Concerns over watchdog’s ‘alarming’ inspection cancellation figures


Disabled campaigners and politicians have raised serious concerns about the social care inspection regime, after last week’s revelations that the number of cancellations and postponements rose by more than 360 per cent in just one year.

The Care Quality Commission (CQC) has so far refused to say why the number of inspections of adult social care services that were cancelled or rescheduled rose so sharply from April 2015 to April 2016.

The figures – revealed by CQC after a freedom of information request by Disability News Service (DNS) – show 25 inspections were cancelled in April 2015, rising to 103 in April 2016, while the number of inspections rescheduled increased from 25 in April 2015 to 130 in April 2016.

Despite CQC’s refusal to explain the rise, the Department of Health (DH) was in disarray this week, suggesting at one point that “ultimately the cancellations are a result of funding and fee issues, of which we would not comment”.

But when DNS tried to clarify how the fees CQC charges care services to be regulated was connected with a rise in the number of cancelled inspections, a DH spokeswoman said she was “not attempting to make a direct link between funding and cancellations”, and then that it “would be both incorrect and wrong to quote me as suggesting that fees and funding are linked”.

Despite the continuing refusal of both DH and CQC to explain why cancellations and rescheduled inspections have risen so sharply, disabled campaigners and politicians have suggested that the figures pose serious questions about the way CQC is being run.

Professor Peter Beresford, co-chair of the service-user network Shaping Our Lives, said there had been concerns ever since CQC replaced its predecessor organisations about whether it was well-funded enough to “make possible the sensitive and thoroughgoing regulation that the human services for which it has responsibility demand”.

Beresford said CQC had continued to make news “for all the wrong reasons” since its launch.

He said this may reflect “the worrying state of social care more generally” but that the cancellation figures provided “no reassurance” that CQC was able to take on the “increasingly difficult and important role it has to play across social care and health”.

He said: “Perhaps a root and branch review is now needed and one that puts service-users and carers more strongly at the centre of its operation – rather than apparently weakened, as its poor handling of the Experts by Experience issue has suggested.”

Jonathan Bartley (pictured), the Green party’s work and pensions spokesman, who is standing alongside Caroline Lucas in a job share to lead the party, said CQC’s regime of adult social care inspection “appears to be disintegrating”.

He said: “The potential impact that so many cancelled inspections will have on rooting out abuse and other poor practice in places where so many people are potentially vulnerable is alarming.”

Labour’s shadow minister for social care, Barbara Keeley, also raised concerns after being shown the figures by DNS.

She said: “It is worrying to see such a significant increase in the number of CQC inspections being cancelled and rescheduled.

“These cancellations, especially if they are last-minute, can be disruptive to staff and to service-users.

“We need an effective body to root out abuse and raise quality standards in social care.

“Ministers need to reconsider the cuts they are making to the CQC’s budget and whether this is impacting on the organisation’s ability to do its job properly.”

The freedom of information request was originally submitted by DNS in an attempt to discover the impact of changes to CQC’s troubled Experts by Experience (EbE) programme.

Earlier this year, three of four new contracts to run the EbE programme – in which people with experience of using services accompany CQC inspectors on their visits – were handed by CQC to Remploy, the disability employment business formerly owned by the government but now mostly owned by the scandal-hit US company Maximus.

In February, DNS reported that these contract awards had led to confusion, chaos and a stream of resignations by Experts, particularly over Remploy’s decision to slash their hourly rates of pay.

The CQC figures show that inspections that were cancelled or rescheduled as a result of “insufficient non-CQC resources” (which includes those where there were problems finding Experts to take part) rose from six in July 2015 to 26 in April 2016, an increase of more than 330 per cent.

Sue Bott, deputy chief executive of Disability Rights UK, said she believed the Experts by Experience programme had been “corrupted to fit in with austerity budgets”, while the “spirit and purpose of the programme has been lost”.  

Bott led the National Centre for Independent Living when it developed the programme with CQC’s predecessor, the Commission for Social Care Inspection, working with local disabled people’s organisations (DPOs), which she said was “still the best way of running a programme like this”.  

She said: “A number of DPOs including ourselves and Spectrum sent a letter of concern about the last tendering process to CQC, but our concerns were not addressed.

“Experts have to be locally recruited and supported in the community. This work is not suitable for large national contractors.”

She added: “I’m not surprised people feel let down and no longer want to have anything to do with it.

“It’s not just a question of recruiting experts but also providing support during and after the inspection.  

“If this doesn’t happen then many people are excluded from being able to take part.  

“The hourly rate is a crucial principle to get right as it reflects respect for the expert. Lowering the fee undermines this principle.”

Last week, journalist and former Expert by Experience Claire Bolderson wrote in her blog that the Remploy part of the EbE programme was “in chaos”, with Experts “leaving in despair”, emails going unanswered, and some Experts being asked to travel “absurd distances” to inspections, while senior Remploy staff had apparently been told by CQC in April that “the company was ‘non-compliant’ in almost a dozen areas”. 

Meanwhile, the Commons public accounts committee has warned that the Department of Health (DH) is not doing enough to safeguard the interests of disabled adults and other service-users receiving personal budgets for social care.

Its report was published against a background of increasing demand for adult social care, but a real terms fall in spending by English local authorities.

The committee concluded that it was “not assured that local authorities can fully personalise care while seeking to save money, and are concerned that users’ outcomes will be adversely affected”.

It criticised DH for its “complacent” response to concerns about social care funding, as it had told the committee that this had been addressed through the spending review process, which introduced new powers for local authorities to raise council tax by an extra two per cent to increase social care funding, and provided extra money through the Better Care Fund.

The committee also warned that adults who receive council-funded social care “are not yet getting the support they need consistently in order to get the most out of personalising their care”.

And it pointed out that DH does not believe that “everyone counted by local authorities as having a personal budget does actually have genuine choice and control over the services they receive”.

The report calls for more research to show how local authorities can implement personal budgets “to maximise benefits to users”.

The previous day, the Commons communities and local government committee launched an inquiry – and an appeal for written evidence – into “the financial sustainability of local authority adult social care and the quality of care provided”.

Clive Betts, the committee’s chair, said that adult social care was “coming under increasing pressure as a result of growing demand and declining local authority budgets”.

He said: “Our inquiry will look at the financial sustainability of this care and support to see what can be done to allow councils to continue to meet their legal obligations for future generations.”

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