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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  • rate this

    Comment number 68.

    @62. The_Whitstable_one - neither. It's reality.

    You only have to look to the US to see the model that is waiting in the wings.

    A model that an estimated 40 million US people cannot access because they do not have the wealth to do so.

    And if you think it won't be a US model used for privatisation - only the other day a US company was awarded a contract for provision to "free schools"...

  • rate this

    Comment number 67.

    Look at all the abuse scandals from Longcare in the 80's to Cornwall; Merton; Fieldhead hospitals; through to Winterbourne and you see that regulators only reacted once the whistle was blown by someone else.

    The solution lies elsewhere.

  • rate this

    Comment number 66.

    Like all QUANGO organisations,the CQC exists to shift responsibility and accountability from those elected but unable or not competent to head their departments.
    They are also instruments of patronage.

  • rate this

    Comment number 65.

    Mum will need a home soon. All are now privatised - ie run for profit. Social Services aren't interested as she has reasonable income so we the ignorant have to select a home where she will be looked after well. I despair. She can't look after herself and is in constant pain but this is not a Health issue! My generation haven't a hope. Impossible to inspect homes for baby boomers.

  • rate this

    Comment number 64.

    I work for the NHS and not one person I know has anything positive to say about the CQC. The inspectors don't seem to have any understanding of the area they are trying to inspect. They are negative, and the negativity is what is picked up on - not the positive work people do.

  • rate this

    Comment number 63.

    It's easily resolved.

    What is needed is a committee of specialists in all fields to look into the problem for a couple of years then recommend a Regulator for the Regulator.

    By the time the process has finished it will have cost millions of pounds and thousands of lives - but it will have put the problem off until after the next election.

    If in doubt, I'm being sarcastic!

  • rate this

    Comment number 62.

    @55. ravenmorpheous2k.
    ".....we might just hang on to the best health service in the world for a bit longer...."
    Is that great irony?....or a bad bout of hysteria?

  • Comment number 61.

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

  • rate this

    Comment number 60.

    "56. CryFreedomMachine - everyone will need to do more for less"

    You've been drinking that Tory cool-aid again haven't you. Surely when you say "everyone" you really mean "everyone" except for MPs on 5-6 figure salaries, CEOs of loss making companies who still take bonuses, and not to mention the bankers who despite failing biblically are still being paid huge salaries and bonuses.

  • rate this

    Comment number 59.

    The CQC is poorly lead, poorly managed, and has a confusing remit.It has enough inspectors to do the job of stamping out bad practise, but they are just not deployed properly.Far too many "senior managers" doing very little, other than propping up an organisation that has lost its way.Get rid of layers of expensive "managers", and give inspectors the proper tools to do the job.

  • rate this

    Comment number 58.

    50. ronald1958

    My point is not that creating new regulators is useful, is that you can't condemn a regulator for awarding a rating it never has done nor could do because it is operating under a different legal mandate.

    Making shallow and ill-informed points about acronyms doesn't improve patient care

  • rate this

    Comment number 57.

    The imposed underspend will no doubt find its way back into Treasury coffers - and from there into the pockets of Osborne's pals profiting from his back-of-fag-packet infrastructure investment programme.
    Meanwhile, CQC will continue to ignore declining standards for the most vulnerable mental health patients previously safeguarded by the Mental Health Act Commission.
    A government without shame.

  • rate this

    Comment number 56.

    Inspecting all these areas of care has always been abysmal.

    The public get to know very little of the horrific ongoing realitys in UK care system.

    Thing is, whats going to be done, because there is no real money to throw at it.

    Depressing as it is, over coming years, public services & pensions will be cut more than planned now, thats the reality, everyone will need to do more for less

  • rate this

    Comment number 55.

    The CQC was created purely to destabilise the NHS making it easier to privatise it. Think about it - CQC says certain hospitals are failing - those hospitals are then privatised under the guise of "making them more effective".

    If the CQC is failing then great - we might just hold onto the best health service in the world for a bit longer.

  • rate this

    Comment number 54.

    @46 Tez
    I agree that a lack of foresight and compassion among some carers is causing distress (and worse) among those being "cared" for, and should be rigorously investigated and sorted out. However, as the saying goes, you pay peanuts.........

  • rate this

    Comment number 53.

    Re - . Kadazan The NHS in the days of the all powerful Matron never.... Check your history. NHS was rife with worse than Winterbourne scandals - late 1950's through to mid 1970's, - the common theme was ministerial complacency and cost cutting without quality measures. Check this out for a single example

  • rate this

    Comment number 52.

    NHS worker I know say they know of inspections - usually several days in advance. The problem is, we measure hospitals against one another, so inspections have to be done to a set formula, which means that various spreadsheet jockeys insist on it being over formalised. Random, truly unannounced inspections by people who know good care from bad is really all that's needed. Cheaper, faster & fairer.

  • rate this

    Comment number 51.

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

    One organisation to do the work of three, that were presumably set up with experts in their particular fields.
    Never mind its cheaper.

  • rate this

    Comment number 50.

    43.Turnip20 "CQC has never awarded 'adequate' or any other such ratings, that was CSCI"

    CSCI. CQC, BHYC, JJYC, NCSC, IJCG, OPPCI...I expect they will just come up with new regulators, quangos and acronyms and they can all point at each other when something goes wrong, useful.

  • rate this

    Comment number 49.

    Its so easy to blame the cares staff but if you saw working conditions reality then maybe people would think otherwise. 2 nurses and 1 healthcare assistant looking after 18 patients on an acute admissions ward is most certainly not quality of care. There is only so much 3 people can do in a set time. I care very much about my patients and am fed up of care staff being the scape goat!!!!!!!!!!!!


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