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18 March 2019 0 Comments
Posted in Health & Social Care, Opinion

“Factual accuracy by Twitter”: CQC implements a word limit and pre-emptive phone calls to managers to discourage challenges to inspection reports

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CQC is imposing a new 325 character limit on factual corrections to draft inspection reports. This means that for every point you wish to contest, you will have to explain your correction in approximately 50 words. To illustrate the new brevity required, in this article, the fiftieth word would be here.

The trouble with this is that the points that inspectors get wrong are usually the complicated ones. It is not a matter of saying, “the sky is blue not green”. Instead, providers must explain why an inspector’s understanding of a particular set of facts was: (a) incorrect; and (b) does not lead to the conclusion that the inspector has drawn. If a factual point is simple, the inspector usually hasn’t got it wrong in the first place.

CQC are not publicising this change in their current provider engagement programme. However, when asked directly, senior CQC officials have confirmed that it is being implemented.

CQC are also actively trying to prevent challenges to draft reports by directing inspectors to phone registered managers two days after they have sent them a draft inspection report. They will discuss the reasons for the ratings they have imposed with the manager.

These phone calls are clearly intended to pressurise managers to agree to the publication of reports without contesting their accuracy. However, this tactic creates problems. Managers often feel intimidated by inspectors. It is therefore not fair to try to use that unequal dynamic to prevent the contesting of factual inaccuracies. Furthermore, targeting managers may pre-empt providers’ rights to be heard. Calling managers puts the question about whether the report should be published to the wrong person. It should be for the provider (not the manager) to make the judgment call about whether they accept the findings in the draft report and forgo their right to contest CQC’s conclusions.

Adequate consultation?

In August 2018, CQC asked for views on how they could improve their factual accuracy process. They indicated that they wished to make the process digital and clearer for providers.

Later, in October 2018, CQC created a list of proposals, which included the following:

  1. to develop specific provider guidance with clearer instructions and examples
  2. to make their factual accuracy form simpler and mandatory
  3. to impose a word limit on each point that is being made on the form, but not the number of points
  4. to ask providers to identify where and how the information supports the point (rather than sending CQC lots of material)
  5. to adhere strictly to the 10-days time limit
  6. to allow discretion to extend the time limit (but only in exceptional circumstances)
  7. to develop a digital solution.

Importantly, this consultation contained no information about the drastic nature of the word limit that CQC are now implementing and failed to mention that they would be calling registered managers to discuss draft reports with them. CQC’s bland statements about their intentions probably raised little in the way of response from providers, who currently have plenty of other things to worry about.

In January 2019, CQC published updated draft guidance, which can be found here (we reported on this in our previous blog). CQC then asked for views on their new guidance which, according to them:

  • was shorter and simpler
  • appeared on their website as a web page, making it easier to find and read
  • emphasised that challenges to the factual accuracy of reports must only be submitted on the form provided and within a strict 10-day deadline (except in exceptional circumstances, for example IT failure), and
  • explained the types of challenge that providers can submit.

The new guidance completely failed to mention the imposition of a word limit or post-inspection calls to registered managers, but CQC have now changed their factual accuracy comments form to impose a character limit on every point. The new factual accuracy form can be found here.

Although CQC have changed the form, we have yet to see further updated guidance published to reflect this.

Tipping the scales against factual accuracy challenges

CQC are clearly trying to tip the scales even further in their favour to prevent effective challenges to inspection reports. The character limit has been introduced to make it harder for providers to explain corrections and easier for CQC to refute challenges. The phone calls to managers are designed to nip any potential challenge in the bud before providers have time to consider a draft report properly. These changes do not make the process clearer and fairer for providers or “better for everyone” as CQC have asserted. If CQC focused on improving the quality of the evidence cited in reports and the consistency and proportionality of their conclusions, it would reduce the need for challenge and enable them to publish reports more quickly.

What providers need to do now

Whilst it is clear that the word limit will inhibit providers’ ability to articulate their points and defend their services, our advice is not to let this deter you. It is important that providers exercise their right to dispute inaccurate findings because inspection reports present your public face to the world. They can make or break your reputation, bolster or demoralise your managers and staff, and heavily influence your chances of obtaining lending, referrals from commissioners, and placements of privately funded service users. There is a lot at stake.

We would also point out that it is the fees paid by providers that fund CQC’s operations. If providers don’t think they will get a fair hearing by CQC, they should complain about these changes in policy. These new policies may end up being the subject of a legal challenge. Until then, providers should make their voices heard and hope that CQC will listen to reason.

Photo by Bethany Legg on Unsplash

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