The Care Quality Commission faced repeated criticism in 2011 and 2012 over its weak leadership, lack of skills and capacity and failure to intervene quickly and strongly enough in failing services.
The National Audit Office concluded in 2011 that it had not provided value for money and in 2012 the public accounts committee found it was a long way off becoming an effective regulator. The CQC has since attempted to transform the way it regulates health and adult social care services.
We returned to examine the CQC four years after our previous report. We looked at what the CQC had done to redesign how it regulates services, and build the staff skills and capacity it needs.
The regulator had made substantial progress in changing its regulatory model. The biggest changes have been in the way it approaches its monitoring and inspection work.
In addition, the Department of Health and CQC have taken substantial action in response to the criticisms of its leadership. The executive team has changed significantly since we looked at the CQC in 2011, and eight new non-executives have been appointed to the board since July 2012.
Despite this very good progress, the CQC is still halfway up a mountain. The healthcare providers that it regulates remain cautious about how the new approach is going to work in practice. The comments we analysed from the CQC’s survey of providers showed they were sceptical about whether inspectors would be able to apply the new approach consistently, accurately and fairly.
We also found the CQC does not have sufficient staff to carry out its work. The vacancy rate for inspectors was 34% in April 2015. The regulator has postponed its target dates for inspecting all providers, partly as a result of the shortages.
Inspection is an important part of the CQC’s work and if it does not recruit enough staff then patients and the public will be receiving less assurance than they should about the quality and safety of services.
A positive finding was that the CQC was using data more effectively to plan inspections, particularly for acute trusts, but in contrast to hospitals and GPs, the regulator does not have access to information on adult social care that is good enough for it to monitor risks and trigger inspections. We recommended the CQC made better use of information from patients – by developing real-time monitoring of online patient feedback and building better partnerships with organisations such as Age UK.
So despite the good progress, the CQC still has some way to go to demonstrate that it is value for money and effective in practice. Our report did not look at the impact of the CQC’s new approach, as it is too early to conclude on this, so it is likely we will come back to examine this issue in a later report.
Sue Higgins, executive leader, National Audit Office