The Care Quality Commission (CQC) now has “a renewed sense of purpose” and is better able to protect patients and the public, MPs believe.
In the past, the Commission “has been a case study in how not to run a regulator,” but essential reforms implemented by the new management are turning it around, said Commons Health Committee chair Stephen Dorrell, launching the report of the Committee’s annual accountability hearing with the CQC.
A new approach to registration and inspection, established in the revised strategy published by the CQC last April, states that the Commission’s clear purpose is “to make sure health and social care services provide people with safe, effective, compassionate, high-quality care and to encourage care services to improve.”
The MPs welcome this clear statement of objectives, and say they believe the CQC “is now ready to undertake a programme of substantial reform to develop and improve its regulation functions.”
“Putting in place systems to inspect hospitals and care homes proved too much for the CQC in previous years. Inspections were superficial and produced reports which bore little relation to reality, but the CQC now has a coherent plan to make sure providers are properly examined,” said Mr Dorrell, Conservative MP for Charnwood. “Giving inspection teams the time and tools to understand what is really happening in hospitals, GP surgeries and care homes is fundamental. The CQC is now doing this by recruiting specialist inspectors who can understand and interpret what they observe during inspections.”
However, witnesses to the Committee’s inquiry expressed concern that the new model of registration and inspection will focus too closely on hospitals, primary care and social care, at the expense of community, ambulance and mental health services. In addition, the CQC has published “substantially” more information on its programme for hospitals than it has for general practice and adult social care, the MPs say, and comment: “at our next accountability hearing we expect the CQC to present clear details of how effective registration, surveillance and inspection will be extended beyond hospitals.”
The inquiry also examined the CQC’s decision to introduce risk-based regulation alongside a rating system which will issue providers with overall ratings ranging from “inadequate” to “outstanding.” Differentiated regulation is the right approach, say the MPs, but they point out that there are some providers where services are inherently high-risk and where regular inspection is vital.
“Achieving an ‘outstanding’ rating should never mean that high-risk services are allowed to operate without oversight. Providers must not regard being awarded a positive rating from the CQC as a mechanism for escaping scrutiny,” Mr Dorrell cautioned.
He also pointed out that while the Department of Health has asked the Commission to oversee the introduction of the “fit and proper persons” test for the directors of care providers, “perversely,” the test will not be applied to the chairs of NHS trusts or foundation trusts.
“We do not believe this exclusion will be understood by patients or the public,” he said.