The Care Quality Commission (CQC) has suspended routine inspections. It has continued, however, to inspect risks and concerns that have been raised. Services have continued to be subjected to close scrutiny with the CQC using a range of intelligence sources, including, for example, the Emergency Support Framework (ESF) monitoring tool. The ESF has provided information to assist in better understanding of the impact of COVID-19 on staff and those who use services. The CQC is also able to identify where inspections may be needed or where concerns should be escalated to partner organisations.
The coronavirus alert level has been reduced. As restrictions are being progressively relaxed, the CQC and other regulators will need to revisit and adapt the emergency frameworks they have in place in order to return to routine inspection of those lower risk services, potentially in the autumn (CQC, 2020a). Over the coming summer months inspections of higher risk services are to take place.
During the pandemic, the CQC has seen an increase in the number of calls it has received from staff raising concerns regarding care. Analysis of these calls to the national call centre, where concerns about the safety or quality of care are fast tracked, reveal that the biggest increase has come from staff working in the adult social care sector. During the period 2 March 2020 to 31 May 2020, 2612 calls were received from these staff, compared to 1685 for the same period in 2019—a 55% increase (CQC, 2020a).
Of calls received, 26% were related to lack of personal protective equipment and other infection control products. These concerns were progressed to local authorities with the aim of ensuring that care providers receive the supplies they needed.
Some 32% of the calls included concerns about how infection control or social distancing was being carried out at services where staff worked and 4% of calls were related to the quality of care being impacted by COVID-19. In those cases, follow up was made with the provider directly, typically by phone. Since mid-March 2020 the CQC has carried out only a small number of physical inspections with the intention of limiting the number of people who have been entering services. Seventeen physical adult social care inspections have been conducted since 17 March, 11 as a result of concerns raised by staff or members of the public.
People with a learning disability have higher rates of morbidity and mortality than the general population and die prematurely. The CQC continues to inspect and take action where learning disability and autism services are failing to protect people's human rights and providing poor care. At least 41% die from respiratory conditions (NHS England, 2020). The number of deaths of people who were receiving care from services that provide support for people with a learning disability and/or autism showed that between 10 April and 15 May 2020, there were 386 deaths of people with a learning disability (some of whom may also be autistic). This compares with 165 people who died in the corresponding period in 2019, a 134% increase in the number of death notifications this year. Of the 386 people who have died in 2020, 206 were as a result of suspected and/or confirmed COVID-19 as notified by the provider, 180 were not related to coronavirus (CQC, 2020b).
Calls about, or from, people detained under the Mental Health Act have increased, voicing distress or confusion as to why people are more likely to be confined to their rooms as opposed to being able to move around freely. Contacts from, or relating to, people who are detained on inpatient units are now prioritised. Eight mental health services have been inspected since routine inspections were paused, five as a result of concerns raised by staff or the public.