How do we prove our service user involvement?

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Nicole Ridgwell answers your legal questions

We are disappointed with the results of our recent CQC review – one of the things we were marked down for was not involving our clients in planning their care. We dispute this as patient involvement has always be central to how our service operates. How can we compile evidence to back up our challenge?

To launch an effective challenge, providers must understand the parameters of the process itself. With CQC draft inspection reports, challenges should be made through the factual accuracy process, through which the provider has ten working days to submit a response from the date of receipt.

It is important to note that CQC factual accuracy guidance implies that providers can only challenge facts. That is wrong as a matter of law – CQC must take into account all written representations about the inspection process and the content of the report. It may be, for example, that a provider agrees that specific documentation error occurred but does not agree with the inspectors using that isolated example to conclude that the service has systemic failures in record-keeping.

Factual accuracy representations must be as detailed as possible. When we draft responses, we scrutinise the draft line by line; identifying not just factual inaccuracies but negative or imprecise wording and vague criticisms. This level of detail is necessary to ensure that providers lodge all valid objections. Should matters progress to enforcement action, it is much more difficult to retrospectively challenge something about which providers were initially silent.

For a successful challenge, providers must provide evidence to rebut the criticisms, where possible using CQC’s own language. It is much harder for CQC to ignore a challenge where a provider demonstrates compliance with CQC’s own guidance.

In our question, the touchstone would be CQC’s Better care in my hands: a review of how people are involved in their care, which ‘can be used by providers… to understand what CQC expects to see when we regulate how well services involve people…’. Where possible, therefore, the evidence gathered will explicitly align to CQC’s own examples. In this case:

• personalised care plans – written with people, for people, and with their wishes and preferences clearly identified and monitored

• the sustained and supported involvement of families and carers in the care of their loved ones

• the coordination of people’s involvement in their care as they move between services

A strong challenge will cross-reference provider polices and policy implementation. Care plans, patient notes, minutes of family meetings and patient reviews (to name potential sources) will demonstrate how patients are involved at every stage of care planning and show the outcomes of that involvement.

In preparing for any challenge, success is in the detail. Sweeping criticisms are rebutted only by specific, consistent evidence of best practice compliance. Compiling the evidence may therefore be painstaking and protracted in the short term, but a successful challenge which restores your service’s reputation will always be worth it in the long run.

Nicole Ridgwell is solicitor at Ridouts Solicitors

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