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13.10.17

NAO: CQC faces challenges if it is to reduce poor care

The CQC must improve its timeliness if it is to continue to improve, the National Audit Office (NAO) has warned.

The NAO found that the CQC does not meet its timeliness targets for some of its regulation activities, including registration and publication of inspection reports.

Whilst most providers and inspectors feel that the Commission’s judgements are fair, stakeholders have expressed concerns about consistency, which the CQC is seeking to address through quality assurance processes and training.

In its report, the NAO said that the Commission has significantly improved how it measures performance, and that it takes action on poor performance.

Where care falls below the expected standards, the report said that the organisation is taking more enforcement action, with 1,910 during 2016-17 - something which the Commission attributes to its increased focus on improving the skills and knowledge of its inspectors.

There is evidence that this influences providers to improve the quality of their services, with those rated ‘inadequate’ or ‘requires improvement’ showing improvement on subsequent inspections.

However, inadequate record keeping means that the CQC cannot be assured that enforcement action is always completed, the NAO warned.

Inspection staff highlighted their concerns about the ability of the current systems to support them in their role.

The organisation had reduced its inspectors vacancy rate to 6% by the end of June this year, and increased its focus on cost saving, reducing its spending by £13m in the last year.

Although the CQC made progress in implementing its new strategy, ‘Shaping the future: CQC’s strategy for 2016 to 2021,’ during 2016-17, the report found that it missed early milestones for rolling out the use of resources assessments and designing the approach to the next phase of inspection.

The NAO cautioned that the Commission’s ambition to base more regulatory activities on intelligence and risk-based information comes with significant challenges, which must be carefully managed if it is to achieve the goal of minimising the risk of poor care.

Amyas Morse, head of the NAO, said: “The Commission has improved as an organisation. Value for money is getting better and the Commission can secure further improvement, if it continues in its current direction of travel.

“Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.”

Responding to the report, Sir David Behan, chief executive of the CQC, said: “I welcome the NAO’s independent review of how well we carry out [our] responsibilities.

“This report recognises the good progress we have made whilst at the same time confirming those areas where we need to continue to improve.”

He praised the CQC staff and board for their commitment and hard work.

Head of policy at NHS Providers, Amber Jabbal, said that timeliness in publishing reports and consistency in how inspections are carried out should be a key focus for the CQC.

She added: “As the CQC moves into its next phase of regulation, it will also need to strengthen its digital capabilities further if it os to meet its ambitions of becoming an intelligence driven regulator.”

Jabbal urged the Commission to be realistic about taking on new responsibilities or expanding its role in order to avoid uncertainty for providers.

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