Size shouldn't matter say care homes angry at CQC's 'six-bed rule' for learning disability settings

Care providers have criticised the Care Quality Commission’s (CQC) guidance to limit registration of learning disability services to housing for six people or less.

Learning disability services should be judged on the merits of what can be achieved not just size, say care providers who argue the care watchdog’s ‘six-bed rule’ will reduce the public’s choice of care services in the community and put more strain on hospitals.

Draft guidance by the Care Quality Commission (CQC) has stated providers who want to register new services for people with learning disabilities, must ‘adopt an understanding that small-scale housing normally means housing for six or fewer people - as outlined in guidance by the National Institute for Health and Care Excellence (NICE).’

The guidance (‘Registering the right support CQC’s policy on registration and variations to registration for providers supporting people with learning disabilities') was published for consultation on 20 December, with the consultation period ending on 14 February.

In response, Care England, which represents independent care providers, said: "There is a strong feeling amongst providers that whilst the NICE guidance has been in place since 2012, it is aimed at people on the autism spectrum and is advisory.

"We are being advised by members that the NICE guidance and, in particular the limit of six beds, is already being treated as mandatory thereby preventing registration and the proper consideration of applications for variation of registration. "There has simply not been the lead in time to allow the market to adjust and to prepare for changes with commissioners because of the new cost basis of smaller services.

"A sudden change of direction cannot be in the interests of residents and providers trying also to deal with enormous financial pressures, alongside the transforming care programme and the need to adapt to new CQC standards."

Post-Winterbourne lessons

The care watchdog's guidance comes in response to a BBC Panorama programme in 2011, which exposed the abuse of people at the private Winterbourne View hospital in Gloucestershire. It also highlighted the issue of people with a learning disability being stuck in inpatient units.

A spokeswoman for the CQC said: “The issue of size follows government policy that is evidenced-based following the tragic events highlighted at Winterbourne View.”

The CQC guidance refers to the Department of Health’s report ‘Transforming Care: A national response to Winterbourne View Hospital, 2012’ which states: ‘People with challenging behaviour benefit from personalised care, not large congregate settings. Best practice is for children, young people and adults to live in small local community-based settings.’

Martin Green, chief executive of Care England, the representative body for independent care providers, said: "We are concerned that the real- life application of the current guidance, that states that CQC will only register units of six beds or fewer, will not offer genuine choice.

"The CQC will destroy many social care services for people with learning disabilities, and because this policy is completely financially unsustainable, will stop the development of many more. It is completely irresponsible of the CQC and their masters in the Government, to issue requirements which are not funded by the system.

“The ‘six bed rule’ seems to be the primary, and in some cases, the only factor in deciding if registration will be granted. This is contrary to the need to look at a range of factors to determine what is suitable for people living in the community and will work counter to the establishment of suitable settings in the community and thus make hospital care more, not less likely, because such services will not, as a result of the policy, be set up at all”.

The watchdog has been accused of limiting the size of learning disability services, while steering clear of suggesting a size limit for services to support older people and those with mental health issues. Mr Green added: “There is an obvious and strong illogicality in the position of CQC with respect to these different services."

'Not true that CQC have stopped registering services of certain size'

In response to criticism by care providers, Andrea Sutcliffe, CQC’s chief inspector of Adult Social Care and Lead for Registration said: “When providers are applying to register a learning disability service with CQC, it is our statutory duty to take decisions which promote the health, safety and welfare of people who will be using that service.

“We rely on national and best-practice evidence such as ‘Building the Right Support’ – developed by NHS England, the Association of Directors of Adult Social Services and the Local Government Association – to inform our decisions.

“In the consultation, we made clear how we will use this guidance to inform our registration decisions and gave examples of applications that are likely to be approved or refused.

“Each application will be considered on their merits and it is not true to suggest we have stopped registering services of a certain size.

“But let’s be clear – recreating large, institutional, distant and hidden-away settings for people to live in is not the 21st century service we want to see.”

The CQC also said responses to its consultation, which ended on 14 February, will inform a final version of its registration guidance, which it plans to publish later this year.