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The Care Quality Commission (the Commission) is the independent regulator of health and adult social care in England. It was formed in 2009 from the merger of three previous regulators. It currently regulates over 21,000 care providers against 16 essential standards of quality and safety. The Commission plays an absolutely vital role in providing assurance to the public, both by ensuring appropriate quality standards and by deterring poor quality and unsafe care. The Commission takes action where it finds standards are not being met. To date, however, it has failed to fulfil this role effectively.
The Commission has more responsibilities but less money than its predecessors. Despite this it has consistently failed to spend its budget because of delays in filling staff vacancies. It is overseen by the Department of Health (the Department), which underestimated the scale of the task it had set in requiring the Commission to merge three bodies at the same time as taking on an expanded role. The Commission did not act quickly on vital issues such as information from whistleblowers. Neither did it deal with problems effectively, and the Department is only now taking action. We have serious concerns about the Commission's governance, leadership and culture. A Board member, Commission staff, and representatives of the health and adult social care sectors have all been critical of how the Commission is run.
Neither the Commission nor the Department have defined what success would look like in regulating health and adult social care. This makes it hard for us to know whether the Commission has the resources it needs to operate effectively. In addition, while the Commission reports what it does, it does not measure the quality or impact of its work. Where information is available, it is not presented in a way that allows the public to make meaningful comparisons between care providers. As a result, the public are unclear what the Commission's role is and lack confidence that it is an effective regulator.
The Commission faces a major challenge later in 2012 with the registration of 10,000 GP practices. In the past, the Commission's inspection work has suffered when it has had to register large groups of providers. It shifted its focus to registration and carried out far fewer inspections than planned. In the light of these problems, the Commission has changed the registration process. Registration will now be decided primarily on the information provided by the GPs themselves. GP practices will be required to declare whether or not they are meeting the essential standards. This process carries risks and the Commission must make sure the registration process is robust and provides meaningful assurance about the quality of GP practices.
The Commission's inspectors are responsible for large and varied portfolios of providers. Individual inspectors do not have sufficient support to develop the range of expertise and experience needed, and there is a lack of consistency in their judgements and in the Commission's approach to taking enforcement action. Whistleblowers have to be a key source of intelligence in helping the Commission to monitor the quality of care, but the Commission has closed the dedicated whistleblowing line that the Healthcare Commission had used.
The Commission has a long way to go to become an effective regulator. It is not ready to take on the functions of other organisations, such as the Human Fertilisation and Embryology Authority, as the Department has proposed.
On the basis of a report from the Comptroller and Auditor General[1] we took evidence from the Commission and the Department on the Commission's management and governance, and on the Commission's operations to regulate the health and adult social care sectors.
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