The Care Quality Commission: Regulating the quality and safety of health and adult social care - Public Accounts Committee Contents

1  The management and governance of the Care Quality Commission

1. The Care Quality Commission (the Commission) is the independent regulator of health and adult social care in England. It is a non-departmental public body, overseen by the Department of Health (the Department). Its objective is to 'protect and promote the health, safety and welfare of people who use health and social care services'.[2] Formed in 2009 by merging the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission, it currently regulates over 21,000 care providers against 16 'essential standards' of quality and safety, through registration, inspection and, where necessary, enforcement action. Tougher enforcement powers were a key element of the Commission's design and the new system brought more providers, including dentists and GPs, within the scope of the regulator.[3]

2. Although the Commission has more responsibilities, its budget for 2010-11 was 6% less than the combined budget of its predecessors for 2008-09.[4] Despite this, the Commission has consistently underspent against its budget. For 2011-12, it is projecting an underspend of £14 million (10%), mainly because of the continuing delays in filling staff vacancies.[5]

3. The Commission focused the staff it did have on registration rather than inspection, and as a result carried out far fewer inspections than planned. The Department clearly underestimated the scale of the task it had set the Commission.[6] The Department told us that it is ultimately responsible for ensuring there is improvement in the Commission's systems and processes, and that where there are problems it is accountable for ensuring these are addressed. The Department's Accounting Officer set out five areas where she would like to see improvements. These were: clarifying the Commission's strategic direction; setting clear priorities, matching resources to them, and understanding what things cost; improving accountability between the Department and the Commission; improving engagement and communication with the public; and developing the regulatory regime to get the right balance between inspection, the 'user voice' and the use of information.[7]

4. We have serious concerns about the leadership, governance and culture of the Commission.[8] In its most recent annual report to Parliament, the Commission reported incorrect information, claiming to have completed twice as many inspections and reviews than was in fact the case. One member of the Commission's Board has been so troubled that she has made public her concerns about how the Commission is being run. She told us that she had still not had adequate opportunity to discuss her concerns with the Department, and that she had been ostracised and vilified since she challenged the Commission's leadership.[9]

5. The Commission has been criticised for being overly concerned with reputation management at the expense of transparency and accountability.[10] Staff leaving the Commission have been made to sign compromise agreements containing confidentiality clauses, tantamount to gagging clauses. This Committee has expressed concern on previous occasions about the use of such clauses. The Department confirmed that confidentiality clauses are not in themselves prohibited, but its guidance makes clear that clauses that seek to prevent the disclosure of information in the public interest should not be allowed. We are concerned, however, that the use of confidentiality clauses makes people reluctant to speak out, even though their whistleblowing rights may be legally protected.[11]

6. The Commission's strategy and focus remain unclear. In particular there is confusion about the extent to which its role goes beyond regulating against the essential minimum standards into wider quality improvement.[12] This was illustrated by the evidence we heard. One witness felt that the Commission should be doing more to drive improvement, while others considered that the Commission's primary role should be to ensure minimum quality and safety standards.[13]

7. The Commission has not defined what successful regulation would look like, even though it has been operating for nearly three years.[14] Currently its performance metrics are quantity-based measures of activity, such as the number of reports produced, with no measures of quality, a position we find astonishing given the Commission's purpose is to regulate quality.[15]

8. The Commission is the third regulator for health and adult social care in the last decade. None of the witnesses we heard from was in favour of further reorganisation, stressing that the existing arrangements need to be made to work better. The Department thought that visible and sustained improvement should be apparent in two years time. [16]

9. The Department has proposed to transfer the functions of the Human Fertilisation and Embryology Authority and the Human Tissue Authority to the Commission in 2015.[17] The Chair of the Human Fertilisation and Embryology Authority (the Authority) argued passionately against this change. The Authority already shares premises and back-office functions with the Commission and has achieved the savings set out in the public spending review. The Chair felt there would be little benefit in merging the Authority's specialist role of regulating IVF services with the wider role of the Commission. Furthermore, a merger would put the standard of regulation at risk and would not provide value for money.[18]

10. The Department congratulated the Authority on the way it had worked with the Commission. In the light of the discussion it had heard at the Committee, the Department said it would have a full consultation before further decisions were made about transferring the functions of the Human Fertilisation and Embryology Authority and the Human Tissue Authority to the Commission. This is a welcome pause.[19]

2   Health and Social Care Act 2008, part one, chapter one, para 3 (1) Back

3   Q 48, C&AG's report para 1.3 & 1.5 Back

4   Q 111 Back

5   Qq 113, 196, Ev 46 Back

6   Q 49 Back

7   Qq 53- 58 Back

8   Qq 52, 118, 165 Back

9   Q 104 Back

10   Qq 22, 35, 40, 56 Back

11   Qq 102-107, Ev 45 Back

12   Q 12 Back

13   Qq 13, 18, 20 Back

14   Qq 143- 149 Back

15   Qq 35, 52 144 Back

16   Qq 32,165, C&AG Report para 1.2 Back

17   Q 5 Back

18   Qq 2-6 Back

19   Q 117 Back

previous page contents next page

© Parliamentary copyright 2012
Prepared 30 March 2012