Appointment of the Chair of the Care Quality Commission - Health Committee Contents


1  Report


Recommendation on appointment

1. On 20 July 2010, the Secretary of State for Health informed the Health Committee that the Government proposed to appoint Dame Jo Williams as Chair of the Care Quality Commission (CQC)[2] and asked the Committee to hold a pre-appointment hearing to consider this proposal. The Committee held the hearing on 9 September 2010 and we are pleased to endorse Dame Jo Williams' candidacy for the post.

Issues relating to the work of the Care Quality Commission

2. In the course of her evidence Dame Jo drew attention to the very challenging agenda faced by the CQC since it formally assumed its duties in April 2009. The tight financial context and the refocusing of CQC responsibilities since proposed by the Government have further contributed to this challenge.[3] We agree with Dame Jo that although the CQC has made encouraging progress in many areas of its agenda, a substantial number of issues remain.

3. A number of these challenges relate to continuing work to consolidate the CQC as a single unified body following the merging of its three predecessor bodies (the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission). As well as that continuing need to work towards successful organisational integration, our questioning identified the following key points:

  • The need to establish a clear understanding of the distinctive roles of the Chair and Board on the one hand, and the Chief Executive and management on the other; and to establish an effective working relationship between the two;
  • The need to develop a common 'CQC culture' across the different historic fields of responsibility;
  • The need to develop clear internal cost and efficiency targets and procedures for reporting performance against these targets to the Board;
  • Practical challenges arising from the merger, such as the consolidation of information technology systems and the development of an integrated management structure.

Dame Jo reported to the Committee that she felt that "we have made some good progress, but we still have work to do".[4] The Committee agrees, and recognises that these objectives need to be achieved against the background of declining real resource.[5] The challenging nature of the reorganisation process and the need to ensure continuity is a specific reason for our support of Dame Jo's candidacy.

4. In addition to the operational agenda within the CQC, our questioning highlighted several areas which we hope Dame Jo will address in her role as Chair of the Commission in order to allow the Commission to make the fullest possible contribution to the delivery of high quality, good value care to patients and service users.

5. We welcome the CQC's progress on registering NHS Trusts and providers of social care in line with the new system introduced by the Health and Social Care Act 2008, but we believe that the data which is collected is not yet being used to its full potential. We hope that Dame Jo will play a leading role in encouraging both commissioners and service providers to use the information generated by the registration process to improve the quality and value of services delivered. We consider it to be particularly important that the information resulting from the registration process is easily accessible to the public and avoids duplicating the work of Monitor, Primary Care Trusts and, in the future, the NHS Commissioning Board and GP commissioners.

6. The evidence provided by Dame Jo led us to conclude that the CQC needs to address five specific areas of concern:

  • It is important that CQC has robust processes which are designed to allow 'whistleblowers' to provide information to the Commission without unnecessarily prejudicing their own position. Dame Jo said in her evidence that "we recognise there's some very real challenges about helping people to speak out". We agree and hope the CQC will address those challenges directly.[6]
  • It is important that 'soft data' is accorded a proper role in assessing the quality of care, particularly in residential social care settings. We strongly support the use of soft data but believe that for it to be truly valuable it must be collected and applied in a rigorous, structured manner rather than on an informal basis.[7]
  • We suggest that the CQC needs to consider the implications of the shortage of doctors to provide second opinions under sections 57 and 58 of the Mental Health Act 1983, which we believe leads to the inappropriate use of section 62 (Urgent Treatment).[8]
  • The Government has proposed the establishment of HealthWatch England as a distinct identity within the CQC. This national organisation is designed, amongst other things, to provide leadership, advice and support to local HealthWatch, advice to the NHS Commissioning Board, Monitor and the Secretary of State and propose CQC investigations of poor services.[9] These are significant responsibilities, and we hope that CQC will work with ministers and established LINk groups to ensure they are discharged effectively.[10]

7. We have a background concern about the quality and accessibility of the information available from the CQC both to the public and to commissioners and providers of care. Dame Jo told us that:

"...one of the most important things that we can contribute is information on our findings that is understandable so that people can use it to make really informed choices…..We are currently consulting on what might be the most appropriate system for the future and anticipate that that will be concluded this year, with the new system probably starting next May."[11]

We welcome this consultation. We will be looking to see what progress is made on these issues when the new system is implemented next year.

8. It is vitally important that the CQC performs effectively and efficiently. The reorganisation of the NHS and the refocusing of the CQC's role will place even greater responsibilities on the CQC at a time when its composition and functions are in flux and its resources are under pressure. Given the breadth of the CQC's agenda and the vital place it occupies in ensuring standards of care, we believe that the CQC's operations should be subject to regular scrutiny by the Committee. We therefore propose to review the work of the CQC on an annual basis, and intend to invite Dame Jo to appear before the Committee again in the summer of 2011.



2   A full CV for Dame Jo Williams is appended to Volume I of this Report. A memorandum from the Department of Health setting out the role of the CQC, its Chair, and the Board, is included in Volume II of this Report. Back

3   See Department of Health, Equity and excellence: Liberating the NHS, July 2010, Cm 7881, and Department of Health, Liberating the NHS: Report of the arm's-length bodies review, July 2010. Back

4   Q1 Back

5   The CQC has an annual budget of £164.4 million compared to the combined budget of £240 million for its predecessor organisations in 2005/06 (CQC annual report 2009-10). Back

6   Q37 Back

7   Qq 18, 35-36 Back

8   Qq 20-24 Back

9   Equity and excellence: Liberating the NHS, July 2010, Cm 7881, p.20. Back

10   Q29 Back

11   Q31 Back


 
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Prepared 15 September 2010