Is the CQC fit for purpose?

There was an interesting article in the Guardian yesterday about the Care Quality Commission which was set up as a new regulatory body for health and social care in 2009.

The CQC is headed by Cynthia Bower at a salary of £195,000 pa who was previously the Chief Executive of the West Midlands Strategic Health Authority – responsible for Stafford Hospital at the time it was found to have been providing substandard care.

How she was able to take post at the CQC is quite staggering to me, as an outsider but there she is, responsible for the regulation of health and adult social care services. You’d think it was the opening of a black comedy. Maybe it is.

There are some chilling facts that the Guardian have uncovered and they deserve repeating – over and over again – because the CQC is responsible for the regulation – not only of hospitals but of every care home and domiciliary care agency in England.

The Guardian lists some of the points it found which I’ll look at one by one

The CQC misled parliament in its annual report, overstating the number of inspections and reviews of the NHS, independent healthcare and adult social care sectors it carried out. Rather than the 15,220 “inspections and reviews” it claimed to have undertaken in the year ending March 2011, it has now admitted to the DoH that the correct figure is 7,368.

Wow, that’s less than half than they told Parliament they were conducting. I wonder if they count an ‘inspection’ as ringing up a care home and asking if everything is ok. I rather suspect it but to have been found to misled not only Parliament but the general public who rely on their inspections – sparse though they are – for protection and safeguarding, it is a massive betrayal of trust.

There has been rising disquiet over the CQC’s “light touch” regulation. Until May 2011, when BBC’s Panorama exposed the scandal of abuse at Winterbourne View, a private hospital for people with learning disabilities, the CQC had launched just one investigation. By contrast, its predecessor, the Healthcare Commission, completed 16 investigations in five years. After the BBC’s story the regulator launched two investigations into NHS hospital trusts.

This indicates the reactionary nature of the CQC and it’s fear of public criticism. See a report that criticises them – rush out and inspect something else to try and put right the damage to the name of the regulatory authority. It shouldn’t be this way because that means we and more importantly those without family or friends to advocate for them are left in poor quality care settings until Panorama shows up.  It isn’t good enough. It is cheaper though and needs fewer staff – something that the CQC has been subject to but they keep repeating that there will be no fall in quality. Hmm. No, there won’t be if they lie and rely on whistleblowers and broadcasters to do their jobs for them.

One of the first acts under Bower’s leadership was to disband the investigations team – because, in the words of the then chair Barbara Young, it was being used to “bayonet the wounded on the battlefield”. The decision caused consternation among NHS bosses, who feared that failing to expose and publicise examples of poor care would encourage complacency.

The investigations team was disbanded because it might not be good for the  morale of failing services. Um. Who is going to investigate? Well, the local authorities have rapidly been disbanding their own monitoring services because  – well – the regulator is there to do it but the regulator clearly isn’t doing anything at all. Just seeing on their respective hands waiting for people to tell them what’s wrong. Hardly a substantial regulatory framework, huh?

Senior CQC staff who disagreed with the board say they felt marginalised and complained of a culture of fear, underlined by the “language of witch hunt”. There has been an exodus of staff who have been gagged to prevent them from speaking about the CQC. In 2009, employees wrote to senior managers complaining about what they saw as a “bullying culture”, following which a senior executive left. The letter warned of the “potential impact of the proposed reduction in inspection frequency for … adult social care services”.

A bullying culture, gagging employees – well, that must be the sign of a healthy organisation, right? Exactly what you want to put your trust in. Having spent a lot of time in and around adult social care services over the years, I feel disheartened, shocked and angered at the lack of care and responsiveness from the CQC to actively involve themselves with maintaining standards. It has been obvious to me as a practitioner that they are overstretched and unable to work in a way that previous incarnations did just because of staffing levels and a lack of expertise in social care settings.

Perhaps in one of the most telling quotes from the article which it says

Heather Wood, who led the inquiry into hundreds of deaths at Stafford hospital, left the CQC last year and had been gagged from speaking out about her time there. However, under subpoena to the Mid Staffs inquiry, Wood warned that under the current regulatory set-up “the investigation [into Stafford hospital] would almost certainly not have taken place”.

So what IS the CQC doing? Where is its expertise? Why is ‘light touch’ inspection allowed?

My own conclusion is that the government, while interested in hospital care settings, wants to wash its hands of the needs of those in residential care settings. They have eminently displayed it by reducing to barely functional the regulation systems. This is not a party political point as it was a procession started under the last government in an attempt to save money and by merging health and social care regulation frameworks it seems that social care again has been sidelined.

But the real reason for increased ‘light touch’ regulation is that it benefits the increasing role of the private sector in health and social care. This allows the sector a freer and less accountable way of delivering what were public services.

So in an answer to my initial question – my answer is no. No, and it hasn’t been for years.

The Guardian print a letter in response to this article today from an inspector who says

The national management of CQC and its predecessors betrayed inspectors and service users by constantly pretending that no matter how far resources were reduced they could still do the job. In other words they were saying what their political masters wanted to hear.

And that is the failing of this new body. It did not advocate for those it sought to serve who rely on the services it regulates. It sought to cover its own back.

I hope the government look not only at putting more money into the system but building more expertise, experience and knowledge into the Care Quality Commission and providing inspectors who know the sectors that they inspect very well rather than having learnt about it in books because if any job needs hands-on experience as a requirement, it is that of an inspector for the CQC.

As for the culture of bullying, that bodes ill. Openness, responsiveness and accountability must be demanded of such an important body.

6 thoughts on “Is the CQC fit for purpose?

  1. They put the head of Stafford Hospital in charge of regulating patient care? Seriously? Why not put the captain of the Herald of Free Enterprise in charge of maritime safety while they’re at it?

  2. CQC are far from fit for purpose. CSCi weren’t a whole lot better, but at least they did actually carry out inspections, without warning and talk to the people being supported or cared for. I personally contacted CQC for advice on reporting a safeguarding concern I had and they just stopped at, “we can’t help you there, as we don’t regulate that particular setup…”. They wouldn’t even offer any advice as to where I should go next. Thankfully the broker is an excellent social worker and handled the situation professionally and correctly, in the end.

    As with many aspects of social care, a real shake up is needed, starting from the top down.

  3. Bowers’ appointment certainly seemed odd. She was unable to manage her own service so is qualified to tell other people how to do it. Or maybe a bit of inspired appointing because having seen how it all goes wrong she is uniquely qualified to spot it happening elsewerhe? I dont know.

    It is a complicated business. Light touch regulation – possibly due to industry pressure has been on the rise since 2000 when fixed staffing levels were abandoned. The star rating system was hated by poor providers because a 0 star Poor rating meant LA’s automatically stopped placements. Now it is gone. Why? It also provided a way for LAs to work out which end of the quality spectrum we were placing in, but now that is much more difficult.

    The Government cannot on the one hand condemn poor care whilst massively cutting in real terms the resources available to pay for care. You get what you pay for in care like everything else, except in the minds of some management consultants. The big consultancy firms are cashing in on LA’s desperation by offering snake oil solutions when the basic problem is obvious – it makes me cross to see consultants paid thousands whilst homes are squeezed dry and tiny efficient voluntary organisations have their grants cut..

    However I am not sure that increasing monitoring always increases quality. You need a certain amount of monitoring of course and regular inspections are in my mind a must, including unannounced. Council monitoring tends to rely too much on paperwork and less on experienced people making a judgement about the care that is happening. I have been told that contract monitoring is a low level activity that would not justify my pay grade ( equivalent to a social work team leader) if my job consisted of that only.

    I do agree about the need for competent inspectors. Prior to the reorganisation in 2010 many inspectors took early retirement. I am told that experience in care was not required for new appointments, as CQC was now about compliance. However I think they might have changed that now having looked at arecent recruitment ad. Ex bankers were amongst those I am told were appointed. Well, I am not a nurse and despite considerable other experience I always feel slightly inadequate when looking at a nursing home – the devil really is in the detail. How would I know if clinical practice was up to date? There is the danger of both missing bad practice and over reacting to small deficiencies.

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  5. Thanks for the comments – sorry about the tardy response. While monitoring doesn’t ensure quality, it is better than no monitoring at all – and yes, absolutely unannounced. My experience is that the council monitoring teams barely exist anymore and have been subject to many cuts.

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