09.01.13
MPs urge clarity on role of CQC in damning report
The Health Select Committee has questioned whether the Care Quality Commission (CQC) should have responsibility for patient safety, following a series of appalling neglect cases.
Its new report says: “The Committee remains concerned that the role and duties of the CQC are not sufficiently clear. Responsibility for patient safety lies at the root of high quality patient care, but is in danger of being obscured by other competing priorities…[we] recommend that the Secretary of State should reconsider whether prime responsibility for patient safety should reside with the CQC.”
The MPs reported on how the CQC failed to communicate the results of its inspections to patients, residents and their families, and stated that this should take place automatically.
The registration process had not been effective in ensuring all essential standards were being met, the report added.
The CQC’s new chief executive David Behan, pictured above, says it is already making changes to the way it works to address these concerns.
But Stephen Dorrell MP, chair of the Health Select Committee, said that public confidence in the CQC was “further undermined” by its failure to address the concerns of whistleblower Kay Sheldon last year in relation to the Mid-Staffs Inquiry.
He said: “It is essential that the CQC reforms its culture and working practices to address these shortcomings.
“The new CQC chair must, as a matter of urgency, overhaul its governance structures to ensure the board sets clear objectives for the organisation, holds the executive effectively to account against these objectives, and regularly assesses its own performance and effectiveness.”
Last year CQC chief executive Cynthia Bower resigned and a strategic review was launched to examine what the organisation’s key objectives should be.
Dorrell added: “It is extraordinary that here we are, five years on, and we are still discussing what its core purpose is.”
The committee also recommended that the CQC should launch a consultation on its methods, and include an assessment of professional culture within a care agency in its inspections.
Dr Peter Carter, chief executive & general secretary of the RCN, welcomed the report and said: “We know that the culture of healthcare organisations cannot be regulated, however, we agree with the report that the CQC can play a vital role in ensuring that organisations support staff in raising concerns without fear of retribution. We look forward to continuing our work with the CQC in this area to make sure staff are fully supported.”
Mike Farrar, NHS Confederation chief executive, said that the new appointments to the CQC were positive steps forward.
“The CQC's new chair and chief executive have brought strong expertise to the organisation, and they have been consulting with those working in the health service alongside patients and the public to take on board their views about how the CQC needs to change.
“The CQC must use the recommendations made by the Health Select Committee – together with what it hears through its consultation exercise and the recommendations due to be made by the Francis report shortly – to drive through the changes needed to give both the public and NHS leaders confidence in its work. It is in everybody's interest to have a strong and respected regulator for health and social care in place.”
CQC’s chief executive David Behan said: “In our strategic review we consulted widely on a clear statement of our purpose and role. We also set out our intentions to improve how we communicate with the public, make better use of information, and work more effectively as an organisation and with others, including those who provide care.
“We also set out our intentions to tailor the way we regulate different types of organisations based on what has the most impact on driving improvement. We will put people’s views at the centre of what we do.
“We have already begun to make some of these changes and will continue this process.
“We have demonstrated through the consultation on the strategy an open and transparent approach. We will ensure that openness and transparency are at the heart of the way we develop. We are focused on protecting and promoting the health, safety and welfare of people who use health and care services.”
(David Behan picture credit: Department of Health)
The Health Committee’s report’s full conclusions and recommendations are copied below:
Management and governance
1. The new Chair must, as a matter of urgency, overhaul the governance structures of the CQC. The Board must provide proper strategic direction to the organisation and hold the Executive effectively to account for their performance against defined objectives. The Chair must ensure that all members of the Board are encouraged to contribute fully to the operation of the Board and that they are always able to enjoy open and free access to the Chair. Board procedures should provide for regular assessments of its own effectiveness and they should also provide a clear process by which a Board Member can express concerns about the performance of the Chair. (Paragraph 14)
Regulatory approach
2. We agree that the CQC's fundamental purpose is to ensure that health and social care providers meet those essential standards which ensure patient safety. The Committee remains concerned that the role and duties of the CQC are not sufficiently clear. Responsibility for patient safety lies at the root of high quality patient care, but is in danger of being obscured by other competing priorities. This is a particular concern given that the Government has abolished the National Patient Safety Agency and absorbed it in to the NHS Commissioning Board. We recommend that the Secretary of State should urgently work with the statutory regulators and commissioners of health and social care in order to simplify and clarify their respective roles. We further recommend that the Secretary of State should reconsider whether prime responsibility for patient safety should reside with the CQC. (Paragraph 19)
Essential standards and raising the bar
3. In relation to social care there is too often a disconnect between the essential standards measured by the CQC and the experiences of residents in social care. In too many cases residential care homes which meet the CQC's essential standards are regarded as unsatisfactory by carers, relatives and residents. In reviewing their regulatory model the CQC must ensure that the 'essential' standards they enforce align with the expectations and experiences of patients, residents and relatives. We look to the new management team to work from the principle of 'first do no harm' and focus on this core issue with a much greater sense of urgency. (Paragraph 22)
4. The first priority for the CQC is to apply its existing standards consistently and effectively. When the CQC is able to command public confidence that it has achieved this objective, the Committee will seek a progress report on this issue and on plans for the progressive raising of these standards in line with public expectation. (Paragraph 24)
Purpose of inspection
5. Commissioners ought to be able to turn to the CQC for evidence of the quality of care provided. The CQC Board and management need to show that they use the resources at their disposal effectively to deliver the necessary assurance to commissioners, patients and their families. The record shows that it has not so far been able to provide such assurance. (Paragraph 27)
6. We welcome the fact that the CQC has undertaken a consultation with its stakeholders about the scope and purpose of the organisation. In view of its unhappy history, we believe that it needs to do more. We believe it should consult with stakeholders about effective means as well as desirable ends. We therefore recommend that before the accountability hearing in 2013 the CQC should undertake an open consultation designed to develop a clearer understanding of effective regulatory method. (Paragraph 28)
7. We recommend that, as part of a general consultation about regulatory method, CQC should consult in particular on how to assess the culture of a care provider - in order to satisfy itself that a healthy open culture prevails amongst professional staff. (Paragraph 31)
Morecambe Bay
8. It is failures such as those witnessed at Morecambe Bay which undermine public confidence in the CQC's essential standards. Registration should be a challenging process for providers and not simply a bureaucratic formality. The CQC must undertake registration with the intention of finding shortcomings where they exist and ensuring that service providers swiftly address their failings. (Paragraph 35)
Cooperation between regulators
9. Without joined up working the regulatory landscape will be burdensome and dysfunctional, but there is also an acute danger that 'when everyone is responsible, no-one is responsible'. There is an urgent requirement to define the role and responsibility of the CQC; within that definition of its role the CQC must operate autonomously of the other health and social care regulators and be accountable to Ministers and Parliament for its actions. (Paragraph 39)
Inconsistency in inspection
10. The Committee welcomes the greater use and availability of clinical expertise to support the work of inspectors. We note, however, that 87% of inspections carried out since this resource became available did not use it. We recommend that the CQC should develop a consistent methodology for their inspectors to follow which would help to regulate when and how clinical experts are allocated to inspection. We also recommend that the CQC should monitor the effect of the deployment of this resource on the quality and consistency of its inspections in order to ensure that its practice evolves in the light of experience. We will examine these issues again at the next accountability hearing and seek a progress report on the balance between generic and specialist inspection. (Paragraph 44)
Allocation of resource
11. We recommend that the Executive Management of CQC should be tasked to ensure that its inspection planning includes sufficient resilience to be able to accommodate unexpected peaks of work, whether they result from the requests of Ministers or from other causes. (Paragraph 47)
Online publication and media reporting
12. We recommend that the CQC should develop clearer guidelines for communicating the results of its inspections to interested parties. When inspections are complete, patients, operators, residents and relatives are all entitled to effective access of the results, both positive and negative which is prompt, accurate and complete. (Paragraph 53)
Supporting whistleblowers
13. While it is essential that proper procedures are established to support whistleblowers who report cases to the CQC, in most circumstances it will be important for staff in the first instance to raise issues through accessible procedures at their place of work. We have noted earlier in this report the importance which CQC inspectors should attach to making an assessment of the professional culture of organisations which provide health and social care. A key element of this assessment should be a judgement about the ability of professional staff within the organisation to raise concerns about patient care and safety issues without concern about the personal implications for the staff member concerned. An organisation which does not operate on this principle does not provide the context in which care staff can work in a manner which is consistent with their professional obligations. It should therefore be refused registration by the CQC. (Paragraph 58)
Managing complaints from the public
14. If the CQC is to genuinely treat feedback from the public as free intelligence then it must show that it can act swiftly on intelligence when serious complaints are made. (Paragraph 60)
(Contains Parliamentary information licensed under the Open Parliament Licence v1.0.)
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