process much simpler for the public to understand and, to an extent, it has done so. However, with little time to adjust to the new system, care homes found it difficult to adapt and hundreds continue to be rated requires improvement or inadequate.

Trust in transparency

As well as changing how it regulates services, the CQC also changed its approach more broadly, championing transparency. Inspection reports and ratings are now published on the CQC’s easy-to-navigate website, and services must now “prominently” publish their ratings on their own websites.

The CQC also has various other tools aimed at making it as easy as possible for the public to assess a service’s performance, including an online map displaying the ratings of every care home in the country (below).

These are basic steps, but have a significant impact on a care home’s reputation and those deemed to be below standard are publicly named.

A snapshot of the CQC’s online care home rating map. Blue=outstanding, green=good, orange=requires improvement and red=inadequate.

Next steps

Despite extensive changes, in a scheduled review of the effectiveness of its new inspection framework published in July, the CQC conceded there was much still to be done to address the fact there was “too much poor care”.

The main consequence of this was a raft of new proposals, which are likely to be mostly implemented following consultation, including giving the CQC powers to take on care home groups, which refers to companies operating several homes.

Currently, the CQC does not have the formal powers to inspect the operators of care home groups, as opposed to the homes themselves, despite large providers making up a significant proportion of the market.

The CQC argues this left an accountability gap – while it could hold individual services and their management to account, it was not within its remit to take action against a parent provider and its management, who potentially have more influence over how a care home is run.

This was in part due to the registration process, which the CQC has proposed updating so any entity that has ‘accountability for quality’, including parent and onshore holding companies, must be registered with the CQC.

As well as updating the registration requirements, the CQC proposes introducing “a provider-level assessment and/or rating for providers” so people can easily assess the performance of a whole group rather than individual homes.

The move will also allow the CQC to take enforcement action against a provider rather than a single service. The CQC wants to further strengthen its enforcement powers, proposing to take action against those repeatedly judged as requires improvement, rather than only those rated inadequate,  and publishing details of enforcement activity as it is undertaken instead of following what can be a lengthy appeals process.

Until the report of the Government’s Review of National Aged Care Quality Regulatory Processes is released, it is unclear exactly what path Australia will take.

However, it is highly likely England’s model will have been studied to see if any parts would help to improve standards here.  Should any be taken forward, Australian care providers are at an advantage; they can look at English care providers to see what was done well, and – just as importantly – what was done badly, ensuring they don’t make the same mistakes.

Nick Albrow is a consultant at PR and public affairs agency Etched Communications based in Sydney. Prior to moving to Australia, he advised several aged care providers in England.

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One Response to Setting a higher standard

  1. John Burton October 25, 2017 at 8:08 pm #

    While its is true to say that the CQC in England have improved since the Winterbourne View scandal, it is not true that they have “transformed” the regulation of social care. They continue to do the wrong thing but righter. Inspection of care homes has to be local and immediately responsive. The CQC fails to respond quickly and is now bringing in inspection scheduling based on their previous – often erroneous – rating of the home. So, homes which are rated “good” or “outstanding” will not be inspected for two years or more. Yet they are finding that 23% of “good” homes on re-inspection a year later are no longer “good”. Their reports take ten weeks or more to be published, so a resident or relative may choose a home that has gone from “good” to “requires improvement” or “inadequate” not realising that it isn’t at all good.
    CQC – a big, national, top-down, extremely bureaucratic and risk averse organisation – is simply the wrong organisational design. It is not and never will be “fit for purpose”. It seems, Nick, that you have been taken in by the CQC’s PR, and failed to read the criticisms (such as “What’s wrong with CQC?” John Burton, The Centre for Welfare Reform).
    So, Australia, please DON’T follow the English CQC’s example. It doesn’t work.

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