Health secretary orders review on merits of OFSTED style ratings for care homes

Care homes and hospitals could be rated under a new ‘OFSTED style’ system, health secretary Jeremy Hunt announced today.

The health secretary has ordered a review identifying how a ratings system could help end the ‘crisis in standards of care’ that exists in parts of the health and social care system.

How services and information can be communicated to the public and how this information can be used to increase standards across the system, are key aims of the review.

Mr Hunt condemned past examples of poor care including patients being left to lie in their own excrement in Stafford Hospital, and residents being kicked, punched and forced into cold showers at Winterbourne View.

In describing these cases, the health secretary said: “In places that should be devoted to patients, where compassion should be uppermost, we find it’s the very opposite; a coldness, resentment, indifference, even contempt.

“Go deeper, and look at the worst cases – like Mid-Staffs and Winterbourne View – then there is something even darker. The normalisation of cruelty, where the unacceptable is legitimised and the callous becomes mundane.”

Mr Hunt continued: “Next year we will roll out the “friends and family” test across the NHS. For the first time hospital users will be asked if they would recommend the care they received to a friend or close member of their family.

“NHS staff will also be asked anonymously whether they would recommend their organisation to their own families.

“That’s the closest measure we can get to “care as you would wish to be cared for”. And we will publish the results. But we need to do more.

“As an MP I know how well each school in my constituency is doing thanks to independent and thorough OFSTED inspections. But because the CQC only measures whether minimum standards have been reached, I do not know the same about hospitals and care homes.

“I am not advocating a return to the old ‘star ratings’ – but the principle that there should be an easy to understand, independent and expert assessment of how well somewhere is doing relative to its peers must be right.

“So this week I have asked for an independent study to be done as to how this might be achieved in a way that does not increase bureaucracy.”

The Secretary of State has asked for recommendations by the end of March 2013.

Whatever recommendations arise from the review, he has made it clear that any proposed ratings system should have:

• no increase in bureaucracy;

• clear, simple results that patients and the public can understand – driving organisations to excel rather than just cover the basics; and

• greater certainty that poor care is identified early.

Jennifer Dixon, director of the Nuffield Trust who will lead the review said: “It’s a sensible question to ask about how the quality of care is assessed in health and social care providers, given all the systems currently in place to boost and monitor quality for the public.

“At the Nuffield Trust we look forward to doing an independent analysis of this issue working with a range of groups across the health and social care world in the UK, learning from past experience, from other sectors, and from other countries.”

The objectives of the review are:

• to map the current system of assessing the quality and safety of care of providers of health and social care and the current system of accountability for quality of care;

• to identify the advantages and disadvantages of assessing providers of health and social care;

• to identify in broad terms how best to combine relevant current and historic data on quality (safety, effectiveness, and user experience) and information from inspection to provide a useful, credible and meaningful assessment for comparing the performance of organisations providing health care and social care;

• key goals will be to use existing metrics, rather than require costly new data collection, and not to create extra burdens on providers;

• to suggest priorities for developing data and testing metrics in the short to medium term to allow better comparative assessment; and

• to identify which organisation/s might be best placed to provide such assessments.

Commenting before the health secretary made his proposals, Cllr David Rogers, chair of the LGA’s Community Wellbeing Board, said: “People rightly expect to be able to make informed choices about the services they use, and care homes are no exception.

“The lack of information around the quality of residential care has resulted in a confusing world for people at what can already be a difficult time of life. Providing greater clarity would undoubtedly provide much needed assurances for those who are naturally looking for the very best care and support in old age.

“Councils understand that ratings are important to drive quality and have used these in the past to pay premiums to the very best care homes. But for a rating to be reliable and trusted it also needs to be current and reflect the true picture of the level of service a care home provides. This means ratings would need to be provided regularly, and certainly be no more than two years old.

“For assessments to reflect a true picture they should also take into account the information that is already available, the views of people who use the service, and information from local authorities and other organisations involved in providing care.“

The health secretary’s proposals have been broadly welcomed by directors of adult social services. However, with the welcome comes their warning that providing a ratings system for care homes will not be easy.

ADASS president Sarah Pickup said: “Different people have very different priorities and expectations when it comes to assessing how well a care home or domiciliary care agency is performing.

“ADASS members will hope that dignity and compassion will be as much a part of any assessment as the accuracy of records and the timeliness and practical and professional skills with which particular interventions are delivered.”

She also insisted that any new duties and responsibilities laid on existing regulators should be fully and transparently funded: “Too often, in the past, additional burdens have been loaded onto the shoulders of statutory bodies – including sometimes local authorities - without any care being taken to ensure that they have the capacity to fulfil them.”

In this respect she said she hoped “that any proposals that are developed will draw on information that is already available, as well as the views of people who use services, and the knowledge of a range of agencies, including local authorities.

“This will help avoid significant additional burdens and diversions of resources from actual service improvement to performance management or servicing inspections.

“Any attempts to promote improvements in the quality of care and making better information available to the public must be seen as good things. There are clearly challenges associated with rating care services for people, but ADASS stands ready to contribute to the review and to play its part in any system that emerges in the future.”