The Public Accounts Committee has been gathering evidence about the Care Quality Commission, following on from the highly critical National Audit Report published 2/12/11. CQC Chief Executive Cynthia Bower (salary £210,000) appeared before the Committee, whose members were openly sceptical about CQC as offering value for money but who evidently still want it to be given time to succeed in recognition of its important public role.
Key points of interest from this uncomfortable hearing for CQC were as follows:
The Department of Health is conducting a performance/capability review of CQC and will be making recommendations in respect of organisational strategy; developing CQC’s methods of regulation; performance yardsticks for measuring the organisation’s effectiveness; engaging with stakeholders better; and improving communications between CQC and DH.
The Committee expressed concern about the widespread impression created that CQC treated hospitals more leniently than care homes. This was denied by CQC who said that all providers were treated the same and enforcement action was being taken against NHS establishments.
The DH said that CQC was an “enforcement-led regulator” that could not be both policeman and advisor to providers. One Committee member objected to this statement, commenting that the Human Fertilisation and Embryology Authority managed to fulfil both roles so why couldn’t CQC?
The Committee raised concern over the lack of performance indicators and a proper internal quality assurance system (legally required of care providers of course - TC) at CQC, which had caused widespread inconsistency of decision-making. This problem had been highlighted in CQC’s own internal audit in 2011. CQC representatives said that this had already been addressed through extra training, increased guidance and upgraded systems in place. The DH commented that real improvements had been made with more to come.
The Committee criticised the cancellation of the social care quality star rating system for providers. The DH said that quality ratings would be reintroduced in the forthcoming Social Care White Paper, with a new rating system that would go beyond compliance with the basic essential standards. This would not be run by CQC.
Committee members raised concern that CQC used generic inspectors inspecting a broad range of services rather than specialists covering a narrower range. They also queried the 14% post vacancy position and 9% underspend for 2010 -11. CQC stated that they had used additional money released by the DH to recruit to fill vacancies for inspectors and compliance managers.
At the end of February CQC will publish a report on healthcare provision in care homes. The Committee criticised the two years taken to produce this.
The Committee criticised CQC’s failure to retain enforcement data. CQC said that from April 2012 a specialist team would be looking at non-compliance with outcome areas of the essential standards, the care market and corporate trends, starting with Adult Social Care. The information obtained would be useful for the regulator as well as commissioners and the general public.
Margaret Hodge asked CQC to supply information about action taken in respect of the 55 hospitals where, in June 2011, CQC had identified significant concerns to do with dignity and nutrition as well as the 407 providers about whom CQC had major concerns as at November 2011. CQC promised to provide the relevant details to the Committee.
The Committee wanted to know when they should re-examine CQC again to find what would hopefully be a more evolved regulator that functioned correctly. The DH representative indicated that another two years would be needed - making five years from start up. One Committee member tartly commented that five years was only slightly less than the time taken to defeat Germany in World War Two!
The good ship CQC sails on into the fog……..