Letter to CQC about unacceptable guidance

The Relatives & Residents Association has written to the Care Quality Commission to express profound concern about their guidance on managing infection in care homes. This unacceptable guidance encourages care providers to restrict the rights of older people.

The letter is the latest in an exchange with the CQC during the pandemic, expressing disappointment with the lack of action by the regulator which has left older people at risk and led to continued suffering. Rather than acting to help prevent the harmful impact of isolation in care homes, CQC’s own guidance is making the situation worse.

Helen Wildbore, director of the Relatives & Residents Association, said:

“Our helpline continues to hear from families struggling to get meaningful contact with loved ones in care. It is little wonder they still face an uphill battle when the CQC’s own guidance is encouraging restrictions on fundamental rights. It is astonishing and completely unacceptable for the regulator, which exists to protect people from harm, to be themselves promoting such poor care.”

A copy of the letter is below. We also wrote to CQC in May 2020 and May 2021

Copy of letter

The Relatives & Residents Association

Via email

20 May 2022

Ian Trenholm

Chief Executive

Care Quality Commission

Dear Ian,

We wrote to you in May 2020 and again in May 2021 to express our disappointment with the role CQC had taken during the Covid-19 pandemic. It is with regret that we write to you again, another year later, to express our continued disappointment and our profound concern about CQC’s guidance on infection prevention and control.

As you know, the Relatives & Residents Association champions the rights of older people needing care in England. The R&RA Helpline has been supporting people at the sharp end of coronavirus and the measures taken to manage it.

In our previous letter exchange with CQC, we outlined how older people needing care feel they have been badly let down by their regulator; at a time of unprecedented challenges and sustained infringements on rights, CQC’s lack of action has left them at continued risk. We have repeatedly called for you to take a proactive role in monitoring compliance with the Government guidance on visiting to end the harmful impact of isolation we hear daily on our helpline. This includes requesting care homes make their visiting policy publicly available and reporting current practice to you for this to be assessed against the Regulations in CQC’s inspections and reports. Rather than focusing on what you can do as the regulator to end this harm, we are saddened that you have focused on what you cannot do. It is important to remember that the focus of your organisation is to protect people in the services you regulate.

Rather than acting to help prevent the harmful impact of isolation, CQC’s own guidance is making the situation worse. ‘Infection prevention and control in care homes’, published on CQC’s website here, encourages care providers to take action which appears to be in breach of your own Regulations and legal rights. For example, it encourages people being “supported to isolate in their own rooms…when returning to a home from hospital” without any reference to Regulations 9, 10 or 12 and the requirement to undertake individual risk assessments to consider the risk to a person’s health and wellbeing of being isolated. There is also no reference to the right to liberty (protected in law via the Human Rights Act) and the duty for legal safeguards to be met when restricting a person’s movements.

This is one example of many, including encouraging providers to use designated visiting rooms, booking systems for visiting, use of barriers etc without any reference to your Regulations requiring individual assessments and supporting people to make their own decisions. Nor is there reference to the right to private and family life (Article 8 of the Human Rights Act) which requires such restrictions to be proportionate.

It is even more concerning that these references in the guidance all fall under headings ‘what good looks like’. It is astounding and entirely unacceptable that CQC consider this to be good practice and to be describing it as such to providers, encouraging them to breach people’s rights.

In addition, this guidance is woefully out of date and contradicts the Government’s guidance on infection prevention and control (available here). This is causing confusion amongst providers and families, leading to conflict between the two, our helpline hears. The Government’s guidance was updated seven weeks ago. It is unacceptable that CQC’s guidance has not been updated in this time. It is a vital tool providers will be using to manage their policy and practice and for it to be out-of-date for so long and encouraging poor practice is shocking. For instance, encouraging the use of booking systems to limit the number of people visiting a home is in direct contradiction with Government guidance which states that there should not normally be any restrictions on visiting. It is also inevitable that booking systems designed to limit access undermine individual resident’s needs and the right to family life as they work on a first-come-first-served basis rather than to individual care plans. We are hearing on an almost daily basis the reality and consequences of this.

Our helpline continues to hear poor practice around visiting and the detrimental impact on older people’s physical and mental health. We continue to report concerns to CQC and support families to challenge the barriers to access but it is little wonder that families face an uphill battle when this CQC guidance seems to be encouraging restrictions to resident’s rights.

We urge you to completely overhaul this guidance as a matter of urgency to bring it in line with the Regulations and legal duties to respect and protect rights. It should ensure providers are acting proportionately to the risk of infection, whilst also meeting their legal duties to protect residents’ wider wellbeing including the risk to their health from isolation.

We look forward to your response.

Yours sincerely,

Helen Wildbore

Director

The Relatives & Residents Association

Copy:

Sajid Javid MP, Secretary of State for Health and Social Care

Wes Streeting MP, Shadow Secretary of State for Health and Social Care

Harriet Harman MP, Chair, Joint Committee on Human Rights

Jeremy Hunt MP, Chair, Health and Social Care Select Committee