PM backs MPs' criticism of health regulator

Chairman of the Health Select Committee, Stephen Dorrell, says there was a 'distortion of priority'

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The prime minister has added his voice to calls for the health regulator to get back to its core function of inspecting hospitals and care homes.

The Care Quality Commission has come under attack after a report by MPs warned there had been an unacceptable drop in inspections in the past year.

The Health Select Committee said a tick-box culture had developed as the regulator focused on bureaucracy.

David Cameron urged the regulator to act on the criticisms.

Speaking at Prime Minister's Questions in the House of Commons, he said the committee had produced a "good report".

"I think it is important that it focuses on inspections and making sure that standards are high, rather than simply on the process of registration and bureaucracy."

It came after the MPs said the regulator had taken its "eye off the ball", although they acknowledged unrealistic expectations had been placed on the body.

The performance of the CQC has been in the spotlight in recent months, particularly after the BBC's Panorama programme uncovered the abuse of vulnerable adults at Winterbourne View, a residential home near Bristol.

The CQC was created in April 2009 following the abolition of three specific bodies covering health, mental health and social care.

Ministers also ordered it to take on the additional responsibility of registering tens of thousands of providers.

The idea was that hospitals, care homes, GPs and private sector groups would be assessed against a set of standards to ensure they were fit to provide a service.

Inspections plummeted

But the MPs said this system, which was effectively a licensing regime, was introduced without sufficient testing, consideration and definition of how the CQC should fulfil its role.

The report acknowledged that funding for the CQC was squeezed and the body suffered because of a recruitment freeze imposed on it.

However, the MPs said the CQC did not do enough to highlight and rectify the problems it was facing.

For example, it took the regulator eight months to fill 70 posts once it was given permission to do so.

Analysis

When the Care Quality Commission started work in April 2009, it was dubbed a "super regulator".

But in many ways the first two years of its existence is a classic tale of what can happen when you try to get more for less.

The CQC effectively took on the work of three previous regulators, but its budget did not reflect that. Five years ago its predecessor bodies were getting a combined £240m a year, whereas the CQC was handed just over £160m.

At the same time, it was asked to administer a new licensing regime. By early summer 2011 the regulator had registered 23,000 organisations.

Time spent processing these meant there were fewer resources available for carrying what MPs said was its core function - inspections.

But what the MPs were baffled by was why the CQC did not do more to raise the alarm.

They believe the CQC should have been doing more to spell out the difficulties it was facing, while prioritising its work more effectively.

This meant it allowed the number of inspections it was carrying out to plummet as the process of registration was rolled out.

Registration started in 2009-10 when nearly 400 NHS trusts were checked. The following year 13,000 social care groups, 8,000 dentists and 350 private ambulance services were supposed to be registered - although this target was eventually missed.

As the CQC undertook these steps, the number of inspections fell from nearly 7,000 from October 2009 to March 2010 to just over 2,000 for the same period the following year.

This decrease to such low levels meant that the regulator was failing to carry out its core functions of protecting the "health, safety and welfare" of people using services, the report said.

However, the MPs accepted steps were now being made to tackle the problems.

The process of GP registration has been postponed, while the CQC has now been allowed to take on extra inspectors and is now increasing the number of inspections it carries out.

But the report said the regulator still faced a tough task in getting back on top of the issue.

Committee chairman Stephen Dorrell accused the CQC of taking its "eye off the ball".

He said registration was essentially a bureaucratic exercise and should not have been prioritised ahead of inspections.

"The core role of the inspectorate is to inspect places where care is provided."

A spokesman for the CQC said it had faced some "major challenges".

"We know registration has been a difficult process for everyone involved, which is why we asked the secretary of state to delay registration of GPs by a year to allow us to improve the way we do it - and to allow our staff to dedicate more time to inspection."

The Department of Health said the CQC must consider the findings of the report.

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