2012 Accountability hearings with Care Quality Commission and Monitor

The House of Commons Health Select Committee published reports of its 2012 accountability hearings with the Care Quality Commission (CQC) and Monitor on 9 January and 5 March 2013 respectively.

The committee highlighted the potential overlap between the CQC and Monitor, suggesting that there could be significant scope for confusion, causing regulatory gaps or duplication.

The committee highlighted concerns about the risk of regulatory standards being compromised, if the government continued in its desire to see all NHS trusts become foundation trusts by April 2014. It highlighted the authorisation process for Mid Staffordshire NHS Foundation Trust and University Hospitals of Morecambe Bay NHS Foundation Trust. In both trusts, serious failings in quality occurred after foundation trust authorisation had been granted by Monitor.

The committee also made some significant criticisms of the CQC.

Background and earlier reviews

On 14 September 2011, the committee had published a highly critical review into the performance of the CQC. It had concluded that the focus on registration and compliance activity had taken the CQC away from its core function of inspection, towards the administrative task of registration, and that this represented a significant distortion of priorities. In the 2011 report, the committee suggested that CQC had been established without clear and realistic priorities and objectives, the time and resources required to introduce universal registration had been underestimated, and the registration process had not been appropriately tested before implementation. The committee also suggested that the information provided by the CQC on adult social care providers was 'unhelpful and often out of date'.

On 23 February 2012, the Department of Health published the report of its performance capability review of the CQC, which suggested that the regulator had faced operational and strategic difficulties in cutting delays to provider registration, as well as shortcomings in compliance activity. The report recognised that both the Department of Health and the CQC had underestimated the scale of CQC's task.

2013 reports

Returning to 2013, regarding the committee’s subsequent criticisms in its reports of its 2012 accountability hearings, Stephen Dorrell, chair of the Health Select Committee, stated that: 'The CQC's primary focus should be to ensure that the public has confidence that its inspections provide an assurance of acceptable standards in care and patient safety. We do not believe that the CQC has yet succeeded in this objective. The CQC needs to ensure that its inspections represent a challenging process which is designed to find service shortcomings where they exist, ensure when appropriate that service providers address them rapidly, and report promptly both to providers and users of the service. The CQC also needs to show that it treats feedback from the public as free intelligence and that it acts swiftly when serious complaints are brought to light this way.'

The committee recommended that, as a matter of urgency, there needed to be an overhaul of the organisation's governance structures and that further clarity was required in relation to the roles and duties of the CQC. The committee also recommended that the responsibility for patient safety should rest with the CQC and not the NHS commissioning board as was intended.

The committee suggested that in relation to social care, the essential standards measured by the CQC did not reflect the experiences of users. For example, there were too many cases of residents receiving unsatisfactory care in residential homes that met the essential standards set out by the CQC. Registration should be a challenging process for providers and not simply a bureaucratic formality.