This article raises some interesting points and I thought it would be helpful to respond briefly to some of them and to clarify some points about the inspection approach which are not entirely accurately reflected in the article.

First, to be pedantic, the grading system we are using does use a six point scale but “three to four being adequate” is not a correct description. The details are on our website but , in brief, the six points of the scale are Excellent, Very Good, Good, Adequate, Weak and Unsatisfactory. It is important to note that the bottom two points in the scale reflect a judgment that the level of quality is below a tolerable level.

The article comments that “providers have been given to understand that the Excellent marking will rarely if ever be awarded.” My concern is that this will be seen as implying that we have somehow instructed our officers not to award this grade. This is certainly not the case.

If a service merits this grade on any of the aspects we inspect then this grade will be awarded.

However no system which lightly awards top grades is likely to have much standing. I am sure all scientists would like to be awarded the Nobel prize but only a few get this because if it was too lightly awarded it would no longer be a real mark of the best achievement.

In grading care services there is a balance to be struck between the needs of providers to feel acknowledged for the good work they do and the need to inform users and others about the real quality of services. All providers want to be seen as excellent but to award such a grade too lightly risks destroying the very meaning of the grade. Excellent providers should be seen as leading lights and so by definition this grade is likely to be awarded infrequently. This seems to me to be hardly an earth shattering conclusion.

The Care Commission system works in such a way that it is possible, but difficult, to earn an Excellent grade on individual aspects of performance within each of the main areas or Quality Themes. Grades for each of four Quality Themes are calculated from the more detailed gradings. At the Quality Theme level an Excellent grade becomes still harder to achieve but not impossible and I refute the assertion that good providers will not strive for this. There are some providers who are very unrealistic about the quality of the services that they are providing and some will feel they merit an Excellent when they are clearly far short of this.

The article refers to concern that “a temporary failing in just one of the four or five areas could drag down the marking for an otherwise excellent establishment and that the reduced marking would feature on the care Commissions website for long after the failing had been addressed”.

There are a number of aspects of this that I wish to address. First it is true that any finding of Weak or Unsatisfactory performance within one of the Quality theme areas does indeeed result in the whole Quality Theme being graded at that level. But if you refer back to my explanation of what Weak or Unsatisfactoory means you will see that this is as it should be.

These are findings that the performance is less than tolerable. We cannot hide such fndings from the public or users and carers as we produce the overall set of grades. One thing our system does do however is allow providers to be quickly regraded if they address the problems which have been found. This provides a great incentive for improvement.

I also dont agree that this could drag down an”otherwise excellent establishment” - in our view Excellent services dont have inspections which find below tolerable performance - thats why we are prepared to grade them Excellent !

The issue of objectivity and subjectivity is a complex one. Judgments which are about QUALITY as opposed to QUANTITY almost always involve some level of subjective judgment. Its not whether there is subjective judgment involved that is the real issue though. Its whether that judgment is guided and “constrained” in ways which ensure that it is applied as consistently as possible across different raters. We can all measure things like bed occupancy in Care homes, staffing ratios and so on and pat ourselves on the back that we are doing this very objectively. the problem is that looking at these things alone often misses the point because they often dont really measure QUALITY.

The Care Commisison has taken extensive measures including significant training inputs for its staff to ensure that the grading system is applied as consistently as possible and we will continue too monitor this closely as the new approach is implemented.

Finally in regard to appeals. The gradings represent a systematic way for the Commission to express its judgment about the Quality of services. As a regulator we have a statutory duty to advise on the quality of services and this is one of the ways we are fulfilling this duty. It is our judgment and therefore not something that is in that sense appealable.

Having said that our approach also is built on providers self assessing themselves and self grading and we encourage real dialogue between the provider and the Inspecting Officer at the conclusion of the inspection about the findings. We will listen to what providers have to say but at the end of the day the Commission has the responsibility to assess the quality of the service and it will do so and express this in the form of the grades that it awards.