NHS’s main regulator has lost public confidence, say MPs

BMJ 2013; 346 doi: (Published 08 January 2013) Cite this as: BMJ 2013;346:f124
  1. Adrian O’Dowd
  1. 1London

The NHS’s main regulator, the Care Quality Commission (CQC), has lost the confidence of the public and will have to work hard to regain trust, MPs have claimed.

MPs on the parliamentary health select committee have also warned that the ongoing registration of general practices by the commission will be a major challenge and a test of whether the regulator has learnt from past mistakes.

MPs on the committee published a critical report on 9 January,1 resulting from its annual accountability hearing in September last year,2 which focused on the commission.

The new report says that despite sustained criticism over a prolonged period and several scandals over standards of healthcare the commission has not yet successfully defined its core purpose or earned public confidence.

The MPs conclude that the commission’s main focus should be to ensure that the essential standards it enforces could be interpreted by the public as a guarantee of acceptable standards in care.

“We do not believe that the CQC’s essential standards in their current form succeed in this objective,” says the report. “As a result, patients, residents and relatives do not have confidence in the CQC’s standards or the outcomes of inspections.”

The commission has been through a year of changes, say the MPs, mentioning the resignation of Cynthia Bower as chief executive in February 2012, her replacement being David Behan, and the resignation of its chairwoman, Jo Williams, in September, her replacement (in December) being David Prior.

In addition, the report mentions several scandals that have taken place in the NHS during what it calls the commission’s “unhappy history,” such as Winterbourne View Care Home and University Hospitals of Morecambe Bay NHS Trust.3 4

Launching the report, the committee’s chairman, Stephen Dorrell, the Conservative MP for Charnwood, said, “The CQC needs to ensure that its inspections represent a challenging process which is designed to find service shortcomings where they exist; ensure, when appropriate, that service providers address them rapidly; and report promptly both to providers and users of the service. The CQC also needs to show that it treats feedback from the public as free intelligence and that it acts swiftly when serious complaints are brought to light this way.”

The committee welcomed the fact that the CQC was carrying out a consultation on its key objectives but recommended that it should also consult on developing a clearer understanding of effective regulatory methods, including how inspectors could assess culture among professional staff.

The report recommends that any care provider that cannot meet its obligation to show that it has “robust procedures” requiring it to recognise and deal with service shortcomings for all staff in pursuit of their professional duties should be refused registration by the commission.

As well as recommending that the new chair of the commission should make it a priority to overhaul its governance structures, the MPs also call on it to improve the way it communicates its findings to all interested parties to make them more accessible.

Ongoing registration of general practices, which is due to be completed by the end of March this year, was certain to prove an indication of the commission’s ability to learn from past mistakes, said the committee.

“Given the magnitude of primary care registration we will, in 2013, examine carefully how successful the CQC has been in streamlining registration and limiting the bureaucratic burden on GPs,” says the report.

Responding to the report, Behan said that his organisation was already making changes. He said, “In our strategic review we consulted widely on a clear statement of our purpose and role. We also set out our intentions to improve how we communicate with the public, make better use of information, and work more effectively as an organisation and with others, including those who provide care.

“We also set out our intentions to tailor the way we regulate different types of organisations, based on what has the most impact on driving improvement. We will put people’s views at the centre of what we do. We have already begun to make some of these changes and will continue this process next year.”


Cite this as: BMJ 2013;346:f124