South East care homes seven times more likely to be rated Inadequate than West Midlands care homes

Care home providers are calling for the Care Quality Commission to make sure they use a ‘standardised approach’, after a study revealed a disparity in CQC ratings of care homes in different regions in England.

One in six of all care homes in the South East of England have been rated ‘inadequate’ by the Care Quality Commission, compared to one in 40 homes in the West Midlands, according to research carried out by Care Sector Innovations.

The study found that across the England the percentage of care home inspections that have been deemed Inadequate varies from a low of 2.5 per cent in the West Midlands to a high of 17.5 per cent in Yorkshire & Humberside and the South East.

Is it the quality of care or lack of standardised inspections?

Mike Short, owner of Care Sector Innovations (CSI), said: “So does that mean that the quality of care actually varies by this much – or should we be questioning the subjectivity, leniency or heavy handed attitude of inspectors in the different regions?

“Like any new initiative it needs time to bed in, but these are very high stakes and we need the CQC to ensure that everything is being judged fairly.

“What is deemed in need of improvement in one region should not be inadequate in another if there is no difference in what the care home is providing.

“This is not a suggestion that individual inspectors are purposefully being too hard or too lenient in their assessments of care providers, but there is probably a situation where there is a difference in the way they are interpreting their briefing from the CQC.”

In October 2014 the Care Quality Commission (CQC) changed the way it assessed and reported its inspections.

There are now five key indicators – Safe, Effective, Caring, Responsive and Well-led. Each criteria, and a final decision based on each is Outstanding, Good, Needs Improvement or Inadequate.

Only one care home rated Outstanding

At the beginning of May, CSI looked at the results of inspections under the new criteria. It found only one care home had been rated Outstanding whilst 63 had been classed at the lowest ranking of Inadequate.

A total of 375 inspections (or 52 per cent) were classed as Good and 281 (39 per cent) as Needs Improvement , with only just over half the homes that have been inspected so far passing the new CQC test.

Mr Short suggests that it “may well be that some regions are targeting homes that may have been whistle-blown or are expected to fail under the new criteria due to results of previous inspections and will therefore show a higher number of Inadequate ratings. But that means other regions are not targeting the same sector and there needs to be a standardised approach to ‘who gets inspected next’ across the country”.

Consistency is 'vital'

Des Kelly, executive director of the National Care Forum said: “This makes for very interesting reading and appears to confirm issues that are being raised with us all the time by providers. It is vital that there is consistency in the rating given to a service by any inspector and from one inspector to another. It is my understanding that CQC have been using a panel to check consistency in both assessment and approach – it is debatable whether this is being translated into the actual judgements being given.

“We (along with many other provider bodies) support the return of the quality ratings but we remain concerned that the system is not working properly at present. We need to find the way to work with CQC to put right whatever is causing the discrepancies highlighted.”

Subjective judgments

Tony Stein, chief executive of Healthcare Management Solutions, which oversees the operation of many care providers and has had direct involvement in the inspection process warned that “the CQC needs to be careful in trying to be the Trip-Advisor for the sector. Making subjective judgments as to quality will inevitably lead to greater variations in inspection outcomes and CSI’s findings demonstrate clearly that this is happening.”

The CQC said that it is too early for it to comment on regional variations at this stage since it has only been rating services under its new regulatory approach for the past seven months, with a spokeswoman saying: “We will have rated all adult social care services by September 2016 and will have a full picture by then. It is the responsibility of providers to deliver services that are safe, caring, effective, responsive and well-led. It is what we expect and what people simply deserve. Where services have been rated as Inadequate or Require Improvement we will follow up improvements in six month’s time and expect to see improvements.”