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For the second time, the Care Quality Commission has received backing from the Care Standards Tribunal over its refusal to register a care home for people with learning disabilities which it deemed “institutional” and “campus style”.

Readers may remember a previous tribunal the CQC also won over a very similar proposal last year, in which it was accused of acting beyond its remit in trying to “shape the market”.

In February, this column warned of the unintended consequences its new registration rules might have in dissuading private investors to enter the care home or supported living market.

Evidence given during the CQC’s latest tribunal, which looked at a privately provided facility in Walsall, revealed further concerns from local authority commissioners.

Real world pressure

A quote from one of the tribunal witnesses, Theresa Joyce, the CQC’s national adviser for learning disabilities, sums up the spirit of the CQC’s registration stance: “If you can’t do it right, it doesn’t mean that you should do the wrong thing; you should continue to try and do the right thing…

“If you register an inappropriate model because there isn’t an alternative at the moment, it exists forever and sucks in more people.”

But the commissioning lead for Walsall Council, Ian Staples, argued: “I am under pressure to get people out of hospital”. He said he supported the policy of “do it once and do it right”, but added: “We have to live in the real world.”

Although the local authority lead acknowledged the proposed care home would not “toe the line” with regulators and might look like a campus, he said: “I have to balance that with local need. We consider money and cost effectiveness and resources… I don’t have an infinite amount of money.”

Mr Staples suggested there is a shortage of supported living accommodation and buying more houses would clearly have major financial implications.

Aside from not being patient-centric, why are Mr Staples comments important?

They are emblematic of the underlying difficulty behind Transforming Care – the financial model.

Taking a patient from an NHS-funded inpatient setting into supported living invariably shifts the costs. This has never been addressed and most would argue the financial backing given to Transforming Care was never enough.

Until alternative and sustainable funding routes for supported accommodation are found, this tension between the CQC’s requirements and the reality of provision is likely to persist.

More nuanced

The main principle and measurement of success in Transforming Care for the centre was always the reduction of big inpatient units. For some, this was a key folly of the national programme.

But recent developments suggest the centre is taking a more nuanced view. Last week, £33m was awarded by the government to Mersey Care Foundation Trust for a new 40 bedded low secure inpatient unit for patients with learning disabilities.

This unit is meant to replace the one located at Calderstones. Aside from the requirement by NHS England to close all things Calderstones related, there are clear patient benefits to the new build and location of this unit.

Is the government’s backing of it a sign it is rethinking its inpatient ambition or at least recognising the issue isn’t quite so black and white? And will it get registered by the CQC?

Mental Health Matters is written by HSJ’s mental health correspondent Rebecca Thomas. Tell her what you think, or suggest issues she could cover, by emailing her in confidence at rebecca.thomas@wilmingtonhealthcare.com or by sending a direct message on Twitter.

Join us at the HSJ Transforming Mental Health Summit (28-29 November 2019, Hilton Leeds) as senior peers from across the NHS, local authority and wider mental health service delivery landscape to discuss the remaining challenges as we reach the end of the Five Year Forward View. Register your interest here: http://bit.ly/2KbYAzJ