The Two Faces of Care Monitoring

Two recent stories point up contrasting aspects of care monitoring. Towards the end of last week, Cynthia Bowers, the head of the CQC (Care Quality Commission) resigned, immediately following a Department of Health review which, notwithstanding the diplomatic language with which such reports tend to be larded, left rather few other options. It is asserted that she jumped rather than being pushed, and there is a widely held belief that this was her best moment to exit, as even worse reviews are likely to be forthcoming, as the Public Accounts Committee of the Commons gets their teeth into the organisation, and the enquiries into specific scandals, namely the CQC's disgraceful non-handling of abuse of residents with learning disabilities at Winterbourne View, and the West Midlands Strategic Health Authority's lamentable reaction to appalling care standards at Stafford Hospital which accounted for the deaths of 400 to 1200 patients. Cynthia Bowers was in charge at the time.

Beyond the specialist media, there has been very little coverage of the resignation, despite the fact that this is the organisation charged with inspecting and holding to account organisations we trust to care for people at their most vulnerable. In many ways, the CQC has been set up for failure, as it was handed more areas of responsibility, with GPs, dentists and domiciliary care added to the hospitals and care homes already under their nominal purview, while at the same time their budget was cut. All the while,  a stream of stories about organisations who had managed to achieve excellent results in their evaluations, while actually delivering rather poor care, demonstrated the inadequacy of the self-certifying, tick box approach adopted by the CQC.

Little wonder, then, that there is such a public appetite for the other form of evaluation of care services launched recently, and which received the saturation media coverage you might have thought the future of the statutory body deserved. Loosely described as Trip Advisor for care homes, the Good Care Guide website allows users (or more likely, relatives of users) to post their opinions and ratings of care providers. Many of us are uneasy about this type of evaluation, not because it isn't good in principle: the people with direct experience of the care provided in a particular establishment are uniquely placed to give a verdict, but such systems are also open to being subverted. Whether it is (as with the original Trip Advisor) cynical consumers blackmailing providers with the threat of an unjustified poor review; competitors posting negative comments on their rivals; PR people writing false positive accounts. There are just so many ways in which the honesty and transparency you would hope for can be undermined. The organisers are apparently confident that their systems for vetting contributors are robust. Let's hope they are right.

Would it not be better, though, to have a proper system of inspection by people who know what they are doing, and have the authority to rummage in the dark corners, so to speak, of an organisation? Even if the Good Care Guide does function perfectly, can you or I tell that a care home is ensuring proper nutrition for residents, for example? We can see, perhaps, that they provide the chocolate ice cream that Mum prefers for dessert, but without some training in dietetics, a good look round the kitchen, or at least an overview of the menus for all residents for all mealtimes, we can't say whether or not the food provided is good in all senses of the word. You can apply the same principle to almost every other aspect of care: at best, you will get an entirely subjective snapshot of one person's experience. Over the years, we have often been asked to include people's opinions of service providers on Independent Living, and it is tempting, when you hear a compelling and well-articulated account. But that is all it is: one person's view, and without the time and resources to dedicate to obtaining the full picture, we have always judged that it is better to abstain.

Now that we have plumbed the depths with the CQC, and the discredited management is on its way out, it would be wonderful if we could look to the future with unscheduled inspection visits, whistleblowers listened to, inspectors that see for themselves, rather than accepting what they are told by the people they are inspecting.  It doesn't seem like a huge ask, I wonder why it proves so difficult to implement?