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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