On Wednesday 25 January 2012, the Public Accounts Committee took evidence on the Care Quality Commission, in light of the critical National Audit Report on CQC published on 2 December 2012. Cynthia Bower, the CQC Chief Executive appeared before the Committee.
It was a lively debate which one Committee member somewhat unsympathetically described as a “car crash.” It is clear that the Public Accounts Committee does not see CQC as fit for purpose but wants to see it succeed given its public importance.
Some of the more illuminating issues that emerged were as follows:
- The Human Fertilisation and Embryology Authority do not want to be merged with the Care Quality Commission (nor does CQC want a further merger). The Department of Health said they would go away and reflect on this issue, describing the HFEA as one of their success stories in terms of regulation.
- The Department of Health will be making recommendations as part of its capability review of CQC focusing on (1) strategy, (2) performance metrics to measure the success of the regulator, (3) engaging with stakeholders, (4) improving information flows between CQC and the Department; and (5) developing CQC’s regulatory model.
- The Committee was concerned about an impression that CQC was more lenient towards hospitals than to care homes. CQC said all providers were treated the same and they had started taking enforcement action against the NHS.
- The Committee was concerned about the absence of effective internal Quality Assurance at CQC and the fact that, as a result, consistency of decision-making was an issue. This had been flagged up by CQC as part of its own internal audit in 2011. CQC talked about improved systems, more training and significant amounts of guidance. The Department of Health representative felt that CQC had made real improvements, with more to follow.
- The Committee was worried about generic inspectors, not specialist ones inspecting a wide range of services. It was also concerned about the absence of quality metrics to judge CQC’s performance. They also queried the 14% underspend for this year. CQC said they had now filled vacancies for compliance managers and inspectors with the additional money from the Department.
- The abandonment of star ratings in respect of social care was criticised by the Committee. The Department said that this would be addressed in the forthcoming Social Care White Paper. There would be the introduction of some form of rating system which would go beyond the essential standards. It would not be run by CQC.
- The Department described CQC as an “enforcement-led regulator”. It could not be a policeman and an advisor. A Committee member disagreed and said that the Human Fertilisation and Embryology Authority managed to do both so why couldn’t CQC!
- CQC is to publish a report about healthcare provision into care homes at the end of February 2012. There was criticism that this had taken 2 years to complete.
- There was criticism of a failure on the part of CQC to capture enforcement data. CQC said it was setting up a specialist team from April 2012 to look at the market, corporate trends and non-compliance with outcome areas. It would start with Adult Social Care. This information would be useful for the regulator, commissioners and the public.
- Margaret Hodge asked CQC to provide information about what action had been taken in relation to the 407 providers who CQC had major concerns about as at November 2011. A similar request was made about the 55 hospitals were there were significant concerns around dignity and nutrition as at June 2011. CQC said it would provide the Committee with details.
- The Committee asked when they should look again at CQC in order to see what would hopefully be a more evolved regulator that operated as it was meant to. The representative from the Department suggested another 2 years was needed (which would be 5 years from start-up). A Committee member riley commented that five years was a little under the time taken to defeat Germany in WW2!
Another day, another CQC mauling…