01 November 2012

A BBC investigation has identified a number of care homes that are rated five-star but also fail to meet the minimum standards of acceptable care. This sounds confusing, but the explanation is disappointingly obvious.

Ensuring our nearest and dearest have access to professional and dignified care in the final years of their life is clearly extremely important. It can also be a distressing time for families and those in need of care so clear, reliable information on the quality of different care homes is crucial. Unfortunately, it appears that getting this information isn’t always easy.

Until 2010 the Care Quality Commission (CQC), the Independent regulator for the sector, provided a complete set of star ratings based on their own impartial inspections. In 2010 however, without consultation, the CQC stopped issuing the ratings, citing concerns that they would be vulnerable to legal challenge. Since then a bewildering array of rating services have sprung up, all vying for the attention of consumers. The CQC also continue to inspect care homes against a set of minimum standards for acceptable care which stipulate, for example, that people have their dietary needs met.

This week’s episode of Five Live Investigates used freedom of information requests to unearth which homes in Sefton were currently failing to meet the minimum conditions for acceptable care set out by the Care Quality Commission. Somewhat surprisingly, they found that 14 of the homes that had failed to meet these standards had also received either four or five star ratings in separate inspections. Which of the ratings gives an accurate picture is open for debate. What is clear is that a system which gives such mixed messages is not fit for the purpose of informing those trying to choose a decent care home.

How did we get into this mess? Many of the care homes in Sefton had been directly employing consultants, from a council-approved list, to inspect and rate their homes and issue them with star ratings. It is painfully obvious that paying somebody to rate your services is open to abuse, especially when Sefton Council were offering additional payments to providers given the top rating, undermining the credibility of the independent inspectors assessment. The Department for Education has recently announced it will stop schools being able to choose exam boards after a Daily Telegraph investigation filmed an EdExcel chief examiner trying to drum up business by boasting about how easy their geography exam was. Poachers should never pay the game keeper.

So what should be done? The previous star ratings system was far from perfect but it did at least provide a comprehensive and authoritative ranking of care homes. Tellingly, several providers have called for it to be reinstated. In our publication Commissioning for Success (p20-24) we discuss some of the issues around providing good consumer information and recommend that departments explicitly assign responsibility for ensuring such information is provided to a particular institution. This is not to say that government itself has to provide the information. If policy makers want to retain private sector involvement in assessing the quality of care providers then they can tender for a single provider, either regionally or nationally, thus removing the conflict of interest. This is the approach that the DfE will now be employing for setting examinations.

This episode also points to a wider lesson about the use of markets to deliver public services. Although their use is often based on a ‘hands off’ mind set, there are still a whole set of conditions, provision of useful information being just one of them, required to make market mechanisms effective. Ultimately, government must be the guarantor that these conditions are met.