Abstract
BackgroundThe quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. In 2013, the health and social care regulator in England, the Care Quality Commission (CQC), introduced a new ratings system and by February 2017, all social care services were inspected and awarded new quality ratings (outstanding, good, requires improvement and inadequate). This study aimed to explore whether quality ratings were associated with residents’ quality of life, controlling for confounding variables.MethodsWe conducted a nested, cross-sectional study, collecting social care-related quality of life (SCRQoL) data for 293 older care home residents in 34 care homes (20 nursing and 14 residential) in the South East of England. CQC ratings and other resident and home-level variables were also collected for the analysis. Multilevel modelling explored whether residents’ social care-related quality of life (SCRQoL) was associated with regulator ratings, controlling for confounding variables.ResultsOutstanding and good homes were collapsed into one category and compared with homes requiring improvement. Nationally, only 2 % of care homes for older people are rated as inadequate and it was not possible to capture sufficient numbers for the analysis. We recruited one but it was re-inspected during the fieldwork period and its rating changed to requires improvement. The random intercept multilevel model, which accounted for 16.93% of the differences in SCRQoL within homes and 69.80% between, indicated that better SCRQoL was significantly associated with being female, better functioning, no dementia diagnosis, fewer communication difficulties, and living in a care home rated as outstanding/good by CQC. Size of home and registration category were not significant predictors.ConclusionsThis study found evidence that quality ratings are associated with residents’ SCRQoL. As well as aiming to improve quality and ensure minimum standards, quality ratings have the potential to inform user choice and help the public compare care homes based on quality. Future research to establish the generalisability and replicability of the results is required.
Highlights
The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown
The results of the multilevel model (MLM) indicate that residents living in outstanding/ good homes have significantly better quality of life than those living in homes requiring improvement, after controlling for individual and home level characteristics
It would be interesting to unpick the forces driving this improvement in quality of life in outstanding and good homes, we were unable to using the data available to us within this study
Summary
The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. Research suggests that this is not necessarily the case, with competition between homes leading to reductions in fees paid by the public sector, which in turn drives down quality [8] Contributing to this problem is the current economic climate facing local authorities in England. Whilst approximately 50% of residents fund their own care [7], the degree to which they are able to ‘shop around’ is questionable [6] and they often pay over and above the fees being paid for publicly-funded residents [7] Under these circumstances, regulation of care quality can play an important role in ensuring that quality is not consistently driven down or allowed to drop below basic minimum standards [7]
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