Regulation 28 Reflections

The process of regulatory inspection often features strict confidentiality and lengthy paperwork, whilst lacking sensitivity and support. The significant, and often public, consequences of a negative assessment outcome only heighten the anxieties of those being scrutinised. 

Similarly, the application for benefits to departments like the Department of Work and Pensions (DWP) and other public service agencies can be an anxiety-inducing and stressful process, with potential negative impacts on mental health. The bureaucratic nature of these applications often involving extensive paperwork, complex eligibility criteria, and a labyrinthine system to navigate. 

Whilst such processes may be necessary for a robust assessment, the emotional strain induced during these evaluations may have profound implications, leading to a deterioration in mental health. This issue has been underscored by the increase in the number of Prevention of Future Death Reports (PFDs) written by Coroners, linking several deaths to these assessments.

Reports to Prevent Future Death 

Under Regulation 28 of the Coroners (Investigations) Regulations 2013, coroners have a duty to issue a PFD Report where they believe action must be taken to prevent such incidents occurring in the future. 

One such report followed the inquest into the death of Kevin Gale, who sadly died in March 2022. The coroner heard how an ongoing source of Mr Gale’s anxiety was his application for Universal Credit. After hearing the evidence, the coroner addressed a PFD to the Department for Work and Pensions (DWP), noting that the number and length of forms, long telephone queues, and the requirement to travel long distances for appointments can be overwhelming and detrimental to those with mental health issues. 

Following the inquest into the death of Phillipa Day, the coroner pointed to the DWP’s failure to respond to the mental distress displayed by Ms Day and concluded that there were deficiencies in their ability to process claims ‘without causing unnecessary distress to claimants.’

More recently, the senior coroner for Berkshire issued a PFD report to Ofsted and the Department of Education following the inquest into the death of Ruth Perry. The coroner concluded that Ms Perry’s death was likely contributed to by the Ofsted inspection, which downgraded Caversham Primary School, where Ms Perry was Head Teacher, from ‘outstanding’ to ‘inadequate.’ The coroner noted that the inspection lacked “fairness, respect and sensitivity” and was, at some points, “rude and intimidating.” 

The coroner specifically expressed her concerns regarding the long wait between Ofsted’s inspection and publication of the final report, and the strict confidentiality warning that came with the draft report. It was concluded that these factors made Ms Perry feel that she could not share the report result with those closest to her, contributing to her mental distress. 

The response of regulators

Once a coroner issues a PFD, the responsible body has 56 days to respond with their plans to prevent future deaths occurring. 

In response to the coroner’s concerns, Ofsted have pledged to introduce training to ensure that any inspection is carried out with care, as well as new policies to include safeguarding, confidentiality, complaints, and communication. 

The DWP, despite a notable history of PFD Reports, responded following Mr Gale’s inquest advising that they are “satisfied that appropriate support is already available” to vulnerable claimants. 

Earlier this year, however, the DWP offered contracts to five private sector providers, who will be responsible for conducting assessments of benefits claims. Following a freedom of information request, it was revealed that a term of these contracts is for any claimant’s travel time not to exceed 90 minutes. The contracts also state that claimants may be accompanied to their assessment by a “companion”, who will be allowed to contribute evidence. Whilst these measures fall short of alleviating concerns completely, it is hoped they are a positive step towards improving the assessment experience for vulnerable people.

The Care Quality Commission; a step in the right direction?

The Care Quality Commission (CQC) has recently published guidance on its new approach to assessments. According to the CQC, a key element of their new approach is improving the transparency of their judgements by introducing a scoring framework into assessments.

Within Ofsted’s current framework, the presence of a safeguarding issue plummets a school’s overall score to ‘inadequate.’ This was the case for Caversham Primary School, despite the other features of the school being rated as ‘good.’ The coroner criticised Ofsted’s framework for allowing a rating of ‘inadequate’ to apply equally to a school which is “dreadful in all respects”, and a school which is otherwise rated good, but has issues which could be remedied by the time the final report is published. 

Within the new CQC framework, a rating of ‘requiring improvement’ would detail whether the service provider was in the upper threshold, nearing good, or in the lower threshold, nearer to inadequate. It is hoped that the CQC’s new approach can provide a cornerstone for other regulatory bodies to adopt more nuanced scoring frameworks and improve the overall transparency of their assessments.

Conclusion

In conclusion, as we acknowledge the essential role of such agencies, it is imperative to acknowledge the potential unintended consequences of assessments on the mental well-being of those being scrutinised. It becomes crucial for regulators to strike a balance between rigorous assessments and the preservation of the psychological welfare. Moving forward, a conscientious approach to regulatory practices, one that priorities sensitivity and support, will be paramount in safeguarding both the quality and fairness of services, and the mental health of those dedicated to providing it.