The CQC publishes a range of data intended to provide insights into the standard of services provided by those organisations which it regulates. That data now includes statistical information about the deaths of care home residents during the COVID-19 pandemic. Our understanding of COVID-19 has developed significantly since the early days of the pandemic and undoubtedly there are lessons to be learnt, for those directly involved in delivering services, those in policy development and for government. Matt Hancock’s May 2020 declaration that the government had thrown a ‘protective ring’ around care homes was promptly scrutinised given the number of deaths which had already occurred in the care home sector at the time. The initial response to COVID-19 in the care home sector is undoubtedly a topic which merits careful consideration.
Whilst the CQC’s decision to publish statistics in relation to care home deaths from COVID-19 at provider level is doubtless intended to promote transparency and learning, there is an inescapable risk that such statistics will be misunderstood or, sadly, misused. It would be very regrettable if the publication of these figures led to criticism being unfairly directed at individual providers when providers and their staff have been working in the most extraordinarily challenging times to do the best for those in their care. The statistics for an individual provider are unlikely to come as a surprise to their own staff, or residents who will have had direct knowledge of the impact of COVID-19 on their own service. However, in comparing the figures with other providers the figures may give the impression of significant differences between providers.
It is well known that humans often perceive patterns in data where none exist. The mortality statistics on their own will rarely be sufficient to get a meaningful understanding of cause and effect. The circumstances of each provider, the vulnerability and age distribution of their residents, and a variety of local factors are all likely to have played a part in outcomes. The limitations of the data are expressly recognised by the CQC which states:
“It is important to note that death notifications do not in themselves indicate poor quality care, particularly given the potential influence of variable factors, including rates of local community transmission, size of the care home, and the age and health and care needs of the people living there. Moreover, many notifications relate to the deaths of care home residents which occurred in other care settings.”
We anticipate that most providers will already have given careful thought to their own experiences in the early part of the pandemic and will have made changes in how they manage risks in the period since. Those changes will have been supported by developments in local and national policies and guidance, the improvements in access to PPE and the vaccine roll-out. Thus, whilst the published statistics may, understandably, be a source of concern or unease for some staff, residents and their relatives, it is likely that there will be good reason to provide reassurance to those concerned. Individual providers are likely to be best placed to assist stakeholders in understanding relevant context, and in illustrating how the current position differs from early 2020. It is also important to bear in mind that the publication of statistics of this sort by the CQC is not a parallel ratings process. Providers will be able to direct stakeholders’ attention to their published ratings which are informed by a much wider range of factors than mortality statistics.
The words of Kate Terroni, CQC’s Chief Inspector for Adult Social Care, merit special consideration:
“As we publish this data, we ask for consideration and respect to be shown to people living in care homes, to families who have been affected, and to the staff who have done everything they could, in incredibly difficult circumstances, to look after those in their care.”
Transparency and good communication – from providers to stakeholders – will assist them in understanding the published data. Many providers will feel well equipped to provide relevant information in a clear and accessible way. However, for some providers the statistics may be more challenging or may prompt more difficult engagement with stakeholders. We would be happy to assist providers in those circumstances.