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A challenging relationship
While maintaining a productive relationship with CQC is essential , so is challenging any worrying issues on their draft reports , says Nicole Ridgwell
Over the past year , one topic is a regular feature when substance misuse providers meet at conferences , at training events , and in the waiting rooms of law firms ; that their CQC inspection reports are peppered with negative commentary . This commentary , according to providers , does not address their core services but the more tangential and arguably minor aspects of their services . Frustratingly for providers , these critical reports appear to disregard clear evidence of statistically positive outcomes being achieved by the service in question .
The reputational and financial damage caused by such negative reporting is leading some to reflect on whether they are able to sustain services in a sector whose regulator appears to be at war with it .
This fear of being ‘ regulated out of the sector ’ is also being reported to us at Ridouts . The concern is that CQC has a fundamental misunderstanding of the services they are now regulating . As previously covered within this section , some of the uncertainty of this inspection cycle arises because it has been the first under the new inspections regime . Indeed , by declining to publish ratings during the first year , CQC tacitly acknowledged that this set of inspections was a trial run . However , providers are worried that their experiences indicate more than the initial hurdles of a newly implemented system ; there is a disquieting suspicion that CQC inherently distrusts the motives of the substance misuse sector .
The CQC press release of September 2014 , setting out the planned changes to the inspection regime , acknowledged that ‘ substance misuse treatment is a unique , diverse sector and people using these services often have complex and varied needs ’. However , it is this very complexity and the corresponding diversity of treatments used which has been at the core of much of the criticism directed at providers .
As with other sectors brought into regulatory regimes , it may take time for the sector and its regulator to understand each other . I would argue that this only strengthens the need for both sides to engage at every opportunity .
Providers may hesitate to challenge an allegation of regulatory breach even in situations where the thing they are being criticised for is at the heart of the care they provide . A common example of this is where the treatment regime is not that recommended within the NICE guidelines . In my experience , it is not that providers were unaware of the guidelines , nor that they had a ‘ devil may care ’ attitude to compliance , but that they and their experts had thought long and hard about the nature and experiences of their service user group and concluded that an alternative care pathway was required .
This returns us to the importance of an outcomes-based inspection process and the corresponding need to challenge CQC ’ s assumptions . If CQC ' s chief inspector of hospitals , Professor Sir Mike Richards , meant what he said in his September 2014 press release – that ‘ it is vital when looking at substance misuse services that the views , opinions and experiences of people who use them are listened to and that any judgement that we make about those services reflects what we have heard ’ – then service user outcomes must be central to all inspections .
It is understandable that providers feeling under siege may hesitate to object , for fear that CQC inspectors would return with a grudge . Yet , not only is there a separate and well-worn complaints process to tackle such blatant prejudice but the advantages of challenging through the factual accuracy process are two-fold : for the service , using legitimate routes to submit a well-drafted and forensically evidenced appeal does lead to substantive changes to reports ; for the sector , a cogent explanation of a service ’ s rationale helps CQC to better understand the sector as a whole .
The impact of challenging draft reports will become even more stark from this month ; April 2017 is identified within the CQC strategy 2016 – 2021 as the month CQC intends to introduce ratings to the substance misuse sector . As any CQC-rated service understands , the blunt headline description of a service as ‘ inadequate ’ or ‘ requires improvement ’ will turn away far more private referrers and local commissioners than reading the more nuanced contents of the actual CQC report balancing the good with the bad .
It is therefore vital that providers scrutinise their draft reports and challenge where they fundamentally disagree . Productive interaction with the regulator can and indeed does lead to measurable improvements in outcomes both in terms of industry standards and inspection results . To do otherwise is to allow public misunderstanding of the individual service , whilst perpetuating the mistrust between the sector and CQC .
Nicole Ridgwell is a solicitor at Ridouts LLP , www . ridout-law . com
‘ Using legitimate routes to submit a well-drafted and forensically evidenced appeal does lead to substantive changes to reports .’
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