In October 2014 the Care Quality Commission (“CQC”) will implement a suite of changes to the way in which it inspects and rates adult social care services in England. The changes come in a  time when there are increasingly frequent media reports of very poor quality care, physical and emotional abuse and neglect of residents. The CQC’s chief inspector of adult social care, Andrea Sutcliffe has said that she hopes the new system will be more effective, more probing and will help raise quality standards across the adult social care sector.

The new regime

Under the new system, care services will be judged on five questions, which have been coined “the mum test”, recognising that for most of us, the critical question in relation to quality of care services is whether we would be comfortable placing our mum, or another loved one, in the service. The five questions are:

  • Is it safe?
  • Is it effective?
  • Is it caring?
  • Is it well-led?
  • Is it responsive to needs?

There will also be changes to the way in which services are evaluated following inspection. Rather than simply stating whether a standard has been met or not, the service will be rated as outstanding, good, requires improvement or inadequate - in respect of each of the five key questions, as well as receiving one overall rating. It is hoped that the revised gradings will provide a clearer reflection of the standards in place and will make it easier for service providers and users to understand how they compare against others, and how they can improve in future (if necessary). As is currently the case, it is likely that under the new system, the overall rating will be heavily influenced by the lowest of the specific ratings achieved. So, it is very important that care services provide a consistent standard of quality in all areas to avoid being unduly penalised in the overall ratings (which is likely to be the most influential indicator of quality of service).

Under the new regime, CQC will focus their attention on those services which are failing to meet required quality standards and the frequency of inspections will reflect this. Services with an outstanding rating should expect an inspection within two years of their last visit, whereas services which are inadequate can expect a call from inspectors within six months, so they can re-assess the service and ensure improvements are being implemented. In addition to these routine inspections, CQC also plans to conduct random inspections of 10% of all good and outstanding services every year.


It is clear that CQC is very keen to tackle the perception that care services are not currently subject to sufficient scrutiny which contributes to poor standards of care and unscrupulous operators continuing to mistreat vulnerable service users. The new inspection regime will certainly provide a greater level of detail, providing service providers and users with a more detailed insight to how their service compares to others (for better or worse) which, as Andrea Sutcliffe comments, should help to raise the bar across the board. However, the overall effectiveness of the scheme will ultimately depend upon the ability of inspectors to properly and consistently evaluate care services and clearly communicate this information to the public. In the meantime, care service providers should ensure they have done everything they can to scrutinise their performance, in advance of the new regime kicking in. Simple steps such as conducting internal audits and mock inspections will go a long way to ensuring services receive a positive quality rating and a lower level of regulatory scrutiny over the longer term.