Display ratings or pay: countdown to CQC deadline

Since 2014, NHS providers have been inspected under a new ratings regime.

Linked to the new ratings system is the forthcoming requirement under regulation 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which requires providers to display their CQC ratings (of “outstanding”, “good”, “requires improvement” or “inadequate”).

This is due to come into force from 1 April. The CQC recently consulted on displaying ratings.

‘Hospitals will not want to be found to be breach of a statutory requirement’

It will be a criminal offence not to comply with the requirement, liable to a fine on conviction in the criminal court up to £100 per offence.

It is not a high fine in the scheme of things but hospitals will not want to be found to be breach of a statutory requirement.     

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Main requirements

Under regulation 20A(2) every website maintained by, or on behalf of, any service provider that has received a rating by CQC following an assessment of its performance will have to display details of that rating.

More particularly, the website will have to display:

• the CQC’s website address;
• the place on CQC’s website where the most recent assessment of the provider’s overall performance may be accessed; and
• the most recent rating by CQC of the service provider’s overall performance and of its performance in relation to particular premises or activities “in a way which makes it clear to which activities or premises a particular rating relates”.

There is also a requirement under regulation 20A(3) for the provider to display at least one sign, showing the most recent CQC rating that relates to the provider’s performance at their premises.

This must be displayed “at each premises from which the service provider provides regulated activities”.

Where a particular premises has not received a rating yet, the provider must display the rating of their overall performance instead (regulation 20(A)(4)).

Similarly, the principal place of business must display:

• at least one sign showing the most recent rating of the service provider’s overall performance; and
• its performance in relation to particular premises or activities “in a way which makes it clear to which activities or premises a particular rating relates’”.

If the principal place of business is itself subject to a separate performance rating then this rating should be displayed instead.

The CQC set out further requirements in its guide on how to display ratings. According to this guide, providers must:

• display ratings “‘where people will be sure to see it” in a way that is “accessible to all of the people who use your services”. This should be done no later than five working days after it has been published on the CQC’s website (failure to do so could lead to a fine or could adversely impact your future inspection ratings);
• ensure the ratings are legible;
• raise awareness of your most recent rating when communicating with people who use your services by letter, email or other means;  
• display the CQC logo, the name of the rated service, the overall rating and any separate key question ratings which go towards that overall rating;
• display the location on the CQC’s website where the assessment and ratings can be accessed;
• provide the date when the inspection report was published.

There are further expectations, which differ slightly according to what kind of provider you are.

For example, hospitals need to display the ratings for each location at the main entrance to the hospital. If there are several entrances then it should be displayed at each one.

They also need to display the information on the main website, in a place where as many people as possible will see it.

The overall rating for the trust and the rating for each of the key questions at the trust level will normally have to be at the entrance to the trust’s/provider main offices. It must also be on the trust’s main website or home page.

The overall rating for core services must be on the relevant page of the website and must be conspicuously displayed at the entrance to each core service ward, where as many people will see it as possible.    

‘There are further expectations, which differ slightly according to what kind of provider you are’

GP practices need to display the overall rating and the rating for the five key questions on the main home page of the website, where it will be seen by as many people as possible. These must also be prominently displayed in the waiting area.

Care homes will usually need to display their ratings at the main entrance to the home and on the main homepage of their website.

Any providers that have been judged to be inadequate or to require improvement are encouraged to display information about what they are going to do to improve the service alongside their ratings.

Challenge ratings

For the majority of providers, displaying ratings will be a legal requirement from 1 April.  This makes it all the more important to challenge ratings that you feel are not a fair representation of your services.

Formal ratings reviews can only be made after the publication of the inspection report, where it can be argued that there has been a flaw in the procedure adopted by the CQC (for example, it has failed to comply with its own rules on how to calculate the overall rating or has failed to abide by fundamental principles set out in the CQC’s provider handbooks, such as proportionality or needing to give equal weighting to each of the five key questions – is the practice safe, effective, caring, responsive and well led?)

If you do disagree with the factual content of a report, this is a separate argument that should be raised as part of your factual accuracy response to the inspection report. Given that the ratings are going to be published, it makes sense to challenge their merits (so far as you are able) at the same time as you submit your factual accuracy response, which you will need to submit within 10 working days of receiving the draft report.  

Conclusion

The CQC’s response to its consultation on the requirement to display ratings will be published later this month. The CQC states in its January 2015 consultation on the display of ratings, that it has produced a “toolkit” to help you display ratings.

This toolkit will be available once the results from the consultation are published later this month.

The CQC will also be making a suite of editable templates for displaying ratings available online. We would encourage providers to check the CQC website this month for further developments.

‘Providers should start to prepare for the change by reviewing the consultation’

Providers, however, should start to prepare for the change by reviewing the consultation referred to above and making themselves aware of the anticipated practical steps that will need to be taken.

There is only going to be a short window between publication of the consultation response and having to get in place the “displays” of ratings from 1 April 2015.

If you are concerned about any ratings you have received we would urge you to seek legal advice as soon as possible. We’re here to help.

Neil Grant is a partner with Ridouts LLP