Care Quality Commission cuts inspections to meet deadlines for registration

BMJ 2011; 343 doi: (Published 02 December 2011) Cite this as: BMJ 2011;343:d7873
  1. Clare Dyer
  1. 1BMJ

The Care Quality Commission halved the number of inspections, or “compliance reviews,” it carried out last winter, while it struggled to meet deadlines for registering providers, says a report from the National Audit Office (NAO).

Between October 2010 and March 2011, the commission completed only 47% of its planned compliance reviews, which aim to ensure hospitals and other providers are delivering safe care, after diverting staff to meet statutory deadlines for registration, according to the public spending watchdog. It concludes that the commission is not yet delivering value for money in regulating the safety and quality of health and social care in England.

The NAO said the commission, created in 2009 from three former regulators, missed deadlines for registering care providers, while its compliance work more than halved in its attempt to meet the deadlines.

Blame for the failure to achieve value for money lies with both the commission and the Department of Health for England, added the watchdog, which said it was unclear how the blame should be apportioned.

It warned that government proposals to transfer other responsibilities, such as regulating infertility clinics, to the hard pressed regulator risk diverting it from its core role.

The report’s findings follow criticisms made to the public inquiry into failings at Mid Staffordshire NHS Foundation Trust by Kay Sheldon, a Care Quality Commission board member, and Amanda Pollard, a compliance inspector, who also took their concerns to the NAO.

At the inquiry, Mrs Sheldon painted a picture of an underperforming organisation with no clear strategy about what it was trying to achieve. Mrs Pollard told the inquiry that staff were undertrained and had been taken off inspection to do registration, adding: “But no one’s going to die through not being registered” (BMJ 2011;343:d7812, doi:10.1136/bmj.d7812).

The NAO pointed out that the commission’s budget is less than the total for the three bodies it replaced—the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission—although it has more responsibilities. Yet it underspent its budget in the first two years and at the end of September 2011 some 14% of appointments were unfilled, in part because public sector recruitment constraints made it difficult to appoint new staff.

Timetables set by the Department of Health for registering adult health and social care providers did not allow time for the process to be tested properly, said the report. Registration of GP practices, which has been deferred until September 2012, will be a “key test” for the commission.

The report pointed to shortcomings in the commission’s performance management arrangements and called for better support for compliance inspectors to help them make “sound, consistent judgments.”

It said whistleblowing should be a key source of information for the commission, which has set up new procedures after it failed to react adequately to information from a nurse that residents with learning disabilities at Winterbourne View care home in Bristol were being mistreated.

The commission’s chief executive, Cynthia Bower, said: “As the NAO report makes clear, we faced a difficult task. Not everything has gone smoothly but we have learned, reviewed what we do and made changes, often with the support of others involved in health and social care.

“In October alone, we conducted more than 1400 unannounced inspections. In the last three months we have recruited and trained over 100 additional inspectors.” She said the public and NHS response to the commission’s recent report on the care older people received in 100 acute hospitals “demonstrates just how effective our regulatory system can be.”

Margaret Hodge, the Labour MP who chairs the Commons Public Accounts Committee, said: “The findings are deeply worrying and highlight significant failures that put patient care at risk. The Care Quality Commission has missed deadlines for its work, not undertaken sufficient compliance and inspection activities, and failed to deliver value for money.

“The commission prioritised registering care providers over checking compliance with essential quality and safety standards. As recent reports about the quality of care for the elderly demonstrate, timely inspections are vital for protecting patients and preventing unnecessary deaths.

“It is shocking that the commission has been held back from getting the staff it needs, and had the budget for, because of the halt on public sector recruitment. There has been too much focus on box ticking and not enough on crossing the threshold and assuring the quality of care.”


Cite this as: BMJ 2011;343:d7873

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