6 in 10 Home Care Providers Have Outdated or No Ratings: Report

File photo of an elderly man dated May 18, 2017. Joe Giddens/PA Wire

An analysis by the Homecare Association has found that six out of 10 home care providers have either significantly outdated ratings or have not been rated at all by the Care Quality Commission (CQC).

As of June, more than one-third (37 percent) of home care providers had last been rated by the CQC between four and eight years ago and nearly a quarter (23 percent) do not have ratings, the Homecare Association’s report published on Friday says.

The organisation, which has around 2,200 members providing domiciliary care around the UK, said that insufficient inspections are putting the quality and safety of those receiving care at risk, as well as damaging public confidence in the sector.

These failings are also causing harm and financial detriment to providers, who are facing “crippling registration delays, inconsistent inspections, and communication breakdowns” with the CQC, which regulates and inspects health and care settings.

Homecare Association CEO Jane Townsend OBE compared the situation to restaurants where health inspectors have not visited in years, “yet you’re still expected to maintain the highest standards with no feedback or support. That’s the reality for many care providers today.”

“The commercial damage is severe. Providers are losing contracts and going out of business because of registration delays and outdated or non-existent ratings,” Townsend added.

Resource Constraints

The report said the failings were caused by issues including severe resource constraints.

Registered community social care location numbers had increased by 5.5 fold in the past decade, from 2,303 in 2013 to 12,574 in June of this year. But according to the Homecare Association, regulator resources have remained “largely static,” with CQC staff numbers per registered location having almost halved during that time.

Councils have also encouraged a proliferation of small home care providers, which has increased pressures on having enough regulator staff to carry out inspections on the growing number of domiciliary care businesses.

This absence of up-to-date assessments and ratings is posing a problem for councils and the NHS when tendering contracts, with some councils having “given up considering CQC ratings and are contracting with new providers that CQC has never assessed,” the report says.

The Homecare Association also pointed to other problems undermining the regulator’s effectiveness, including “flaws in CQC’s funding model and fee structure,” poor leadership, and “ineffective” IT systems.

The organisation recommended a review of CQC’s resource needs, IT system upgrades, and improved coordination between the regulator and local authorities.

Responding to the report, a Department of Health and Social Care (DHSC) spokesperson said: “It is completely unacceptable that homecare services are not being properly inspected. The Secretary of State has been clear there is an urgent need for rapid improvements at the Care Quality Commission (CQC) to give people confidence that the care they’re receiving has been assessed.”

The spokesperson said this has already started with increased government oversight and the appointment of Professor Mike Richards, a senior cancer doctor, to review the CQC’s assessment framework.

“We are determined to grip the crisis in social care. We will reform the sector and take steps to create a National Care Service,” the DHSC spokesperson added.

‘Not Fit for Purpose’

The findings from the Homecare Association come after Health and Social Care Secretary Wes Streeting branded the CQC as “not fit for purpose,” after an interim report revealed significant failings in the health care watchdog.

The report published in July and headed by Dr. Penny Dash found that failings were impeding the regulator’s ability to spot poor performance at care homes, GP practices, and hospitals during inspections.

Similar to the Homecare Association’s findings, Dash said that some health and social care settings had not been inspected for years, with one NHS hospital not being rated since June 2014 and the oldest rating for a social care organisation being from October 2015.

Dash said her interim report underscored the urgent need for reform within the CQC. As a result, the DHSC announced the government would have oversight of the watchdog, with the regulator updating the DHSC regularly on its progress in implementing Dash’s recommendations.

Kate Terroni, the CQC’s interim chief executive, said at the time that the regulator had accepted “in full” the findings and recommendations of the Dash report and it would work “at pace and in consultation with our stakeholders to rebuild that trust and become the strong, credible, and effective regulator of health and care services that the public and providers need and deserve.”

“We’ve committed to increasing the number of inspections we are doing so that the public have an up-to-date understanding of quality and providers are able to demonstrate improvement,” Terroni added.

The CQC is also increasing the number of people working in registration and is working to improve its IT systems, the watchdog said.

Dash’s full report will be published in the autumn.

PA Media contributed to this report.