Care regulator 'struggled to deliver'

Surgeons operating The commission monitors hospitals and care homes

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The health regulator which inspects hospitals and care homes in England has "struggled" since its creation two years ago, a report says.

The National Audit Office found the Care Quality Commission had carried out just 47% of planned reviews between October 2010 and April this year.

The CQC took over the work of three previous regulators in 2009 and has had to implement new monitoring systems.

It said it had been a "challenging period" but that it was now "on track".

The commission is responsible for checking if hospitals and care homes meet minimum standards.

It took over from the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

The NAO said this shift had "created disruption for providers and confusion for the public".

An additional problem was a lack of staff.

Start Quote

There has been too much focus on box-ticking and not enough on crossing the threshold and assuring the quality of care”

End Quote Margaret Hodge, Commons public accounts committee chair

As of the end of September, 14% of posts were unfilled - including 100 inspectors' posts, with the CQC affected by government recruitment constraints, which have now been relaxed.

In its report, the NAO added that the process for registering care providers - one of its core jobs - "did not go smoothly".

The CQC did not meet the timetable for two of the three tranches of registrations, it said. And inspectors were diverted from assessing providers in an attempt to meet that timetable.

This and the staff shortage meant that the commission had completed just 47% of its planned assessments between October 2010 and April 2011.

The NAO concluded that the CQC had not, so far, achieved value for money - and said both the commission and the Department of Health were responsible.

'Considerable upheaval'

It is not the first time the CQC has faced criticism.

In September, MPs said patients had been put at risk by the fall in the number of inspections of hospitals and care homes.

At the time, Prime Minister David Cameron urged the regulator to act on the MPs' criticisms.


  • £139m spent in 2010-11
  • 21,600 organisations currently registered
  • 14% of vacancies unfilled as of 30 September 2011
  • 47% of registrations not completed on time
  • 47% of planned inspections not carried out October 2010- April 2011

Its work also came under scrutiny after abuse at the Winterbourne View residential home near Bristol came to light.

Publishing this latest report, Amyas Morse, head of the NAO, said: "Against a backdrop of considerable upheaval, the CQC has had an uphill struggle to carry out its work effectively and has experienced serious difficulties.

"It is welcome that it is now taking action to improve its performance.

"There is a gap between what the public and providers expect of the Care Quality Commission and what it can achieve as a regulator. The commission and the Department of Health should make clear what successful regulation of this critical sector would look like."

CQC chief executive Cynthia Bower said: "Not everything has gone smoothly, but we have learned, reviewed what we do and made changes.

"We are a young organisation and we are still evolving - but I firmly believe that we are making real progress."

A Department of Health spokesman said it was currently reviewing the CQC, and the findings of its review would be published in 2012.

But Margaret Hodge, chair of the House of Commons public accounts committee, said the NAO report raised concerns about whether the CQC was "up to scratch".

She added: "The findings are deeply worrying and highlight significant failures that put patient care at risk.

"There has been too much focus on box-ticking and not enough on crossing the threshold and assuring the quality of care."


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  • Comment number 48.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 47.

    Three prev regulators have been mashed into one. HCC-for acute hospitals-inspectors (without power at the time) who had specialist health skills. CSCI - for social care, and despite its faults (I worked here) was finally making progress weeding out the dreadful Winterbournes of this world using OBSERVATIONAL METHODS. MHAC - experts in mental health support. Services & users are not homogeneous

  • rate this

    Comment number 46.

    The basic problem is not the system - it's the lack of care that individuals have for each other. No matter what system is used for Patient care - if the carers themselves do not have real compassion / responsibility for others - any system is doomed to failure.

    The CQC needs an in-depth investigation into the PERSONALITES of all caring-staff hired...

  • rate this

    Comment number 45.

    Cameron should keep his mouth shut I believe!
    This man is intent on destroying the public sector bit by bit and if he wants to continually criticise public services maybe he should start to FUND it properly first!! The CQC has been cut by THIS GOVERNMENT. The NHS is being CUT right NOW - wake up everyone!
    (His comment on striking workers on Wednesday were as bad as Clarkson's. Disgraceful.)

  • rate this

    Comment number 44.

    And before CSCI there was the NCSC... I left this organization on principle & with sadness; it's regulatory processes, just like CSCI and CQC, were disproportionate & expensive - paid for by providers trying hard to offer good care against silly "minimum standards". Inspections now take days and to what end? It takes an undercover reporter to ascertain that a registered home is abusing residents

  • rate this

    Comment number 43.

    @ 2. schoolies

    Homes that CQC has claimed to have closed down; because patients were found dehydrated, with pressure sores lying in their own excrement have simply renamed themselves and received a "new" adequate CQC rating.

    CQC has never awarded 'adequate' or any other such ratings, that was CSCI, try and engage your brain before regurgitating half-baked nonsense from private eye

  • rate this

    Comment number 42.

    The WHY duplicate the work of the General Dental Council, Government Acts, Health And Saftey, PCT's et al in over the top regulation of dental practices??! WHY treat these small practices in the same way as a massive hospital? Wasting vital resourses on something already well under control and regulated. Cameron "cutting bureaucracy" AS IF!

  • rate this

    Comment number 41.

    Lets spend some more money on pointless wars instead of at home. that'll help.

  • rate this

    Comment number 40.

    It's not the Care Quality Commission's fault.
    This is another scandal showing the contempt a government holds for its population.
    A small percentage of 'our' money that was 'given' to the banks, Thatcher (et al) and all the other pigs around the trough would ensure proper, sufficient care for those in need.
    Think carefully about Cameron's motives because, one day, you may need care yourself.

  • rate this

    Comment number 39.

    The NHS in the days of the all powerful Matron never, ever needed regulation. Yes there were patient queues but that in many ways was a measure of the care given.Today's tawdry state of affairs is the direct result of political meddling where the NHS watchdog can't perform simple measures to ensure patient care on an acceptable time-scale consistent with financial constraints and NICE.

  • rate this

    Comment number 38.

    Have the Tories stopped funding this yet ? If not, it won't be long. It's only the NHS and only poor people use it so they don't care about the quality.

  • rate this

    Comment number 37.

    The problem here is the lack of staff and the constant changes in management structure due to political interference by the present government. CQC managers and staff work long hours with huge commitment to their task of preserving and raising good practice in care services.

  • rate this

    Comment number 36.

    We are a nation which has a 'fit and proper person ' test for would be football club owners but which allows any Tom,Dick or Harry to set up a 'care home'.Its very bizarre.Where profits can be made corners will be cut.If we continue to involve private enterprise in healthcare we will need a regulatory body of huge proportions to properly police it.CQC is that body and it isn't big enough.

  • rate this

    Comment number 35.

    There is insufficient involvement of the families and friends of people in hospital and in care homes. We are your real inspectors. If things aren't right it feels there is nowhere to go. I doubt the majority of people have heard of the CQC. Putting up a leaflet on a notice board doesn't do it. I once contacted an inspector at the CQC and she very haughtily asked me how I had come by her name!

  • rate this

    Comment number 34.

    How many heads will role over this? Or will they just get "retired early" with a full pension, golden goodbye and a customary knighthood?

  • rate this

    Comment number 33.

    The previous Gov was just interested in paper trails, so long as a system was there on paper in did not matter if it worked or not.
    This Gov is fixated on money and cuts funding then wonders why more work is not being done.
    The NHS, despite nice words, ensures that any whistle blower forfeits their career. so why is it any news the CQC is failing

  • rate this

    Comment number 32.

    As usual the failure is at the top. These organisations should be run by people with passion who are prepared to 'kick arse' to get things up and running. Recruitment for a well run organisation is never a problem.
    Complacentcy + 'learning lessons' = poor leadership
    Making a decision + rapid correction if wrong = good leadership

  • rate this

    Comment number 31.

    Richard Grey is incorrect. This has nothing to do with the current govt (other than not having the sense to put the brakes on ) this was invented by Labour. They adopted the most aggressive stance possible with dentists: threatening closure if practices didn't register (using standards designed for hospitals) by 1st April 2011 yet on 2nd April they had processed just 20% of applications -Appalling

  • rate this

    Comment number 30.

    My wife works for the CQC and is constantly out on the road inspecting hospitals and care-homes or writing up inspections on shoddy IT systems. I can tell from her workload that there is not enough staff in the CQC nor the right systems in place for her to do her job effectively. Plus, some of the staff (from other amalgamated quangos) seem under-qualified for the job

  • rate this

    Comment number 29.

    Sandy Winder-
    You should read the report before you publish opinions on it!:
    it doesn't call for the end of the CQC, it says theres been too much disruption allready. And Its Castlebeck Care, a private company, that is to blame for Winterbourne view!
    Solomon- inspecting care homes sounds pretty grim to me hardly a jolly!


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