(But what is going on in the South?)
For more than a year I have had the painful task of reporting that, quarter on quarter, care quality – at least according to CQC ratings, has been getting worse. It therefore gives me great pleasure to acknowledge that it looks as though things are getting better – with improvements for the second quarter running.
Whilst I was compiling my 2017 report Say Hello Wave Goodbye which analysed openings and closures of care homes for older people during that year, I noticed a worrying upward trend in the percentage of homes that were being rated as non-compliant with either a Requires Improvement, or more worryingly Inadequate rating from the CQC.
In the first quarter (Q1) of 2017 less than a third of published inspections were rated in the two lowest categories, but by the end of the year it had grown close to half of all inspections. Even worse, the dreaded Inadequate rating had grown massively from 0.1% to 11% across the year.
I made a mental note to keep an eye on the situation on a quarterly basis and have reported my findings since then.
2018 started just as badly as the previous year had ended with more non-compliant ratings than compliant ones, and then whilst Quarter 2 showed a hopeful improvement, Quarter 3 fell away again.
However, we have since seen two improving quarters across the 2018 to 2019 divide. Quarter 1 of 2019 has been the first time the ratings have improved on a year on year basis.
So where have the improvements come from?
From a nursing versus residential basis (image 2), the analysis is baffling. In Q4 2018 nursing got worse, with a 6.6% reduction in the share of Good and Outstanding (compliant) ratings over the previous quarter. However, a great improvement of 10.6% in Q1 2019, means that the nursing sector is around 4% better than it was 6 months ago.
Residential went in the opposite direction , with around a 12% improvement and a 12% reduction over the two quarters, meaning than over the period it has stayed the same – with the improvement coming from nursing.
But if the nursing versus residential analysis was confusing looking at the regional performances is much clearer where the improvements in the percentage of compliant inspection ratings have come from – The Midlands and The North with each of those 5 regions showing improvements in both quarters.(Image 3)
West and East Midlands performed best net improvements over the 6 months of 21% and 19% respectively. The North East improved by 17%, the North West by 7%, and Yorkshire by 9%.
So, what is going on in the South and East of England? Rather than improving they are going in the opposite direction – or more probably continuing in the same direction based on the trend of the last two years.
Whilst the South East did recover from a poor Q4 2018, to show a nominal 1% improvement over the 6-month period, the remaining 3 regions have seen their share of complaint ratings decrease.
The encouraging improvements in the North and the Midlands means that those 5 regions were in the top performing regions in the last quarter. (Image 4)
So, in summary, the much-needed improvements in ratings over the last two quarters is all due to efforts from the upper half of the country. And as the current level of compliant ratings is still well below that of the first 6 months of 2017, there is still some way to get to get back to the days when two thirds of inspections would get the thumbs up.
When the numbers I extracted for the last quarter showed a second consecutive improvement I was really optimistic about my findings. It would have been really good to back that up with improvements right across the country.
However, the corporate structure of the CQC has North, Central and South boundaries at Deputy Chief Inspector level – and after seeing that improvements were polarised in the North and Central regions, with a reduction in performance in the South, I must question whether these subjective ratings are being affected by the CQC’s regional management and directorship – rather than purely the homes’ performance levels.