The National Audit Office has released a report dated 2 December 2011 on the Care Quality Commission (CQC), which has identified a range of failings and inefficiencies within CQC.
Some key points include:
· The providers regulated by CQC account for approximately 10 per cent of GDP. Currently over 21,000 providers in over 40,000 locations.
· CQC does not have proper measurable performance indicators. The data it keeps is more about activity levels and that is not complete.
· CQC needs to address gaps in performance data, in particular by collecting data on the types of enforcement action taken and the timescales. The NAO also says that CQC should be publishing more information about the impact of its enforcement activity.
· A major recruitment drive is underway. One hundred and two registration assessors and compliance inspectors had been recruited by November 2011 (since the summer).
· CQC had planned to review every provider at least once every 2 years and, beyond this, to adopt a risk based approach. This is changing (see below).
· Each inspector has a mixed health and social care portfolio of between 50 and 62 locations. CQC says this needs to be reduced to between 30 and 40. The recruitment of additional staff will help them do this.
· There are significant variations in data as between the NHS and adult social care. The Quality and Risk Profile for a NHS Trust has an average of 500 data items compared to an average of 50 for adult social care providers.
· The NAO says CQC should look at additional sources of information including financial data from providers. The Report states, “The Commission does collect financial information but does not use it to assess risk”.
· Following on from Winterbourne View, CQC set up a dedicated whistleblowing team. Whistleblowing information is included in their regional risk registers.
· As at November 2011, CQC had major concerns in relation to 407 providers, 94 per cent of whom are adult social care. A considerable number of these arise from whistleblowing concerns.
· In the first half of 2010-11, 30 per cent of reviews included a visit. Now it is over 90 per cent.
· It is planned that from April 2012, NHS, independent healthcare and adult social care providers will have an annual inspection. Dentists and ambulance trusts will be inspected every 2 years. CQC estimates that to achieve this it will need to recruit an extra 229 compliance inspectors and 19 compliance managers. The Department of Health has approved funding for this.
· There is a rise in enforcement action. In the first six months of 2011-12, 383 enforcement actions were taken compared to a total of 510 for the whole of 2010-11. This corresponds with the rise in inspections.
A copy of the National Audit Office report is available at the National Audit Office website: