The Care Quality Commission (CQC) in England: End of Term Report Card

By John Tingle

In terms of NHS health quality and patient safety regulation, the Care Quality Commission (CQC) occupies a pivotal role as the independent regulator of health and social care in England. How well it performs its function is fundamental to the health of the nation. The CQC functions and operations has been recently put under the microscope by the National Audit Office (NAO).The NAO scrutinises public spending for Parliament, making sure it is well spent. Both good and bad findings are made on the work of the CQC in the report and a number of recommendations are made.

On reading the report it’s fair to say that overall the CQC is doing a good job but there are deficiencies identified which need to be remedied. The report is divided into four parts:

Part One, The Care Quality Commission, Part Two, Ensuring high quality care and encouraging improvement, Part Three, Using resources and measuring performance,  and Part Four, Developments in the Commission’s regulatory approach.

On the plus side in the report, the CQC has completed its inspection and rating programme comprising more than 28,000 health and social care provider locations. This provides for the first time in England a baseline assessment of the quality of service. On the negative side a number of operational issues relating to speed and burden of CQC registration of providers persist. The CQC did not meet its key performance indicator to complete the registration process for 90% of cases within 50 days during 2016-17. The CQC systems for bringing information together on the quality of services are not supporting inspectors effectively.

Consistency of CQC judgements by inspectors is another problem. On the plus side again the CQC is being more robust when it comes to taking enforcement action against providers who fail to maintain fundamental standards. Enforcement actions by the CQC increased over 2015-16 and 2016-2017.There is however a problem of record keeping by inspectors in noting about the conclusion of enforcement actions and what happened.

Does the CQC’s work improve care quality?

The report found that there is evidence that suggests that the CQC is influencing providers to improve the services that they offer. Most of the providers rated either ‘inadequate’ or ‘requires improvement’ improved their CQC rating on re-inspection. Interestingly, the ratings by General Medical Practitioners (GP’s) for CQC influence on helping them improve is markedly lower than most hospitals and adult social care providers. NAO recommendations include:

  • Ensuring that digital systems effectively support inspection staff by bringing information together and helping to identify emerging risks to people’s care.
  • Assessing how inspection staff engage with other local stakeholders and share information. The results should be used to develop approaches that will support staff in improving local engagement and maximise local intelligence.
  • Reviewing the activities, it currently uses to test and demonstrate consistency in inspection approaches and judgements

The CQC is on an upward trajectory of improvement, it has improved as an organisation. It has completed its inspection and rating and we now have a national benchmark of the quality of health and social care services for the first time. On the negative side a number of matters require attention including the timeliness of some of its regulatory activities.

John Tingle

John Tingle is a regular contributor to the Bill of Health blog. I am a Lecturer in Law, Birmingham Law School, University of Birmingham, UK; and a Visiting Professor of Law, Loyola University Chicago, School of Law. I was a Visiting Scholar at Harvard Law School in November 2018 and formerly Associate Professor at Nottingham Law School, Nottingham Trent University in the UK. I have a fortnightly magazine column in the British Journal of Nursing where I focus on patient safety and the legal aspects of nursing and medicine. I have published over 500 articles and a number of leading texts in patient safety and nursing law. My current research interests are in global patient safety, policy and practice, particularly in African health care systems. My most recent publication is: "Global Patient-Safety Law Policy and Practice," edited by John Tingle, Clayton O'Neill, and Morgan Shimwell, Routledge 2018.

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