England’s chief care regulator is finally going to release data this week showing the extent to which different categories of care homes (Inadequate, Requires Improvement, Good and Outstanding) have been hit by Covid-19. Or is it?
How do we know the CQC is finally going to reveal Covid information? Because a couple of days ago, it said so. We can only wait with excitement and anticipation. But the letter, the CQC sent to OLM last week, revealing it is about to publish this information, raises serious questions whether the data will be tailored to create the 'right' impression.
The regulator said it will release this information, along with its own analysis, in its own way. It says bluntly, it does not trust individuals (aka families and journalists) to interpret the data: ‘Following discussion with our strategic partners, we consider that it is not in the public interest to disclose this information in a piecemeal manner to individuals, but rather it is in the public interest to disclose the information in an organised way to the public at large.’
Who are these influential strategic partners? The Department of Health and Social Care? The owners of care homes? And why is the CQC so reluctant to provide this data and insists on disclosing it only in an 'organised way'? What can it all possibly mean? Well, odds are on the CQC completely exonerating the care industry.
How do we know this? In its letter, the CQC said it has already released information ‘which relates to your request for information’. An interesting choice of words.
Mea culpa. I saw the ‘State of Care’ report, but I did not see the sentences: ‘In the first months of the pandemic, we have not seen any clear relationship between care home ratings and the number of deaths due to COVID-19 in those homes. As at 7 July 2020, for every 1,000 beds there were 40 deaths in care homes rated overall as inadequate, 47 in those rated as requires improvement, 44 in those rated as good and 41 in those rated as outstanding. There was a similar pattern when comparing against the specific ratings for the safe and well-led questions.’
Those figures could be pretty horrifying - a 4% death rate across care homes?! How could I have missed this carefully-phrased sentence, on page 47 of a 113-page document, not highlighted elsewhere in the report?
The trouble is, this raises as many questions as it answer, beginning with why did it take six months for the CQC even to provide this information? Why didn’t the regulator shout it from the rooftops, or highlight it in the report, if it had clear proof there was nothing that could be done in the face of Covid?
There are other questions, including:
Why does the CQC talk about the death rate per 1,000 beds, not by the number of affected care homes in each category?
Why not are total deaths per care home category not given, or average deaths per care home category or deaths per 1,000 residents?
Why does the CQC only talk about deaths and not Covid outbreaks?
Why does it give a strangely specific timeframe – deaths to a Tuesday in July? Why not a monthly or weekly breakdown? The report was published in October.
Maybe the industry as a whole was initially thrown off balance by Covid, particularly given the discharge from hospitals of infected individuals? But what happened in the months that followed? Did poor hygiene standards have no impact? Did all deaths follow discharges? How much did staff working between homes have an impact?
And families will want to know if there is there any evidence that family members or visitors introduced infections?
Maybe the answer to all these questions, is that the CQC chose its data with great care to show that its 'strategic partners' and, it as a regulator, have no responsibility. Whatever the pressures on the sector, the data from the October report suggests the CQC's hygiene and anti-infection regulations could not save thousand of residents from Covid. It is a virulent virus. But how safe is 'care' when many more older people died in 'care' than outside.
According to the ONS, there are more than 10 million people over the age of 65 in England and 348,932 people of this age group reside in care homes. Some 15,000 older people have died of Covid in care homes. This suggests a Covid care home death rate of more than four per cent - which is in line with the CQC's 40 deaths per 1,000 beds' figure. This compares with a death rate for older people in general of less than one per cent, except for over 90s, for whom it is 1.8 per cent.
Of course, the death rate in residential homes is, sadly, usually higher, with people only going to live in homes in the last years of their lives, just 2-4 years, on average. Every year, tens of thousands of care home residents die from multiple causes, pre-existing and new.
But, although the CQC's carefully-selected information implies that the entire care home industry was swept away by Covid and is unsafe, the truth is, fewer than half of care homes experienced Covid outbreaks. So many were 'safe'.
And, perhaps that's the question to ask: Which type of care homes did not have Covid deaths? What were the factors at play? If a real understanding of the terrible death toll is to be understood, not just shrugged off, it is essential to understand why certain homes were affected and others were not.
Trying to avoid 'blame' with bizarrely massaged figures, suggests a failure to confront the reality and to 'learn lessons', to use a favoured CQC phrase.
Still, whatever the damn statistics say, CQC's published data is not a good advertisement for care homes. And, by throwing ‘Outstanding’ homes under a bus, the CQC effectively says the best homes were worse at dealing with Covid than the worst homes.
This preposterous claim is, obviously, intended to show that no home could withstand the force of Covid but, of course, many thousand did.
In the last couple of days, the CQC has released another raft of distressing and depressing reports about the life in care homes during the pandemic, showing lack of basic infection controls, inadequate staffing levels and, sometimes, appalling conditions.
These homes had almost all been sitting on bad reports, even before Covid. But some had not. Which is even more worrying, because it suggest the CQC’s system of regulation does not identify risk and in the past has too easily accepted glossy publicity.
After all, if ‘Good’ can suddenly become ‘Inadequate’, was it ever ‘Good’ in the first place?
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