Annual Report and Accounts 2018/19

Annual report and accounts 2018/19 HC 2479 Care Quality Commission Annual report and accounts 2018/19 Presented to Parliament pursuant to paragraph 10(4) of Schedule 1 of the Health and Social Care Act 2008. Ordered by the House of Commons to be printed on 24 July 2019. HC 2479 © Care Quality Commission copyright 2019 The text of this document (this excludes, where present, the Royal Arms and all departmental or agency logos) may be reproduced free of charge in any format or medium provided that it is reproduced accurately and not in a misleading context. The material must be acknowledged as Care Quality Commission copyright and the document title specified. Where third party material has been identified, permission from the respective copyright holder must be sought. Any enquiries related to this publication should be sent to us at [email protected]. This publication is available at www.gov.uk/official-documents. ISBN 978-1-5286-1521-1 ID CCS0619531556 07/19 Printed on paper containing 75% recycled fibre content minimum. Printed in the UK by APS Group on behalf of the Controller of Her Majesty’s Stationery Office. Contents Who we are and what we do 2 Performance report 4 Foreword 5 Performance summary 7 Performance analysis 11 Accountability report 51 Corporate governance report 52 Remuneration and people report 68 Parliamentary accountability and audit report 82 Certificate and report of the Comptroller and Auditor General 84 to the Houses of Parliament Financial statements 87 Statement of Comprehensive Net Expenditure 88 Statement of Financial Position 89 Statement of Cash Flows 90 Statement of Changes in Taxpayers’ Equity 91 Notes to the financial statements 92 Who we are and what we do Who we are and what we do Who we are: The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. HOW WE ARE Adult Social ORGANISED Strategy and OUR PURPOSE Care We are organised under Intelligence six directorates We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. Hospitals Regulatory, (including Customer and mental Primary Corporate health) Medical Digital Operations STRATEGIC Services and PRIORITIES Integrated Care 1 4 PERFORMANCE REPORT Encourage Improve our improvement, efficiency and innovation and effectiveness. sustainability in care. OUR 2 3 Excellence Caring VALUES Integrity Teamwork Deliver an Promote a intelligence-driven single shared view approach of quality. to regulation. We are independent, but we report to Parliament through the Department of Health and Social Care (DHSC). OUR We work with other regulators, local authorities and commissioning groups, health ROLE and social care organisations, and organisations that represent, or act on behalf of, WHO people who use services, including the Healthwatch network. Register Monitor, inspect, rate Enforce Independent voice WE WORK We register health and We monitor and inspect We use our legal powers We speak independently, WITH Healthwatch England, the national consumer champion for users of health and social adult social care providers. services to see whether to take action where we publishing regional and care services, is a statutory committee of CQC’s Board. they are safe, effective, identify poor care. national views of the caring, responsive and major quality issues in well-led, and we publish health and social care, and what we find, including encouraging improvement The National Guardian’s Freedom to Speak Up Office (NGO) is jointly funded by CQC, quality ratings. by highlighting good NHS Improvement and NHS England. CQC’s Chief Executive has responsibility as practice. Accounting Officer for the NGO and for Healthwatch England. 2 Care Quality Commission Annual report and accounts 2017/18 Care Quality Commission Annual report and accounts 2018/192017/18 3 1 Performance report The performance report consists of four sections: Foreword from CQC’s Chair and Chief Executive 5 Performance summary 7 A performance summary for 2018/19 that highlights important achievements, progress towards our objectives and targets, and our impact as a regulator. Performance analysis 11 A performance analysis for 2018/19 that is a detailed explanation of our performance during the year, with evidence to support the performance summary. Foreword Peter Wyman CBE DL Ian Trenholm Chair Chief Executive In 2018/19 we made good progress and focused on what we need to do to complete the delivery of our strategy. In 2019/20 we will concentrate on improving our efficiency and effectiveness to make it easier for members of the public to use our information, for providers to work with us, and for our people to do their jobs. Our progress 2017/18. We must continue to improve in this PERFORMANCE REPORT area, including developing new ways to make Using our baseline understanding of the quality our information easier for members of the public of care, over the last year we continued to to access. encourage improvement and to help inform choice for people. We know that many providers As we continue to make these improvements, now use our five key questions in their we know we need to keep our focus on protecting governance, an important part of building a people who are most at risk of poor care. In our shared view of quality. We also built on our strong review of restraint, seclusion and segregation for reputation for raising the issues that need to be people with a mental health problem, a learning tackled, such as through our State of Care report. disability or autism we stressed the urgent need to fix a failed system of care and to strengthen Our local system review programme has enabled the safeguards that protect the rights of people an understanding of how different parts of the held in segregation. Some of the hospitals we health and social care system need to work visited during the review have features of together better to improve the experience of institutions that are at risk of developing a closed care, especially for people who may struggle to and even punitive culture. The treatment of have a voice and to secure their right to good people at Whorlton Hall in County Durham care. Our stakeholders have told us that our reinforced how difficult it can be to uncover reviews have helped them to understand how abusive practices in such institutions. We are care is coordinated across their area. looking closely at what we could have done Our intelligence-driven approach to monitoring differently to detect this abuse and protect the care quality means that we have started to use our people who were living at Whorlton Hall. information and data to target inspections more effectively when quality changes, and to take Realising our ambition decisive enforcement action to protect people. We have more to do to make sure we meet the We are publishing our inspection reports more ambition of our 2016 to 2021 strategy to have a quickly and this has improved substantially since more targeted, responsive and collaborative approach to regulation, so more people get sharing with us and that we get clearer high-quality care. information from people with as many different experiences and backgrounds as we can, to Most importantly, we are accountable to people inform where we need to inspect. We have made who use services and we act independently to good progress and the new service will launch make sure that people receive a good quality of later in 2019/20. care. We also have a clear obligation to providers that fund most of our work through their fees – We want our people to feel more connected and in 2018/19 the fees raised largely covered our better able to collaborate across teams and costs on the activities for which we charge manage their workload. We have invested in new providers. We want to make sure that we do all mobile capability, enhanced wifi and broadband, we can to protect people from poor care and and integrated office IT solutions that will encourage improvement, while offering value for support our people to do their jobs. money, and being an efficient and effective Our vision is for a fully inclusive organisation regulator. that values difference and is known as a great In 2019/20 we will start to discuss, design and place to work. We are focused on improving develop our regulatory approach, including how recruitment, retention and progression for all we monitor, inspect and rate. This will enable us prospective and current CQC colleagues, to achieve our strategic ambition for a more particularly for people from Black and Minority targeted and responsive approach to regulation, Ethnic backgrounds, as well as increasing make sure our regulatory approach is responsive learning and development opportunities. to changes in the health and social care As we increasingly look at health and social care landscape, and support the development of our delivery as part of a system, we need to be able strategy for 2021 and beyond. to adapt our approach as new types of care Achieving greater productivity is at the heart of provision emerge and new technology is used. our ambition and business plan. We know that We will continue to build relationships with local our internal systems and processes, and our partners, including with integrated care systems. public and provider tools need to improve. To do Following a commitment from the Secretary of this, we have started an important programme to State for Health and Social Care, we aim to carry improve our processes and technology, alongside out more local system reviews that will help us investing in the skills of our people. to develop a more wide-reaching understanding Our digital investment supports the redesign of a of how a person’s experience of care can be range of digital tools and products over the next improved when services collaborate around few years.

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