CQC – who regulates the regulator?

First published in Independent Practitioner Today in July 2020

It was disappointing to read in the press that the CQC has found that dozens of its reports are flawed.

In January 2020, it was reported that CQC had been compelled to retract almost 40 inspection reports into care and nursing homes after finding that there was “duplicate material” in 78 reports, where identical quotes from patients, service users or families or sections of evidence had been pasted into reports and different institutions. In 38 out of the 78 reports, CQC had found that the homes in question would need to be re-inspected in order for them to be “confident in the ratings and findings”. All of the homes were in the North of England with the exception of one in London.

This is devastating news for the sector. It does however underline the importance of challenging a CQC inspection if you are a provider from any sector and feel that the due process has not been followed.

Ultimately, it is the providers who regulate the CQC.  Only if providers complain, challenge or report back to the CQC can poor inspection practices be identified and addressed.

We recently complained regarding the conduct of an inspector during and immediately following the inspection of a private hospital. The CQC immediately suspended the production of the draft inspection report pending the outcome of the investigation into the inspectors conduct.

CQC encourage providers to speak up and will take proportionate action where justified.

We have supported a number of GP practice to challenge their Inspection Reports, including where they have been placed in special measures.  We supported the collection of feedback from staff and commenced the complaints process to scrutinise the sometimes overbearing approach of inspectors.

We have supported dentists and achieved a turnaround on ratings and sought to limit co-ordinated reviews of practices in the same group on the same day.

We recommend bringing a complaint to the CQC as soon as an issue arises. If you feel that your CQC inspection has been conducted by someone who was unprofessional, was not listening to what you had to say or came with a very fixed agenda, you should raise this through the CQC complaints process straightaway. Do not wait for your inspection report as a complaint at that point can seem a little like “sour grapes”. An early complaint can result in the production of a draft report being placed on hold pending the outcome of the investigation and it is far easier to prevent the publication of a report in the first place, than it is to get one removed once it is online.

CQC must investigate concerns when they are presented to it and must treat every concern as a legitimate verifiable concern even if providers have a suspicion that vexatious or vindictive complaints have been made.  A fair and balanced process must be followed. If it is not – speak up.

Alongside this, the Factual Accuracy Challenge process is a key and important process to utilise to its fullest. CQC would have you believe that the process is limited to saying we have 5 staff members, not 4, but the FAC is the only real opportunity you have, post inspection, to address any anomalies. So “go to town” and “throw the kitchen sink” at your Factual Accuracy Challenge – but do it fast – you only have 10 working days to respond – and rarely will you get an extension on that. Every single point you take issue with, needs to be addressed. If you don’t challenge it, it will stand as drafted.

Your main route then is a Rating Review. We recently launched a Rating Review for a private cosmetic clinician. A Rating Review can only be a challenge against failure to follow due process. The review resulted in changes to the Providers report as CQC had failed to follow their own internal processes in ensuring all sections of the report were peer reviewed prior to publication. A Rating Review is a little like a Judicial Review – if a public body has failed to take relevant evidence into consideration, has taken into consideration irrelevant evidence or has failed to follow due process, then a challenge is worth taking. Particularly given the potential impact on reputation.

Inspectors do sometimes get it wrong. They miss things. They mis-interpret information.

Make sure you have your say and make sure your report is the most accurate representation of your service that it can be.

In the current Covid -19 situation, there will be a small number of draft reports still coming through the system from inspections carried out before the shut down – these will still need to be challenged in the usual way if you are not content. Whilst routine inspections are now not taking place, CQC can and will still take enforcement action where serious cases of risk and safety arise and once lock down is lifted, the inspection process will in time re-commence.

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