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Undeniable proof – Quality of Care is getting worse


Since the start of 2017 I have been monitoring quarterly published ratings by the CQC for care homes for older people, and what I have found is really worrying, with an apparent trend towards poorer care standards, if CQC inspection ratings are assumed to be a good guide.

In the first quarter of 2017 there was a 70/30 split between compliant homes (Outstanding and Good) and non-compliant homes (Requires Improvement and Inadequate) but a rapid trend away from compliance showed that by the 4th quarter it was down to basically a 50/50 split.

The first quarter of 2018 continued the downward trend, and whilst Quarter 2 this year showed a very slight improvement on Quarter 1, year on year, the share of Requires Improvement grew by 4% and Inadequates grew its share 5 times over from 1.7% to 8.4%.

Comparing the first halves of each year, Inadequates has shown a massive increase – accounting for around 9% of inspections during 2018, against 1% in the first half of 2017.


(Chart 1 – Quarterly trend in published CQC ratings)

Just over 900 of the 1025 homes with a published rating from Quarter 2 had been rated before, and a like for like snapshot from January 2017 shows that these homes have generally performed worse in their latest ratings. Of the 500 homes that were rated Good from this sample in January 2017, about a third now require improvement – and 5% are currently rated Inadequate.

Some slightly better news is that over half of the homes rated as Inadequate before are now Good.

On a geographical basis, each of the 9 English regions performed worse in Quarter 2 than they have across all their inspections. What are “worse performances” for the total market, are “best performances” in the last quarter for every region:

Rating Regional Shares of all Inspections, between: Regional Shares of Quarter 2 2018 Inspections, between:

1% and 4%

5% and 12%

Requires Improvement

19% and 30%

31% and 54%


66% and 76%

35% and 60%


1% and 4%

0% and 7% (!)


Strange that the only exception to the rule is with Outstanding ratings in one region – East of England who managed 7 top ratings from just 101 inspections. The South West also had 7 Outstandings, so between the two regions they shared 60% of the top ratings handed out, whilst 3 regions didn’t get any. How does that happen?

The percentage shares by region for both samples are shown in the following two charts.


All Inspections by Region


Q2 Inspections by Region)

On a sector basis, breaking down nursing and residential, with or without dementia, the same worsening performance levels are true, as the charts show.


All Inspections by Type of Home


Q2 Inspections by Type of Home)

So, is care quality worsening or are the CQC increasing their expectations about what makes a complaint home?

In November 2017 CQC changed its Key Lines of Enquiry (KLOEs) but as we can see the worsening performance started well before this date – and of course there will have been a time lapse of several weeks between the actual inspection and its publication.

Brexit has seen a worrying exodus of foreign workers from the UK, and social care is obviously sharing the loss of valuable care workers and RNs through this. Continuing under funding from Local Authorities, whilst minimum wage levels increase will be putting pressure on head counts and pay roll costs. Perhaps we are losing good employees fed up with the long-term stress they have had to put up with?

It would be useful if the CQC could do a report on why, and where they are finding poorer care quality in their more recent inspections. I am sure that, in his new role as CEO, Ian Trenholm would be very interested to find out what is going on.

Mike Short


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