CQC’s review of the year

On 22 October 2021 the Care Quality Commission published their annual report on the State of Health Care and Social Care in England.


The report (covering just under 100 pages) is split into four parts:

  1. People’s experiences of care
  2. Flexibility to respond to the pandemic
  3. Ongoing quality concerns
  4. Challenges for systems

Summary ratings charts can be found in the Appendix (pages 76-87).

The report is written at a time of great change and pressure both in respect of the pandemic and the creation of Integrated Care Systems. The foreword acknowledges the toll taken on those working in the sector as well as, of course, those receiving care. They conclude this by saying that the future must be focussed on outcomes for people, supported by transformational change.

Some of the chapters probably will not tell readers anything they do not already know but they are brought to life with some case studies. 

Points to note include:

  • CQC are carrying out a year-long programme of work to transform the way they regulate services for people with a learning disability and autistic people. They have improved their inspection methodology to focus on the culture of services and on identifying where people living in hospitals and care services may be at greater risk of poor quality of life.
  • Reference is made in several parts to their provider collaboration reviews (pages 18, 24 and chapter 4).
  • The section on Discharge to Assess (pages 31 and 32) reminds readers of DHSC guidance on hospital discharge and community support updated in July 2021.
  • The section on Adult Social Care Fragility (pages 39-43) sets out analysis from the Market Oversight Scheme.

Quality concerns

Readers will probably be most interested in Chapter 3.

Three key points are flagged by CQC:

  • Through their reviews of high-risk mental health services, they are concerned that people continue to be put at risk in a small number of services where there are warning signs of closed cultures.
  • Improvements in maternity care are far too slow, with continuing issues around staff not having the right skills or knowledge, poor working relationships, and not learning from when things go wrong. Other concerns, include a lack of engagement with local women by maternity services and limited action taken by these services to improve equitable access.
  • While services have largely maintained levels of Deprivation of Liberty Safeguards during 2020/21, they need to have a continued focus on people subject to a deprivation of liberty. They continue to have concerns about delays in authorisations, which mean that individuals are deprived of their liberty longer than necessary, or without the appropriate legal authority and safeguards in place.

Closed cultures

  • They will continue to review whistleblowing concerns, feedback about quality of care and notifications to proactively identify services they think could be at risk of developing a closed culture.
  • CQC remind readers of the common features of closed cultures set out in their July Insight report
  • This section of the report covers the use of restrictive practices, issues with staffing and management and lack of external oversight.
  • CQC are testing a new methodology that is designed to get under the culture of a service.

Maternity Improvements

  • As at July 2021, 41 per cent of services were rated as requires improvement or inadequate.
  • They reference their review of nine maternity services where they had concerns between March and June 2021.

Deprivation of Liberty Safeguards

  • Many of the issues they have reported on previously have continued and /or been exacerbated in the context of the pandemic and associated pressures on the system.
  • National and regional variations are covered at pages 58-60.
  • CQC are concerned that providers’ focus shifted away from DoLS resulting in isolation and withdrawal, lack of visits from RRPs, families and other professionals and lack of a truly up to date picture of people’s lives.
  • They continue to be concerned that lack of understanding about DoLS is having an impact on providers’ confidence about whether restrictions introduced in response to the pandemic amounted to a DoL or not.
  • Better training is needed to improve staff knowledge and understanding of DoLS and the Mental Capacity Act and their importance in protecting people’s human rights.

So a lot to take on board. In addition, we have the prospect of DoLS to Liberty Protectin Safeguards taking place in 2022.

We have a friendly and experienced team able to guide you through the MCA and/or regulatory issues.

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