CQC inspections and regulation of Whorlton Hall: second independent report

Just before Christmas the Care Quality Commission published this report by Professor Glynis Murphy.  She had previously presented her first report on Whorlton Hall to CQC’s board in March 2020.

In that report she had made six recommendations and this second report looks at how CQC have progressed with those (despite the pandemic) and also sets out a review of international research evidence in relation to the detection and prevention of abuse in services.

Recommendations

These had been:

  • To improve data display and analysis
  • Unannounced visits / visit on evenings and weekends / make inspections less predicable
  • Closer working with local authorities over abuse allegations and safeguarding concerns
  • Interviews and observations with service users and family carers
  • Level 2 inspections of services at risk of failing
  • Registration

The review of progress against these recommendations is set out at a table at pages 8-12.

Professor Murphy also notes the publication Out of Sight: Who Cares?: Restraint, seclusion and segregation review.  You can read our blog on this report here.

Research evidence

This is covered in some detail at pages 13 – 36 and Professor Murphy then discusses this at pages 37 – 38 where she notes:

  • Much abuse comes to light as a result of service user disclosures and some also comes to light as a result of family members and staff whistleblowers, who both report the process of complaining to be distressing and difficult in a number of ways.
  • Staff are not always clear about what constitutes abuse and neither are residents with learning disabilities and / or autism which means that providers should ensure there is training on abuse and safeguarding, not just for staff but also for service users.
  • CQC has become too process driven and is not considering the outcomes for service users sufficiently.
  • At times CQC inspectors seem to be missing closed and unhealthy cultures in settings that may, on the surface, through their paperwork, seem to be adequate.
  • CQC inspections need to be more focussed on observing what is actually happening to service users on their visits and reinforces the need for thorough interviews of staff, service users and their families.
  • CQC needs to consider whether it needs to instigate surveillance itself.

Conclusion

This is set out at pages 39 and 40.

Professor Murphy makes five more recommendations:

  • Services should not be rated 'good' or 'outstanding' if they have used frequent restraint, seclusion and segregation.
  • Services should not be rated 'good' or 'outstanding' if they cannot show how they support whistleblowing and reporting of concerns.
  • The Group Home Culture Scale tool should be trialled.
  • The Quality of Life tool that is being developed should be trialled.
  • CQC should develop more guidelines for when the evidence of quality of care should be gathered from overt or covert surveillance.

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