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Annual Accountability Hearing with the Care Quality Commission House of Commons Health Committee Annual accountability hearing with the Care Quality Commission Ninth Report of Session 2010–12 HC 1430 House of Commons Health Committee Annual accountability hearing with the Care Quality Commission Ninth Report of Session 2010–12 Report, together with formal minutes, oral and written evidence Ordered by the House of Commons to be printed 6 September 2011 HC 1430 Incorporating HC 1203-ii (Qq 149–258), Session 2010–12 Published on 14 September 2011 by authority of the House of Commons London: The Stationery Office Limited £0.00 The Health Committee The Health Committee is appointed by the House of Commons to examine the expenditure, administration, and policy of the Department of Health and its associated bodies. Membership Rt Hon Stephen Dorrell MP (Conservative, Charnwood) (Chair)1 Rosie Cooper MP (Labour, West Lancashire) Yvonne Fovargue MP (Labour, Makerfield) Andrew George MP (Liberal Democrat, St Ives) Grahame M. Morris MP (Labour, Easington) Dr Daniel Poulter MP (Conservative, Central Suffolk and North Ipswich) Mr Virendra Sharma MP (Labour, Ealing Southall) Chris Skidmore MP (Conservative, Kingswood) David Tredinnick MP (Conservative, Bosworth) Valerie Vaz MP (Labour, Walsall South) Dr Sarah Wollaston MP (Conservative, Totnes) Powers The Committee is one of the departmental select committees, the powers of which are set out in House of Commons Standing Orders, principally in SO No 152. These are available on the Internet via www.parliament.uk. Publications The Reports and evidence of the Committee are published by The Stationery Office by Order of the House. All publications of the Committee (including press notices) are on the Internet at www.parliament.uk/healthcom. The Reports of the Committee, the formal minutes relating to that report, oral evidence taken and some or all written evidence are available in printed volume(s). Additional written evidence may be published on the internet only. Committee staff The staff of the Committee are David Lloyd (Clerk), Sara Howe (Second Clerk), David Turner (Committee Specialist), Steve Clarke (Committee Specialist), Frances Allingham (Senior Committee Assistant), and Ronnie Jefferson (Committee Assistant). Contacts All correspondence should be addressed to the Clerk of the Health Committee, House of Commons, 7 Millbank, London SW1P 3JA. The telephone number for general enquiries is 020 7219 5466. The Committee’s email address is [email protected]. 1 Mr Stephen Dorrell was elected as the Chair of the Committee on 9 June 2010, in accordance with Standing Order No. 122B (see House of Commons Votes and Proceedings, 10 June 2010). Annual accountability hearing with the Care Quality Commission 1 Contents Report Page 1 Introduction 3 2 The balance between registration and compliance activity 4 Moving to a registration model 4 The fall in compliance activity 5 Vacancies 7 Changes to the regulations 7 Progress in 2011 8 Budgetary constraints 9 3 The inspection and review process 11 Quality and Risk Profiles (QRPs) 13 Importance of an open culture 16 HealthWatch 18 4 The registration process 19 The operation of the registration system 19 Initial registration 19 Applications to vary registrations 21 5 Provision of information to the public 23 Information on adult social care providers 23 The Excellence Award 24 Conclusions and recommendations 26 Formal Minutes 31 Witnesses 32 List of printed written evidence 32 List of Reports from the Committee during the current Parliament 33 Annual accountability hearing with the Care Quality Commission 3 1 Introduction 1. The Care Quality Commission (CQC) was established under the Health and Social Care Act 2008. It is a non-departmental public body, and the first regulator to cover both health and social care in England. The CQC is responsible for the registration, review and inspection of health and adult social care services and monitors the operation of the Mental Health Act in England.2 The 2008 Act set out the CQC’s objectives as follows: (1) The main objective of the Commission in performing its functions is to protect and promote the health, safety and welfare of people who use health and social care services. (2) The Commission is to perform its functions for the general purpose of encouraging— (a) the improvement of health and social care services, (b) the provision of health and social care services in a way that focuses on the needs and experiences of people who use those services, and (c) the efficient and effective use of resources in the provision of health and social care services.3 2. For the first six months of its existence the CQC shadowed its predecessor organisations (the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission). The CQC took over and merged the responsibilities of those bodies on 1 April 2009. 3. On Thursday 9 September 2010 the Committee held a pre-appointment hearing to assess the proposed appointment of Dame Jo Williams (then a CQC commissioner and acting Chair of the organisation) as permanent Chair.4 The Committee approved the appointment, but our Report raised several points of concern that we expected the CQC to address, including: issues arising from the merger of the three predecessor organisations; the need to provide robust procedures for whistleblowers; and the use by the public of information arising from the registration process. In that Report we signalled our intention to review the work of the CQC on an annual basis, given the breadth of the CQC’s agenda and the vital place it occupies in ensuring standards of care. Dame Jo Williams and Amanda Sherlock, Director of Operations Delivery, consequently appeared before the Committee on 28 June. 2 Further information on the duties of the CQC can be found in the Department of Health’s memorandum to the Committee, Ev 14. 3 Health and Social Care Act 2008, Ch 1, s.3. 4 See Health Committee, Appointment of the Care Quality Commission, HC (2010–12) HC 461. The transcript of the session can be found on the Committee’s website (http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/uc461-ii/uc46102.htm) 4 Annual accountability hearing with the Care Quality Commission 2 The balance between registration and compliance activity 4. A significant proportion of the memoranda we received raised concerns about various aspects of the work of the CQC. The overall impression is one of frustration with the CQC and a lack of confidence in its ability to execute its main functions efficiently. 5. The most striking and concerning aspect of the CQC’s operations over the past year is the decision to divert resources from inspection and review activities towards meeting the demands placed on it by the process of registering providers, to the extent that the number of inspections fell far below usual levels. 6. The Committee concluded that the bias in the work of the CQC away from its core function of inspection and towards the essentially administrative task of registration represented a significant distortion of priorities. Although the evidence presented by the CQC acknowledged this distortion of priorities and argues that corrective action has now been taken, the Committee believes it is important to understand how this misallocation of resources arose, not least in order to reduce the risk of the same thing happening again. 7. The Committee has identified the following factors which contributed to this distortion of priorities: • The CQC was originally established without a sufficiently clear and realistic definition of its priorities and objectives; • The timescale and resource implications of the functions of the CQC, in particular the legal requirement to introduce universal registration of primary and social care providers, were not properly analysed; • The registration process itself 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. Moving to a registration model 8. As well as establishing the CQC, the Health and Social Care Act 2008 also set out a new model for regulation. Under the new model, providers of health and social care would be registered against a set of essential standards of quality and safety. The CQC would then monitor registered providers against compliance with these standards, undertaking inspections in response to indications of risk. On its establishment the CQC was therefore faced with the task of registering the tens of thousands of providers it was due to regulate. 9. The timetable for registration of providers by the CQC was dictated by the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. The registration of different providers was staggered to enable the CQC to ‘work with providers to build capability, so that the registration and ongoing compliance processes are implemented efficiently and Annual accountability hearing with the Care Quality Commission 5 effectively’.5 In the financial year 2009–10 the CQC registered all 378 NHS providers; by April 2011 the CQC was due to have registered 13,000 adult social care and independent health care providers, 8000 dentists and 350 private ambulance services; and by April 2012 the CQC was required to have registered some 8000 providers of primary care, including GP practices, out-of-hours primary care services and NHS walk-in centres. These deadlines were challenging (the British Dental Association told us that the Government had set the CQC ‘an almost impossible task to perform’ in registering its sector6) and were hampered by shortcomings in the registration process itself (see Chapter 4). In consequence the CQC did not complete registration of dentists and private ambulance services by the statutory deadline of April 2011 and it was estimated that only 75% would have been registered by the end of June.7 At the CQC’s request, the Government conducted a consultation into postponing until April 2013 the deadline for registration of GP practices, to give the CQC time to catch up and improve its processes.
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