Healthcare regulatory partner Amanda Narkiewicz from law firm Mills & Reeve considers the Care Quality Commission’s response to recent reports following the death of head teacher Ruth Perry

The Care Quality Commission has confirmed it will learn lessons from the death of Caversham Primary School head teacher, Ruth Perry, who took her own life after an Ofsted inspection, and is overhauling its training of inspectors. The regulator plans to roll out a training programme designed to support assessors and inspectors and identify signs when providers may be distressed.

In its February board report, the CQC considered what it has learned from recent reports following the death of Perry, as comparisons have been drawn with its work and the CQC’s use of ratings to describe quality. Interestingly, the CQC makes the point that the quality of care provided by large healthcare settings is not usually perceived as the sole ‘responsibility’ of an individual in a comparable way: we expect registered managers may take a different view.

The regulator acknowledges it has had contact from providers and provider representatives to highlight the stress of inspections and pressure they experience on the ground, and the effect of this on wellbeing and long-term recruitment.

In addition to reviewing the training of inspectors and assessors, the CQC recognises there are “further areas” where it “must act”.

Key areas include:

• A review of quality assurance processes to ensure reports are published in a timely way, such that “where there has been an unusually long delay between inspection of a service and publication of a report, consideration will be given to how any progress made since the inspection is reflected in any accompanying media materials at the point of publication to ensure an up-to-date picture of quality”.
• Further guidance for providers to support them with the new Single Assessment Framework (SAF), as the CQC recognises that it is a transition from an old model to a new model with new technology.
• A review of the process for supporting the wellbeing of providers.
• A review of other pathways for providers to raise concerns with the CQC which cannot be resolved by assessors and inspectors on site.
• Reassessment of the call for an independent complaints process. However, the CQC emphasises that if providers are unhappy with the CQC’s complaints process they have the right to contact the Parliamentary and Health Service Ombudsman via their local MP. This is a live issue for care home providers who have been calling for an improved pathway for complaints. 

Ofsted learning

Senior coroner Heidi Connor raises concerns in her ‘Preventing future deaths’ report that the current Ofsted system allows for the single-word judgement of Inadequate to be applied equally to a school failing in all areas and to a school rated otherwise Good, but with issues that could be remedied by the time the report is published. Care providers’ ratings, similarly, can at times be dictated by a small number of findings that can be remedied quickly and before the publication of the CQC’s rating.

The roll-out of the CQC’s SAF 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, it will also mean that the CQC will be quicker to downgrade ratings and take enforcement action.

The impact of an Inadequate rating, particularly for care providers, cannot be underestimated. That one-word rating can often trigger enforcement action, a financially distressing local authority embargo (preventing new admissions), adverse local press, difficulty in recruitment and retention of staff, and home managers feeling exposed to public scrutiny from residents, their families and the local community.  All of this in our experience impacts a provider’s ability to address the concerns that led to the rating.