At the end of March 2012 the Public Accounts Committee (“PAC”) produced a report on the Care Quality Commission (“CQC”). It will come as no great surprise to readers that the report did not bathe the Commission in glory nor will the criticisms come as a big surprise to those who encounter CQC on a regular basis.
The PAC stated that CQC had been poorly governed and led. We saw Cynthia Bower step down as Chief Executive of CQC on 23 February 2012 amid criticisms that the CQC was failing to regulate the sector properly. Concerns surrounding CQC management were raised by CQC Board member Kay Sheldon in her evidence to the Mid-Staffordshire Enquiry in November 2011 and the PAC has brought to light staff who have left CQC being required to sign “gagging clauses” in compromise agreements.
The PAC criticised CQC for failing to measure its own success and the impact its work has on driving up quality. It states that CQC’s role is unclear – is it there to ensure that the basics required by the Essential Standards are met or should they be pushing providers to make bigger, better improvements beyond the basics. This of course raises the question of whether CQC inspectors are qualified to be making those suggestions. The PAC noted there were inconsistencies in the judgments and enforcement practices of inspectors. PAC recommended that training be provided to inspectors to ensure that these inconsistencies are ironed out. However, such training should be extended to educating inspectors on the workings of different services they regulate. A 10 bed care home is very different to an NHS Trust, yet inspectors are approaching the latter as if it were the former – a feature we often see in our work at Ridouts.
It was noted by the PAC that when CQC start to inspect GPs (registration begins later this year), inspectors will be accompanied by GPs to “help establish the things they should be looking for”.
This cannot inspire confidence the public. Is the average CQC inspector any more knowledgeable than the man on the street with a set of the Essential Standards in hand? Indeed, the PAC noted that the information publically available on the quality of care is inadequate and does not engender confidence in the care system. CQC responded by referencing the “clear system of ticks and crosses” on its website to indicate whether a provider is meeting the essential standards. However, please see the Ridout Report February 2012 for Ridouts views on the pitfalls of such provider profiles.
So the public have no confidence in the care system, the body that regulates that system nor the people leading the regulator.
Surely, there can be no more criticisms to level at the Commission? Well indeed there is. The PAC criticised CQC for getting rid of its dedicated whistleblowing hotline (something that CQC has since denied); and for failing to define what successful regulation consisted of – CQC being more concerned with level of activity rather than the quality of inspectors work.
The Department of Health (“DoH”) has set CQC five areas for improvement and wants to see that progress has been made by the end of April 2012. These are as follows:
- Clarifying CQC’s strategic direction;
- Setting clear priorities, matching resources to them and understanding what things cost;
- Improving accountability between the DoH and CQC;
- Improving engagement and communication with the public;
- Developing the regulatory regime to get the right balance between inspection, the ‘user voice’ and the use of information.
It has to be asked whether these actions will make any difference and if no improvement is made what will be done about the regulator? Cynthia will remain in post until Autumn 2012. However, in light of the leadership of CQC being heavily criticised, who will take the helm and ensure the above action is taken? How many employees do you know who have handed in their resignation pull out all the stops right to the end?