The bias of work at the Care Quality Commission (CQC) away from its core function of inspection and towards "the essentially administrative task of registration" has resulted in increased risk to patients, say MPs.
This "signification distortion of priorities" at the CQC was due to a statutory deadline for the registration of dentists, which led directly to a 70% drop in inspection activity during second-half 2010-11 compared with the same period the previous year, says the House of Commons Health Select Committee, in its annual review of the Commission's work.
"The primary causes of this distortion, which resulted in increased risk to patients, were the unrealistic statutory obligations imposed on the CQC," the Committee adds.
According to the MPs: - the CQC was established without sufficiently clear and realistic definition of its priorities and objectives; - the timescales and resource implications of the Commission's functions were not properly analysed; - the registration process was not properly tested and proven before it was rolled out; and - the CQC failed to draw the implications of these failures adequately to the attention of Ministers, Parliament and the public.
In light of these findings, the Committee says it welcomes the government's decision to postpone registration of GP practices.
Turning to the Commission's inspection activity, the MPs say they welcome recent announcements that the CQC intends to undertake annual visits of all NHS and social care providers, and emphasise that it should be a "key objective" of such inspections to ensure that each provider organisation recognises and respects the "obligation which rests on all healthcare professionals to raise concerns if they recognise, or ought to have recognised, evidence of failure of professional standards."
CQC inspections must also ensure that provider organisations provider "proper security" to staff which discharge this obligation effectively, it adds.
Commenting on this recommendation, Committee chair Stephen Dorrell described it as "an absolutely key finding. CQC inspectors cannot hope to uncover every failure of care - they can and should, however, focus on the culture of the organisation to ensure that professionalism is respected and that the proper systems of reporting and accountability operate effectively."
"We are often asked what assurance can be given to whistleblowers. The best answer is to secure an open culture in which the professional obligation to raise concerns is embedded and respected. That is what CQC inspectors should be looking for, and why their inspection activity is so important to patients," said Mr Dorrell, who is Conservative MP for Charnwood.
Responding to the Health Committee's findings, the CQC says the report highlights "the major challenges we have faced in merging three existing regulators, setting up a new regulatory model and registering more than 39,000 provider locations - including previously unregulated sectors - against aggressive Parliamentary deadlines and with a 30% budget reduction."
Inspection figures are now rising rapidly again, the Commission points out, and it adds that it "welcomes" the MPs' recommendations on the need to further incorporate the concerns of sector professionals, and those who use services, into the information it uses to make a judgement about a provider.
The CQC has already increased its focus on this area, it says, and adds: "we will be launching a campaign later this autumn to encourage healthcare professionals to raise concerns with us directly - with the assurance that we will treat these concerns in confidence and will act swiftly where necessary."
- Speaking at Prime Minister's Questions in the Commons, David Cameron praised the Committee report, saying it was important that it had "focused on inspections and making sure that standards are high, rather than simply on the process of registration and bureaucracy."