Care Quality Commission

History

Until 31 March 2009, regulation of health and adult social care in England was carried out by the Healthcare Commission and the Commission for Social Care Inspection. The Mental Health Act Commission had monitoring functions with regard to the operation of the Mental Health Act 1983.

The commission was established as a single, integrated regulator for England's health and adult social care services by the Health and Social Care Act 2008 to replace these three bodies. The Commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.

Board

Chief inspectors

The Commission has three chief inspectors who are also board members:

Non-executive

Previous board members

Previous board members have included:

Operations

In October 2014 Field announced that the Commission was going to begin inspecting health systems across whole geographical areas from 2015, including social care and NHS 111. There are suggestions that it could inspect clinical commissioning groups.

Behan admitted in March 2015 that the Commission would not be able to inspect all acute trusts before the end of 2015 as it had intended. In February 2015 it reported that it was missing its targets for following up on the safeguarding information it received that might indicate that patients are at risk. He also said the CQC would update its oversight in line with the growth of new provider models and would begin looking at care quality along pathways to a greater degree and, for the first time, across localities.

In December 2015 the Public Accounts Committee (PAC) was critical of the regulator, and said that it was "behind where it should be, six years after it was established”. Meg Hillier MP, the chair of the PAC, noted that reports prepared by the CQC contained many errors; one foundation trust said that their staff had found more than 200 errors in a draft CQC report. Hillier said "The fact these errors were picked up offers some reassurance, but this is clearly unacceptable from a public body in which taxpayers are placing their trust.”

In July 2016 the commission issued an apology after admitting that up to 500 Disclosure and Barring Service (DBS) certificates submitted by applicants to become registered managers and providers had been lost during a planned office refurbishment; a locked filing cabinet had been incorrectly marked up to be taken away and destroyed.

Basildon and Thurrock University Hospitals NHS Foundation Trust

In November 2009 Barbara Young, then the CQC chair, resigned from the commission when a report detailing poor standards at Basildon and Thurrock University Hospitals NHS Foundation Trust was leaked to the media. The report found that "hundreds of people had died needlessly due to appalling standards of care." One month earlier the commission had rated the quality of care at the hospital as "good."

Grant Thornton report

In August 2012 chief executive David Behan commissioned a report by management consultants Grant Thornton. The report examined the CQC's response to complaints about baby and maternal deaths and injuries at Furness General Hospital in Barrow-in-Furness, Cumbria and was instigated by a complaint from a member of the public and "an allegation of a "cover-up" submitted by a whistleblower at CQC." It was published on 19 June 2013.

Among the findings, the CQC was "accused of quashing an internal review that uncovered weaknesses in its processes" and had allegedly "deleted the review of their failure to act on concerns about University Hospitals of Morecambe Bay NHS Trust." One CQC employee claimed that he was instructed by a senior manager "to destroy his review because it would expose the regulator to public criticism." The report concluded: "We think that the information contained in the [deleted] report was sufficiently important that the deliberate failure to provide it could properly be characterised as a 'cover-up'." David Prior, who joined the commission as chairman in January 2013, responded that the organisation's previous management had been "totally dysfunctional" and admitted that the organisation was "not fit for purpose."

On 20 June 2013, Behan and Prior agreed to release the names of previously redacted senior managers within the Grant Thornton report, who it is alleged had suppressed the internal CQC report. The people named were former CQC Chief Executive Cynthia Bower, deputy CEO Jill Finney and media manager Anna Jefferson. All were reportedly present at a meeting where deletion of a critical report was allegedly discussed. Bower and Jefferson immediately denied being involved in a cover-up. The Guardian newspaper reported on 19 June 2013 that Tim Farron MP had written to the Metropolitan Police asking them to investigate the alleged cover-up.

Following an investigation, CQC found that Jefferson had not been party to any alleged 'delete' instruction. Jefferson was cleared of any wrong-doing and CQC apologised for the distress caused by the allegation.

Finney subsequently started litigation seeking at least £1.3 million libel damages from the CQC on the basis that the CQC’s current chair David Prior and chief executive David Behan abused their power and acted maliciously in publishing allegations that she ordered a “cover-up” of its failings. The Grant Thornton report said it was “more likely than not” that Ms Finney had ordered the deletion of an internal report by Louise Dineley, the CQC’s head of regulatory risk. The CQC started litigation against Grant Thornton claiming a contribution towards any “damages, interests and/or costs” incurred in the case.

Social care

Residential establishments, unlike hospitals, can easily be closed, or sold, and reopened with a new identity. Private Eye reported in November 2015 that most of the 34 homes closed under Cynthia Bower after failing their inspection later reopened with a new name or under new ownership, but with similar problems. Compassion in Care told the magazine that if a home changed name or ownership it was then listed by the CQC as "new services" and "uninspected" by the CQC, and there was no link to reports on the same establishment under different ownership, even if the new owners were linked to the previous owners, and there was no follow up inspection if problems had been identified. They had found 152 homes reregistered as new, when they had only changed owner or name. The Commission had identified safety concerns in more than 40% of the homes it had inspected, and 10% were rated as inadequate.

In April 2016 it was reported that 44% of care homes in the South East inspected over an 18 month period were rated as inadequate or requiring improvement. Only 0.9% of the 1200 homes inspected were rated as outstanding.

Winterbourne View

Winterbourne View was a private hospital at Hambrook, South Gloucestershire, owned and operated by Castlebeck. It was exposed in a Panorama investigation into physical and psychological abuse suffered by people with learning disabilities and challenging behaviour, first broadcast in 2011. One senior nurse had reported his concerns directly to CQC, but his complaint was not taken up. The public funded hospital was shut down as a result of the abuse that took place. Cynthia Bower, then the chief executive of the commission, resigned ahead of a critical government report in which Winterbourne View was cited.

Ash Court

Ash Court is a residential nursing home for the elderly in London, operated by Forest Healthcare. In April 2012 hidden camera footage was broadcast in a BBC Panorama exposé which showed an elderly woman being physically assaulted at Ash Court by a male carer and mistreated by four others. The standard of care at the nursing home had been rated "excellent." The victim was an 81-year-old woman suffering Alzheimer's disease and severe arthritis. Although the commission's primary function is to enforce national standards including safeguarding the vulnerable and "enabling them to live free from harm, abuse and neglect" the CQC responded by stating that they "should not be criticised for failing to protect people from harm" and could not be expected to spot abuse "which often takes place behind closed doors."

Primary care

In January 2015 the Commission for the first time took action in respect of primary care. Three GP practices were put into special measures after unsatisfactory inspection results: Priory Avenue Surgery in Reading, Berkshire; Dr Michael Florin’s surgery in Sale, Greater Manchester; and Dr Srinivas Dharmana’s family and general practice in Walton, Liverpool.

Priory Avenue Surgery was taken out of the special measures category later in 2015; it was rated "good" for being caring and "requires improvement" for being safe, effective, responsive and well led.

Staffing

In a report to the audit committee revealed by the Health Service Journal in July 2014 it was reported that the Commission had employed 134 applicants in 2012 who “failed some or all of its recruitment activities”. Of that group 121 were still in post. The report said: “This in essence implies that our regulatory judgments may be impaired as we have not always appointed staff with the core competencies required to do the job properly, and they may not have received appropriate training to bring them up to the standard required.” In the same month the chief executive David Behan said that recruiting extra inspectors was taking longer than expected due to the "high standards" set for new recruits. As a result some teams were operating at 50% capacity. In response to this situation the number of inspections scheduled for the second half of 2014 was scaled back.

A report of the CQC board in December 2014 showed the organisation had 852 full-time equivalent inspectors in post but a target of 1,411 by December 2015 - the number needed to “discharge the commitments that we’ve made in our business plan”.

Funding

The budget for 2015/6 was £249 million, but is to be reduced to £236 million for 2016/7. It had a budget of £1.1 million for “travel and subsistence” for hospital inspections in 2014-15, but actually spent £4.4 million. In response to a Freedom of information request in November 2015 it was stated that CQC have a database support contract with Computacenter which costs approximately £700,000 per annum; the contract expires in September 2016 with the option of a 1 year extension.

Substantial increases are expected in future years as it moves to a full cost recovery basis. NHS Providers described the decision to increase fees as "regrettable". For 2016/7 fees will increase by 75% as its government funding is reduced by 25%. The increase in fee levels has been criticised by the Registered Nursing Home association (RNHA), Care England and the Voluntary Organisations Disability Group (VODG).

Fees relate to the size and type of organisation and have been increased on a yearly basis:

Related issues