This review looks at the perspectives of social care providers on CQC's single assessment framework and their views on future regulation by CQC.
We commissioned the Care Provider Alliance to carry out this review, write the summary below, and the full report.
Executive summary
The Care Provider Alliance (CPA) CQC Single Assessment Framework (SAF) Review is a project commissioned by the CQC, seeking to examine social care providers’ perspectives of the SAF and what they want the future of regulation to look like. This work was necessary to ensure that any further change to CQC’s regulatory approach accounts for the diversity of service types and perspectives in the sector. The CPA approach deliberately sought not to replicate the work of Professor Sir Mike Richards, but rather to work alongside his broader scope of work and give a deep dive into the experience of social care providers.
Care providers support effective, proportionate regulation that they can trust. It is important that their voices and those of the people they care for and support are centred in any regulatory approach. This work aims to support the CQC in its decision-making by engaging with the voices of a wide range of care providers to understand their views about the SAF.
Whilst the focus of the work was the SAF itself, other elements of the regulatory landscape such as the current backlog of assessments inevitably contribute to and nuance the perspectives of providers and as such are not possible to keep entirely removed from the findings.
The project was formed of two stages. The first stage was a large-scale outreach effort involving an online survey gathering over 1200 qualifying responses. The second stage involved over 100 care providers in five 90-minute workshop discussions.
This project has also drawn on the input of a steering group, comprised of 19 representatives from CPA member organisations and a range of care providers who form part of the CPA membership.
Readers should remain cognisant throughout this report of the fact that 85% of adult social care providers are small to medium enterprises (SMEs) with fewer than 50 employees1. SMEs range from having fewer than 10 members of staff to those with up to 250 members of staff. All challenges presented below are magnified for these organisations, who make up a very large proportion of the sector and often do not have individual roles and resources dedicated to quality improvement. This means that all work carried out in preparing for and undergoing assessment is completed by staff members who also hold other roles, as opposed to many larger organisations who are more likely to have a dedicated quality lead or department. What is practical and achievable for SME organisations is a vital consideration in responding to the recommendations below.
Several issues were made clear across both stages of this work, the most prevalent of which were:
- The quality statements are too numerous and overlapping, and the guidance to support them is unclear and not specific enough to the type of service inspected. This makes preparation for assessment and self-assessment within services a significant administrative burden and relies on individual interpretation of the quality statements. This in turn means that providers often spend a disproportionate amount of time in preparation for assessment and remain unsure of the inspectors’ interpretation of what ‘good’ looks like.
- The ‘flexible’ application of a sample of quality statements in each assessment creates opportunity for inspections to miss key information. For example, the selected sample may not encompass work that providers are proud of, or areas previously rated Requires Improvement which should be re-assessed and updated.
- Providers who have been assessed under the SAF have found it disorientating and upsetting. They describe staff feeling “devastated” and “distressed”, with registered managers leaving their jobs, and organisations considering closing their services. These experiences were consistent between those who received both good ratings and requires improvement ratings.
- Challenging assessment processes and outcomes is a very difficult, lengthy and frustrating administrative process and often yields little to no satisfactory outcomes for providers. Stage 1 data showed that smaller providers were less likely to challenge their outcomes, despite stage 2 indicating that they did not feel they had had a better experience or outcome. This may suggest that SME’s lower rate of challenge is due to a lack of resource and a need for support during these processes.
- Inspectors do not always have sufficient knowledge of a wide diversity of service types within social care, and the changing context in which they operate, meaning they do not always understand how to apply the quality statements appropriately in all cases and can draw inappropriate and inaccurate conclusions about services.
- Reports are often unclear, inaccurate and not timely, meaning ratings are not meaningful to the public, and the inspection process and report do not drive quality improvement for providers. Unclear reports make it challenging for providers to know where to improve, particularly when decisions are not explained clearly and the evidence influencing decisions may not be corroborated, meaning it disproportionately contributes to providers’ ratings.
- Communicating with the CQC has become very difficult for providers, with no reliable route through online systems and often no acknowledgement or feedback from CQC on receipt of information from providers.
- Communications within the CQC do not appear to reach all inspectors, meaning that they are not always aware of recent changes in the currently shifting landscape.
Read the full report
We are also publishing the CPA's survey findings, which informed the review.