CQC to consider hidden cameras and mystery shoppers to monitor adult care

The Care Quality Commission is to consider the risks and benefits of using hidden cameras and mystery shoppers to monitor care, the Chief Inspector of Adult Social Care has announced.

In a report entitled A Fresh Start for Adult Social Care, Andrea Sutcliffe said the regulator would look to see whether such approaches “could contribute to promoting a culture of safety and quality, while respecting people’s privacy and dignity”.

Other key proposals in the report include:

  • Awarding ratings to every care home and adult social care service by March 2016. The proposed ratings are ‘outstanding’, ‘good’, ‘requires improvement’ or ‘inadequate’;
  • Establishing expert inspection teams involving people who have experience of care services;
  • From April 2015 and subject to the Care Bill becoming law, monitoring the finances of an estimated 50 to 60 care providers that would be difficult to replace if they were to go out of business;
  • Taking a tougher stance when registering care services “by ensuring that those who apply to run them have the right values, motives, ability and experience”;
  • Taking tougher action against services that do not have registered managers in place;
  • Encouraging those providing care in residential homes to explore how they can be involved in the local community; and
  • Working with Healthwatch to get its views on care homes locally.

The CQC said inspections would be structured around five key questions which it said mattered most to people: “are the services safe, caring, effective, well-led and responsive to people’s needs”.

A public consultation on the plans will be held in spring 2014.

Sutcliffe said: “This is a fresh start for how care homes, home care, and other adult social care services are inspected and regulated across the country. I will be leading CQC’s new approach by making more use of people’s views and by using expert inspection teams involving people who have personal experience of care.

“We will always be on the side of the people who use care services. For every care service we look at, I want us to ask, is this good enough for my Mum? If it is, this should be celebrated. If not, then as the regulator, we will take action.”

She added: “Our assessments will be based on expert judgement, not regulatory compliance. You cannot regulate for love, compassion, tenderness, dignity and respect but these are values that our inspectors will be looking for. Adult social care is the largest and fastest growing sector that CQC regulates and so it is imperative that we get it right.”

Norman Lamb, Care and Support Minister, said: “No one should have to put up with substandard care - there are serious flaws in the system when people are worrying about the quality of care their loved ones are receiving. We have made it clear that there must be a sharper focus on taking tougher action when things go wrong and holding those responsible to account.

“Confidence in the regulation regime has been shaken, but we have turned a corner. I welcome the Chief Inspector’s new commitment to protecting people vulnerable to abuse and neglect, and to delivering better care.”

Katie Hall, Chair of the Local Government Association’s Health and Wellbeing Board, said: “The LGA welcomes the fact that the new Care Quality Commission inspections will determine whether services are safe, caring, effective, well led and responsive to people's needs.

“The LGA has shared growing disquiet about the fundamental problems of provision, commissioning and regulation highlighted by recent studies into Winterbourne View, and the North Staffordshire and Morecambe Bay NHS Foundation Trusts, and other instances of market failure. We are pleased to see the CQC Board addressing these concerns head on in its plans for transforming how care homes will be monitored and inspected in future.”

Hall said the LGA wanted to see a move away from a tick-box approach to care inspections towards a more integrated system of care monitoring. She described the CQC’s latest recommendations as “a step in the right direction” towards increasing public involvement in decisions about how care homes should be monitored, across the sector.

She added: “The LGA’s Community Wellbeing Board has had a longstanding concern about a compliance only model of regulation, particularly in understanding where the bar was set and how failure was addressed. Councillors have also supported a return to a more transparent system of rating. The CQC’s report provides some welcome detail and a timetable for introducing the new changes.”

The top ten changes highlighted by the CQC in A Fresh Start for Adult Social Care are:

  1. More systematic use of people’s views and experiences, including complaints.
  2. Inspections by expert inspectors, with more experts by experience and specialist advisors.
  3. Tougher action in response to breaches of regulations, particularly when services are without a registered manager for too long.
  4. Checking providers who apply to be registered have the right values, motives, ability and experience.
  5. Ratings to support people’s choice of service and drive improvement.
  6. Frequency of inspection to be based on ratings rather than annually.
  7. Better data and analysis to help us target our efforts.
  8. New standards and guidance to underpin the five key questions we ask of services – are they safe, effective, caring, responsive and well-led? – with personalisation and choice at their heart.
  9. Avoiding duplicating activity with local authorities.
  10. Focus on leadership, governance and culture with a different approach for larger and smaller providers.