Despite sustained criticism over a prolonged period, the Care Quality Commission (CQC) has failed to defend its core purpose or earn public confidence, the House of Commons Health Committee has said.The CQC's primary focus should be to ensure the public is confident that its inspections provide assurance of acceptable standards in care and patient safety, but "we do not believe the CQC has yet succeeded in this objective", Committee chair Stephen Dorrell MP said today, launching the report of the MPs' second annual accountability hearing held with the regulator.
"Patients, residents and relatives do not have confidence in the CQC's standards, or the outcomes of inspections," says the report.
Continued strong criticism of the CQC during 2011-12 prompted the Department of Health to undertake a performance and capability review, and the controversy surrounding the agency grew still further when board member Kay Sheldon decided to give evidence as a whistleblower to the public inquiry into the Mid-Staffordshire NHS Foundation Trust, during which she identified serious failings within the management, organisation, functions and culture of the CQC.
"Kay Sheldon's concerns were legitimate and it is unacceptable that the CQC failed to address and act on them before she felt compelled to approach the public inquiry," say the MPs.
Evidence given to the parliamentary hearing by the CQC's outgoing chair, Dame Jo Williams, and its recently appointed chief executive, David Behan, made it clear the regulator was aware of the reforms that must be implemented. "The CQC has developed a much keener focus on patient safety and has a better appreciation of what it exists to do, but we remain to be convinced that the CQC has successfully defined its core purpose," says the Committee.
The MPs are also highly critical of the Commission's failings to communicate the outcomes of its inspections directly to operators, residents and relatives, as well as to public sector commissioners. "No-one who relies upon a service should be expected to scour the CQC website for inspection results, or chance upon them in a local newspaper report,” said Mr Dorrell, who is Conservative MP for Charnwood.
The report welcomes the regulator's decision to strengthen its inspection process by including expert clinical advisers, but the MPs remain concerned that such expertise is not always available when necessary - some 87% of inspections carried out since this resource became available did not use it. The CQC needs to develop a consistent methodology for inspectors to follow that will ensure clinical experts are available when required, they say.On whistleblowing, the MPs said the Commission needs to do more to support the most vulnerable workers to come forward and report their concerns and that, in the long term, it has a role to play in facilitating "a culture of challenge and response" so that identifying and addressing failures becomes a standard process for staff and management. Providers that fail to support staff in raising concerns should be refused registration by the CQC, they recommend.
"The CQC needs to ensure its inspections represent a challenging process that 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 it treats feedback from the public as free intelligence and that it acts swiftly when serious complaints are brought to light this way," said Mr Dorrell.
Turning to primary care registration, the Committee said this will be a major challenge for the CQC. It has been able to demonstrate that it has made a positive start to the process, say the MPs, and they have welcomed its emphasis on the extent to which it has cooperated with third parties in designing the system."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," said the Committee.
Commenting on the MPs' report, NHS Confederation chief executive Mike Farrar said this morning that, last year, more than two-thirds of NHS chairs and chief executives who responded to the Confederation's annual survey said they were not confident the CQC would be ready to effectively discharge its responsibilities this year.However, he added, "since then, the CQC's new chair and chief executive have brought strong expertise to the organisation, and they have been consulting with those working in the health service alongside patients and the public to take on board their views about how the CQC needs to change."
Farrar called on the Commission to use the Health Committee's recommendations, together with what it hears through its consultation exercise and the recommendations due to be made shortly following the Mid-Staffs public inquiry, to drive through the changes needed to give both the public and NHS leaders confidence in its work.
"It is in everybody's interest to have a strong and respected regulator for health and social care in place," he said.