What is wrong with the Care Quality Commission?

The Care Quality Commission is in a bad state, argues Terry Philpot, but it hasn’t been given many tools to work with

The Equality and Human Rights Commission’s damning report on home care services confirms for many of its critics that the industry’s regulator, the Care Quality Commission (CQC), has again been caught on the back foot.

The CQC’s less than two-and-a-half year history has not been a happy one. Cynthia Bower, its chief executive, was appointed on a salary of £195,000 a year despite her heading up the West Midlands strategic health authority, which had oversight of Stafford hospital, where a long history of poor care caused hundreds of patients to die between 2005 and 2008. The report of a public inquiry report is due in the new year.

Seven months into its life, the CQC lost its chair, Baroness Young, who resigned in December 2009 after inspectors were sent into Basildon hospital, where dozens of patients had died through inadequate care. Just a month before, the CQC had ranked the hospital as “good”.

When the Winterbourne View scandal erupted last May, her successor, Dame Jo Williams, chose to stay at her well-remunerated post. The appalling abuse at the specialist unit in Bristol for people with a learning disability was exposed not by the CQC but by BBC Panorama. The CQC later admitted to ignoring a whistleblower. Likewise, it was Age UK, not the commission, which reported on the “grossly inadequate” social care of older people in May.

The CQC’s now infamous switch to “light touch” inspection gave others leeway to dig where the inspectors were not allowed to go. Ironically however, when CQC did undertake on-the-spot inspections in May, it found that three out of 12 hospitals in England failed to meet basic but legally enforceable standards about privacy and proper feeding of older patients.

CQC is not known for listening to others. Users of adult social care services and their relatives do not want a light touch. When CQC began, many stakeholders warned it against re-registering all adult social care providers; the sheer task coupled with incompatible IT systems led to a wasted year. It was also urged not to replace the star system to indicate quality – which had become known and trusted – with a new excellence kitemark from a variety of outside assessors, which it has now dropped.

In its annual report the commission misled parliament by stating the number of inspections and reviews it carried out in the year ending March 2011 was 15,220. It has now admitted that there were 7,368.

Senior staff have complained of a culture of fear, even going so far as talking of “witch hunts” when they have disagreed with their employer. In its first year, junior staff complained about a “bullying culture”. Last year, according to the CQC’s own staff survey, only 16% of staff believed that the commission was well managed – 8% felt it was – while only 14% had confidence in executive board decisions.

The CQC was an unhappy creation. A merger of the Commission for Social Care Inspection, the Health Commission, and the Mental Health Act Commission, its budget is a third less than the total budget of its predecessors and it has a third less staff. It had to reconcile three different management systems and three very different managerial cultures. To add to its burdens, dentists and GPs are now to be brought under its oversight.

But, when, in September, the Commons health select committee concluded that the commission’s brief was unclear and its objectives unreasonable, it also said that it had failed to raise its own concerns with ministers, parliament and the public. The committee was frustrated and had “a lack of confidence in its ability to execute its main functions efficiently”. However, it noted but did not support CQC’s request for a 10% funding increase.

The CQC has inherited, at least as social care is concerned, an erratic history. A decade ago, arms-length inspection by local authorities was abolished in favour of the independent National Care Standards Commission. This had been in existence for 17 days when its abolition was announced. A year after the CSCI, its successor, started work, it, too, was told that its time was up.

An across-the-board regulator sits well with the trend to try and integrate health and social care. Although health secretary Andrew Lansley is less supportive, Paul Burstow, the social care minister, has said that he knows the sector does not want another reorganisation, with attendant costs and distraction from government reforms. If his patience runs out, there is still time to start all over again with an amendment to the NHS bill.