Care Quality Commission: regulating health and social care Contents

1Current performance

1.On the basis of a Report by the Comptroller and Auditor General, we took evidence from the Care Quality Commission (the Commission) and the Department of Health and Social Care (the Department) on the Commission’s regulation of health and social care.1

2.The Commission is the independent regulator of health and adult social care in England. It is a non-departmental public body accountable to Parliament, sponsored by the Department. The Commission has two main purposes: to make sure health and social care services provide people with safe, effective, compassionate, high-quality care; and to encourage providers to improve the quality of care.2

3.The Commission registers, monitors and inspects providers, and publishes its assessments and provider ratings. It can also take enforcement action when care falls below fundamental standards. The Commission regulates providers across three sectors:

Hospitals—including NHS acute, community and mental health hospitals; ambulance services; and independent sector hospitals;
primary medical services—including GP practices; GP out-of-hours services; dental practices; prison healthcare services; urgent care centres; and independent consulting doctors; and
adult social care services—including nursing homes; residential care homes; domiciliary care services; hospices; and supported living services.3

4.This Committee reported on the Commission in 2012 and again in 2015. In 2012, the Committee raised serious concerns about the Commission’s governance, leadership and culture. In 2015, it found the Commission had made substantial progress since 2012, but there remained issues with: staffing levels; the accuracy and timeliness of inspection reports; its capacity to take on new responsibilities; and how it measures its own performance.4 We recognise that the Commission has continued to improve as an organisation since the previous Committee reported in 2015.5

Publication of inspection reports

5.In December 2015 the Committee recommended that the Commission should ensure it published its reports more quickly after completing its inspections.6 The Commission’s performance has generally improved in both the adult social care and primary medical services sectors since 2015. Compared with a target to publish 90% of reports within 50 days, in quarter one 2017–18 it achieved 83% for adult social care reports and 64% for primary medical services reports. This compares with 67% and 50% respectively during 2015–16.7 The Commission acknowledged that performance in the hospital sector is markedly worse. The Commission aims to publish 90% of hospital reports within 50 days, where the inspection covers fewer than three core services, and 90% within 65 days, where the inspection covers three or more core services. In quarter one 2017–18, it achieved 25% and 38% respectively against these targets.8 The Commission explained that hospitals are complex organisations and this adds to the size and complexity of inspection reports.9

6.Delays in publishing reports means that information is not provided to the public in a timely way. Delays can occur due to: inefficient processes within the Commission; time taken to resolve comments from providers on the factual accuracy of reports; delays because of enforcement actions (for example, because of the need to seek legal advice); and issues with the technology to support report writing.10

7.The Commission set out its plans to improve its performance on hospital reports. It told us that it is: looking to produce shorter reports; learning from areas of good practice within the Commission; and setting out more clearly the role of inspectors and how other staff can support them in writing reports. The Commission stated that it has also streamlined some of its quality assurance processes, although it is conscious that it needs to strike the right balance between improving the timeliness of reports and maintaining quality and consistency.11 The Commission also highlighted that its revised approach to inspecting hospitals will mean smaller inspections, with fewer individual services inspected, and this will also improve the speed with which reports are published.12 The Commission committed to publishing at least 50% of hospital inspection reports within its timeliness targets by 2018–19.13

8.The Commission explained that where there are concerns around safety following an inspection, it writes to the hospital immediately after the inspection setting out the issues and the actions it expects the hospital to take.14 The Commission confirmed that it does not publish these letters as the current regulations do not allow it to make public any enforcement actions it intends to take before taking the action. It said that many hospitals make the letter public by presenting it at the public session of the hospital’s board meeting.15

Regulating GP practices

9.In its comprehensive inspection and rating programme, the Commission has rated nine out of ten GP practices as either good or outstanding. The Commission stated that, while this is a good news story, its inspections had still found poor and unacceptable services which had not been highlighted before.16

10.The Commission’s own provider survey shows that GPs view the Commission’s regulation less favourably than other sectors. For example, in the Commission’s 2017 survey, 42% of primary medical services providers (mostly made up of GP practices) agreed that enforcement action is effective in encouraging compliance, compared to 74% of adult social care providers and 72% of hospitals. In addition, while most adult social care and hospital providers thought that the Commission’s inspections or inspection reports helped them to identify or make improvements, this was only the case for a minority of primary medical services providers.17

11.While the Commission thought these poor survey results were partly due to GPs being regulated by an external independent regulator for the first time, it acknowledged that it needed to improve how it regulates GP practices.18 It is meeting regularly with the Royal College of GPs and the British Medical Association to discuss how to work together to make improvements. The Commission highlighted areas for improvement including: reducing the regulatory burden on GP practices, for example, when registering simple changes to a GP practice partnership; and ensuring that the data it collects and publishes on GP practices is relevant to practices.19

12.The Royal College of GPs submitted written evidence which described the good working relationship between the Royal College and the Commission and was positive about the Commission’s plans to move to a more proportionate regulatory approach. However, it did also state that there remains work to do. For example, the Royal College commissioned a survey of 316 GP practices in 2015 which showed that, whilst 88% of respondents agreed with regulation in principle, 74% felt that changes were needed to the Commission’s current approach.20

1 Report by the Comptroller and Auditor General, Care Quality Commission – regulating health and social care, Session 2017–2019, HC 409, 13 October 2017

2 C&AG’s Report, paras 1.1–1.2

3 C&AG’s Report, paras 1.3–1.4

4 The Committee of Public Accounts, The Care Quality Commission: Regulating the quality and safety of health and adult social care, Seventy-eighth Report of Session 2010–12, HC 1779, 30 March 2012; The Committee of Public Accounts, Care Quality Commission, Twelfth Report of Session 2015–16, HC 501, 11 December 2015

5 Q 32; C&AG’s Report, para 25

6 See Footnote 4

7 C&AG’s Report, para 2.17, figure 3

8 Qq 37–38; C&AG’s Report, para 2.17, figure 3

9 Qq 38, 45

10 C&AG’s Report, para 2.17

11 Q 37

12 Qq 39–40

13 Qq 41–42

14 Q 44

15 Qq 110–111

16 Q 105