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 108.

    In the not distant past, I am sure there were more managers in the NHS than actual care staff. Looks like no lessons were learned when the CQC was formed. As JulieG highlighted, it became a box ticking exercise rather than a proactive interaction with the service users and staff at the working level.

  • rate this

    Comment number 107.

    Over the years CQC and its predecessors have had their budgets cut again and again. DH continually hampers CQC by imposing impossible timelines, and by demanding the re-writing of 'business cases' for more staff over and over again. Don't demonise CQC. Point the finger fairly and squarely at the cause - the jobsworths at DH and elsewhere in government who prevent them from getting on with the job.

  • Comment number 106.

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

  • rate this

    Comment number 105.

    "The chief executive of the CQC, Cynthia Bower, paid more than £195,000 a year, was formerly chief executive of the NHS West Midlands' strategic health authority, where she was responsible for supervising the performance of Stafford hospital during the time of the scandal." The Guardian

    That explains it then.

  • rate this

    Comment number 104.

    "The whole operation was nationalised and went from being local teams led by highly motivated, experienced people to a box ticking exercise. Many good people left/were made redundant"

    There are, I know, similar problems currently destroying our education, health and police/law enforcement authorities and, I am sure, many other quasi government organisations. Some like it that way.

  • rate this

    Comment number 103.

    How much more could an organisation do if instead of being investigated they received funding that the government of the day instead decides to spend on the commissioning of an often out of date report.

    Everything now seems to require a report rather than ministers using commonsense and backbone to determine the direction they take.

    Scapegoat culture ?

    Maybe they'll commission a report.

  • rate this

    Comment number 102.

    The CQC take a lot of money from registered organisations, i struggle to understand what they do with it all and their outcome inspections are more beuracratic than any other previous systems that used to be in place.

  • rate this

    Comment number 101.

    Am sure that the CQC looked like a very good idea on paper. But my experience is that these type of agencies (HSE is another) are not set up with any comprehensive understanding of what is being assessed. The criteria used are the basic distillation of what constitutes good care and so its easy for bad organisations to tick those boxes whist being wide off the mark on intangible fundamentals .

  • rate this

    Comment number 100.

    When my husband was in hospital for a week , he discharged himself he had terminal cancer, i saw people calling for help and being ignored ,some of the staff were very good but others no, the care staff we had coming to see him at home were brilliant caring and cheerful for him and me ,its like no one wants the job of actually looking after patients anymore its very sad and in some cases criminal

  • rate this

    Comment number 99.

    I worked for CQC, and from the start confusion reigned. The whole operation was nationalised and went from being local teams led by highly motivated, experienced people to a box ticking exercise. Many good people left or were made redundant. So much time and money is now spent on staff travelling miles for pointless meetings, and the senior management have little to do with service users or staff

  • rate this

    Comment number 98.

    If you had ever met the Chief Exec of the CQC you would establish within 3 nana seconds why the CQC failed!

  • rate this

    Comment number 97.

    So, now it`s the turn of CQC to be demonised for not doing the job it can`t do because it doesn`t have the staff to carry out necessary inspections and doesn`t have the power to actually do anything apart from producing reports. Expect to see calls from the condems for the role of CQC to be "outsourced" (privatised)

  • rate this

    Comment number 96.

    For shame's sake Bower should have resigned long ago but she clung on (maybe the £200,000 salary was a factor). Maybe they'll get her now.

  • Comment number 95.

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

  • rate this

    Comment number 94.

    Well with the GMC been a big joke there is no wonder that the CQC is a joke as well. Try reporting anything to and you get a load of it not our job.
    The inspectors need real power. I.e. to close a ward down over night all inspections should be unannounced. It is a sad fact that most hospital manager do not care one bit. They need be to finded or give the boot. They need to be feared.

  • rate this

    Comment number 93.

    All of the tax payers pay enough to expect good hospital treatment and good care once we are all of that age. With every company there are people who do an excellent job and there are people who are there for a free ride. It is portrayed that the problem is the front line staff, but its about time the higher level staff are reviewed and replaced if they are not up to the position.

  • Comment number 92.

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

  • rate this

    Comment number 91.

    @69.The Green Hornet
    You might be right, and its true most nurses sit at nurses stations looking at party photos on the computer (certainly judging from my personal experience). But most care homes a private, and staffed by part timers with no training and minimum wage (my wife was one for a period - not even first aid training!)

  • rate this

    Comment number 90.

    CQC is not fit for purpose. It is run by a woman who thinks everything should be inspected and regulated without limit but who has failed to deliver services she was responsible for. Why do GPs need to be regulated? Care homes I can understand and other services for vulnerable people but that is where it should end. Extending the scope of a failing organisation is madness.

  • rate this

    Comment number 89.

    CQC was in one of the hospitals I am linked with. They commented negatively on the stationary in use as it did not have the name of the current trust, it had the name of the preceeding trust. The knee jerk reaction was this - in my hospital, all stationary were discarded and the new trust name was put on. Now, someone please tell me, how can this have any bearing on the care we provide ?


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