End of star ratings brings confusion

Amid the hubbub about the announcement of the coalition government’s plans – or lack of them – for social care last month, the Care Quality Commission’s announcement that it was scrapping its star ratings system for registered care services almost slipped under the radar – but it is an important decision and deserves more publicity than it has received so far.

But while the CQC is abandoning star ratings – 3 stars for an excellent service down to no stars for a poor one – it hasn’t got anything to replace it yet, and this has drawn criticism from some in the sector.

However, the passing of star ratings will not be much mourned. The system has been generally unpopular among care home operators ever since it was introduced 2 years ago by the then CSCI. Around the time it was introduced I was writing a lot about care homes, and to raise the subject of inspections – and the star rating the home received – to the manager often resulted in the sort of look that I’d get if I’d just sworn at them. Many objected to their rating and some were even prepared to go to court over it.

At the time, Frank Ursell, CEO of the Registered Nursing Home Association, voiced one of the major concerns – that a care home can receive a zero stars rating for being rated ‘poor’ in one of the three key areas involving safety and management, even if other areas are rated ‘excellent’.

The use of 3 stars, rather than the more common 5, was also queried as it was thought that it may confuse people trying to find care homes.

Getting rid of star ratings without having a replacement lined up has not gone down well either. Martin Green, chief executive of the English Community Care Association (ECCA) was unusually forthright on it:

“The CQC has told providers that it is interested in quality and yet… we have seen it bring forward the abolition of the star ratings system without a clearly defined timescale for its replacement,” he said. “The manner of this announcement, the lack of consultation, and the fact that CQC is not even adhering to its own published timescale gives us grave concern about its commitment to quality and its understanding and engagement with the social care sector.

“The CQC has been in existence for 13 months and it is becoming increasingly clear that it has little understanding of the social care sector, is administratively and bureaucratically shambolic, and lacks leadership and direction.”   

Harsh stuff, but if the head of the ECCA is saying it, imagine what those on the ground are.

The CQC says it is in talks with stakeholders to “discuss how a new system may work”. This can be seen as the regulator working with the sector to find a solution that suits everyone, or that it hasn’t got a clue what to replace star ratings with, depending on your view of the CQC.

But quite what they will come up with remains to be seen. In theory, star ratings should have been great to give an at-a-glance view of the quality of a home/service, but with the previously mentioned wrinkles in the system, this was not always the case.

Whatever does come from this consultation, the hope is that any new system is easy to understand, fair and remains in place for some time, rather than chopping and changing every couple of years.

This decision is crucial for the CQC, not only in terms of helping service users, carers etc navigate the system and find the right care, but for the body’s own credibility, which is seemingly on the line as well.

More work needed to raise social care standards

While the Care Quality Commission has tried its best to get a positive spin on the findings in its review of adult social care services  published today, as ever, most people and the media have focused on the negative aspects of it. And they’re right to.

Despite the overall quality of services improving in the past year in all areas, there is still a significant minority of ‘poor’ and ‘adequate’ services being provided to adults and especially older people.

Poor services are always unacceptable and need to be rooted out or given help to improve. Reports like these highlight them, but it means nothing if it doesn’t help to bring about change.

To this end, the CQC’s chief executive, Dame Cynthia Bower, said the CQC is determined to raise standards, hence why 8 councils have been designated as ‘priority for improvement’ councils and another 16 are to have an in-depth inspection of their services.

Elsewhere, the new registration system for adult social care providers, NHS providers and independent healthcare will have a single set of safety and quality standards. Also, the CQC is to get tougher powers and will be able to respond to concerns more quickly.

But local councils also have a role to play in improving services, especially commissioners; they need to look at the services they are purchasing and, if they are failing, move elsewhere. Obvious perhaps, but still needs to be said because it seems some commissioners don’t do this.

Unfortunately, this may be easier said than done. While eligibility criteria for receiving social care remained largely constant in the past year, after the previous 2 years when the number of councils providing care for ‘moderate’ or ‘low’ needs fell markedly, the spectre of eligibility levels being raised again in the coming years because of dwindling budgets looms large.

With budgets being squeezed, commissioners may feel under pressure to look at the cost of services rather than the quality. By the same token, service providers may also be under financial pressure and be looking to make cutbacks, which could affect the quality of their services.

So, in essence, the CQC’s reports are positive – let’s not forget standards are improving – but they show how much work still needs to be done. But by acknowledging this, and laying out strategies to help, the next report should be more positive still. As long as budget considerations don’t impact too much, that is.

Big week for social care

For those of us involved in reporting on social care – adults and children – this week is shaping up to be a busy one, with 2 major reports coming out that should make mainstream national headlines.

The much-vaunted final report from Moira Gibb’s Social Work Task Force (SWTF) is due out tomorrow, with the Care Quality Commission’s first major assessment of the quality of adult social care in England coming on Wednesday.

The SWTF report is awaited with particular interest because that should contain elements that – it is hoped – will change social work practice for the better. Some of its contents have already been trailed (including in this blog on November 20) including implementing a probationary year for newly-qualified social workers and the establishment of a national college of social work along the lines of medical Royal Colleges, which augur well for the full contents of the report.

Meanwhile, the CQC’s report has been less well trailed but should also put social care in the spotlight. The report will contain information on all 148 councils’ performance in adult social care, an analysis of how well commissioners are purchasing services, the performance of residential homes and home care agencies, and the CQC’s response to the adult social care green paper.

The media response to both should be interesting because I suspect they will vary significantly. I imagine the SWTF report will be welcomed, with its emphasis on how practice and training can be improved, although there will be gripes about what isn’t included in it.

However, I suspect the emphasis of reporting on the CQC report will focus on the areas that are failing – undoubtedly the minority – and virtually ignore the rest of the content. As usual in the national media, a cheap, sensational, social care-bashing headline and story will be produced, rather than more balanced reportage.

I’ll be covering both reports in the blog over the next few days and try to give a balanced take of the content – whether it is good or bad – as well as looking at the reaction to it elsewhere.