The Care Quality Commission responds

After a recent raft of criticism the Care Quality Commission says more resources are now being put into a new inspection regime, writes Alan Rosenbach, the watchdog’s special policy lead

The Care Quality Commission has been the subject of a significant level of public and parliamentary scrutiny. We expect that to be the case given that we are the regulator of vital services which at some point affect the welfare of everybody in our society.

CQC has faced an immensely difficult challenge, the size and complexity of which would have tested any organisation to the limit.

We were charged with bringing together the work of three predecessor regulators – with a reduced overall budget – and implementing a brand new regulatory system.

There is a perception that we got our priorities wrong, that we somehow made a misjudgement, in allowing the level of our inspection activity to drop while we concentrated our resources on the new registration process. But in fact, registering all care providers under the provisions of the Health and Social Care Act 2008 was a legislative requirement which had to be achieved within prescribed timescales.

After successfully registering NHS trusts, we tackled what was by far the largest piece of registration – adult social care, with about 12,000 providers. It is this that has had the most significant impact on our work. But though inspection levels dropped as a result, we continued to focus on those providers that had the poorest records.

We have learned valuable lessons and many of the problems are behind us. The numbers of inspections have risen steadily this year, increasing dramatically over the last few months. However, we recognise that we need additional resources if we are to meet the universal demand for a greater frequency of inspection. Crucially, the Department of Health has approved our request for extra funding to increase the number of inspectors we employ so that we can inspect social care services and hospitals at least once every year.

We are delighted about this. It not only gives us the opportunity to deliver a programme of unannounced annual inspections, but also to allocate each of our inspectors a more manageable portfolio and provide the support they need to do their jobs even better.

Combined with our business-as-usual inspections, we are looking forward to carrying out two themed sets of inspections in 2012. There will be a programme of 500 inspections focusing on standards of dignity and nutrition in nursing homes, similar to a programme of hospital inspections that we carried out recently. And we hope to achieve similar results.

Seventy-four per cent of the NHS trusts we visited said subsequently that they had made changes to the way they looked at dignity and nutrition for older patients. And in a survey of the trusts that weren’t inspected, just as many said they were prompted to review or enhance their processes because of our work in this area.

Then we will turn the spotlight on domiciliary care, with a programme of 250 inspections focusing this time on three aspects – respect and involvement, care and welfare, and providers supporting workers to deliver their responsibilities effectively. Domiciliary care is one of the most difficult areas to monitor, and we have carried out a pilot programme involving 30 services to trial different ways of hearing the views of service users and their families.

We believe that we have now started to make a real impact on the quality and safety of care. We are concentrating on developing effective methods of ensuring that care providers comply with essential standards. We are determined to deliver a regulatory model that everyone can have confidence in. And we will continue to focus on what matters most – identifying and tackling poor care, and protecting the welfare of people who use services.

Alan Rosenbach is the special policy lead at the Care Quality Commission