Andrea Sutcliffe, who has been appointed as the Care Quality Commission’s (CQC) first chief inspector of social care, set out her early priorities this week for how the organisation will monitor, inspect and regulate nearly 25,000 adult social care services, including nursing homes, domiciliary care services and hospices.
Among her plans is to make far greater use of the “experts by experience” (EBE) programme that was first devised by CQC’s predecessor organisation the Commission for Social Care Inspection, which worked on it with the user-led National Centre for Independent Living (NCIL).
Sutcliffe said that experts by experience, who all have personal experience of care, have “a unique and valuable role to play in helping us to listen to the views and experiences of people who use a service”.
The move to expand EBE was welcomed by Sue Bott, former director of NCIL and now director of policy at Disability Rights UK (DR UK), which was formed from a merger between NCIL, RADAR and Disability Alliance.
Bott said there had been a struggle to convince CQC to take EBE seriously.
She said: “In the early days, there was a lot of resistance from inspectors who didn’t think it was the right thing to have [service-users] ‘interfering with our professionalism’.
“Until recent times, I don’t think there was clearly the direction from the top that EBE was a useful tool.”
Bott believes that an inspection involving an “expert by experience” would have exposed the Winterbourne View abuse scandal far earlier, so saving CQC from one of its most damaging episodes.
She said: “People who are using a service will feel far more comfortable speaking to an expert by experience than they will to a professional.
“It is critical to having good robust inspections that there is an expert by experience present, and I am delighted to see it recognised.”
Bott said DR UK would be bidding to run the expanded EBE programme, alongside a number of other disabled people’s organisations, housing associations and local impairment-specific self-help groups.
But although she welcomed the new document and Sutcliffe’s appointment, Bott raised concerns about the suggestion that hidden cameras could be used in care homes and other services to try to expose abuse and poor standards.
Bott said: “I do feel concerned about the general lack of attention to civil liberties and people’s privacy in respect of people receiving social care services.
“It is the idea that the only way you can protect people is if you know exactly what they are doing from one moment to the next.
“I don’t think it is the answer to people getting good care. You need to have the right people with the right training, with the right attitude, and organisations that have the right culture. That is what will give people good care.”
Bott also raised concerns about Sutcliffe’s proposal to scrap annual inspections for those services that secure the best ratings, which she fears could lead to some facilities escaping without inspections for several years.
But she welcomed Sutcliffe’s plan to find a way of regulating supported living schemes that “enables people to maintain their independence but offers appropriate safeguards”.
Many supported living services currently fall outside CQC’s remit.
Bott said: “There are a lot of concerns about supported living and the experiences of people who live in supported living.
“What we don’t want to do is replace huge institutions with mini-institutions in the community. I am principally concerned about whether people are genuinely getting an opportunity for independent living.”
Peter Beresford, who chairs the national user-led Shaping Our Lives network, said Sutcliffe’s announcement was “important”, because her appointment had followed the Francis inquiry report on the Mid Staffordshire NHS trust scandal, which “highlighted the importance of strengthening service-users’/patients’ organisations so that they could be an effective voice for good services and blow the whistle on bad”.
“‘Top down’ needs to combine with ‘bottom up’. Everything Andrea Sutcliffe can do to strengthen service users’/patients’ collective voice in social care must be helpful.
“She’s shown herself a believer in co-production. This is the way to go for inspections, regulation and improvement.”
CQC’s plan is to bring some of the changes in by April 2014, with a public consultation next spring.
Other proposals include awarding ratings – “outstanding”, “good”, “requires improvement” or “inadequate” – to every adult social care service by March 2016.
Sutcliffe said CQC would “always be on the side of the people who use care services”, with inspections built around five key questions: whether services are safe, caring, effective, well-led, and responsive to people’s needs.
She also said there would be “tougher action in response to breaches of regulations, particularly when services are without a registered manager for too long”.
Meanwhile, the Liberal Democrat care services minister Norman Lamb said CQC would also be looking at whether home care visits were long enough to meet people’s needs, following concerns raised in the media about the use of 15-minute visits by many home care providers.
He said CQC was considering assessing whether a service was delivered with “compassion, dignity and respect”, how many of its staff were on so-called “zero hour contracts”, and the level of staff turnover.
17 October 2013