Healthcare regulatory partner Amanda Narkiewicz from law firm Mills & Reeve asks whether the Care Quality Commission should persist with one-word ratings in light of the coroner’s conclusion in the Ruth Perry inquest

The damning conclusion that an Office for Standards in Education, Children’s Services and Skills (Ofsted) inspection “contributed” to the death of headteacher Ruth Perry will probably resonate with care home managers and care providers up and down the country. It is said to be the first time Ofsted has been listed as a contributing factor in the death of a headteacher.

Senior coroner, Heidi Connor, concluded that Perry’s suicide was “contributed to by an Ofsted inspection carried out in November 2022” at her primary school in Reading. Connor said the inspection “lacked fairness, respect and sensitivity” and was at times “rude and intimidating”. Ofsted resumed school inspections on 22 January following a pause to train staff on considering the wellbeing of heads and teachers.

Coroner’s concerns

Connor says in her Prevention of Future Death (PFD) report that the current Ofsted system allows for the single-word judgement of Inadequate to be applied equally to a school rated otherwise Good, but with issues that could be remedied by the time the report was published, as to a school receiving the same rating as one failing in all areas. She is concerned about the “impact on school leader welfare that this system may continue to have”.

This is a not an uncommon issue for care providers where concerns can be remedied quickly and before the publication of the Care Quality Commission’s rating. The roll-out of the CQC’s new Single Assessment Framework and its aspiration to be a dynamic regulator should mean that, in future, ratings are updated in a timely way once concerns have been remedied. However, how dynamic the CQC’s new approach will be in practice remains to be seen.

Other concerns in the PFD report include:

• The complete absence of Ofsted training or published policy in the following areas:
  • Signs of distress in school leaders during an inspection.
  • Practical steps to deal with such distress.
  • Pausing an inspection by reason of the distress of a school leader.
  • Who can attend meetings with the inspectors during the inspection process.
• The absence of a “clear path to raise concerns during an inspection if these cannot be resolved directly with the lead inspector”.
• The confidentiality requirement after an inspection. The coroner acknowledges that some changes have been made already, but this is not yet written into policy.
• Timescales for report publication.
• The absence of learning reviews conducted by Ofsted; currently there is no policy requiring this to be done.

CQC’s Ofsted-style inspections  

The health and care regulator’s Ofsted-style ratings were prompted by the Mid Staffordshire NHS Foundation Trust Public Inquiry in 2013. The switch from the CQC’s widely criticised hospital monitoring system was ordered by then secretary of state for health, Jeremy Hunt, in the wake of Sir Robert Francis KC’s report into the poor standards of care at Stafford Hospital where up to 1,200 patients died. The new approach was adopted in the hope that it would drive up improvements in care as inspectors would be inspecting services against five key questions – is the service safe, caring, effective, responsive to a person’s needs, and well-led? – before giving a rating.

The Ofsted-style inspection included the introduction of a four-tier ratings system which saw services rated as Outstanding, Good, Requires Improvement or Inadequate.

The then chief executive of CQC, David Behan commenting on the new approach, said: “It’s going to be tougher and much more rigorous, and will be much more clear about when services are failing or inadequate.”

Time to pause and reflect

As the CQC rolls out its new Single Assessment Framework, it will continue to deliver one-word ratings despite many care home operators favouring a narrative judgement. Many argue that one-word ratings often tell a partial story and risk weakening services that inspectors are seeking to improve.

The question remains, with Ofsted’s single-word ratings of schools under scrutiny, should the CQC be persisting with one-word ratings going forward?

The Education Select Committee published its report recommending the removal of one word ratings for Ofsted on 29 January. The government has two months to respond.