Helen Salisbury: Failings at the Care Quality Commission

We learnt recently that the Care Quality Commission (CQC) has been branded not fit for purpose in an interim report.1 Founded in 2009, the CQC is responsible for ensuring the safety of health and care provision in England, and this verdict came as no surprise to organisations that have endured its inspections.

Some practices probably believe that the inspectors were fair in their judgments and helpful in their feedback—but these seem to be a minority. Rather than a supportive system that helps practices improve, colleagues describe interactions that are highly stressful, confrontational, and accusatory. “Incompetent and callous” was a recent description from one care home provider.2

For most GPs, the overwhelming feelings when they hear that an inspection is imminent are of weariness and dread. Weariness, because we know that we’ll spend the next fortnight burning the midnight oil updating pointless protocols, few of which anyone will ever read again, except under duress. Dread, because we know that however good the service we offer may be, it’s perfectly possible that we’ll be rated unsafe because someone failed to document the fridge temperature accurately last December, or the inspection team takes exception to the way we store our liquid nitrogen (these were the areas where we were found wanting last time).

We’re currently struggling to sign up to the new CQC online portal, but we’ve decided not to panic, as clearly many other surgeries are in the same position. The dire state of the IT infrastructure is just one of the reasons for the CQC’s failings identified in the interim report.3

More importantly, the CQC has lost the confidence of both the government and the people it regulates.4 This is partly because of a loss of expertise, both at the top of the organisation and in its inspection teams. Inspections can take place without involving anyone with relevant experience: the interim report gives an example of care homes being inspected by people who had never met a patient with dementia. Another major failing highlighted is a lack of clarity about what exactly the CQC is looking for and how it reaches judgments about what’s “good” or “outstanding.” That lack of transparency leads to an inevitable perception that ratings are subjective, inconsistent, and unfair.

Doctors and practice managers spend a huge amount of time preparing for CQC visits, and we have to ask ourselves whether this is time well spent or whether it would be better used looking after our patients. There’s also the small matter of the £240m annual cost of the CQC.5

CQC inspections examine and rate surgeries, hospitals, and care homes, judging whether they operate in a manner that’s safe, effective, caring, responsive, and well led. The first task for the interim chief executive, Kate Terroni, is to prove to the people in those services that her own organisation can lead by example. We wish her luck.