MPs warn on "distorted priorities" of care regulator

A recent bias in the Care Quality Commission’s work away from its core function of inspection and towards the administrative task of registration, represented “a significant distortion of priorities”, MPs have said.

The Commons Health Committee said a statutory deadline for the registration of dentists had led directly to a drop of 70% in inspection activity during the second half of 2010/11 compared with the same period the previous year.

MPs said the statutory obligations imposed on the CQC were “unrealistic” and had, through the distortion, resulted in increased risk to patients.

The select committee’s report found that:

• The CQC was established “without sufficiently clear and realistic definition of its priorities and objectives”
• The timescales and resource implications of the functions of the CQC “were not properly analysed”
• The registration process itself “was not properly tested and proven before it was rolled out”
• The CQC “failed to draw the implications of these failures adequately to the attention of ministers, Parliament and the public.”

The MPs said that they welcomed the government's decision to postpone registration of GP practices. The committee recommended that “proper planning, including piloting of the model for registration, should be undertaken before the revised date of April 2013 is confirmed”.

The MPs also stressed the importance of the role of inspectors in assessing the culture in care providers. The committee had previously highlighted the importance of the obligation on healthcare professionals to “raise concerns if they recognize, or ought to have recognized, evidence of failure of professional standards”.

The committee argued that a key objective of CQC inspections should be to ensure that each provider organisation recognises and respects this professional obligation and provides proper security to those professional staff who discharge it effectively.

Stephen Dorrell MP, chairman of the committeee, said: “This is an absolutely key finding. CQC inspectors cannot hope to uncover every failure of care; they can and should, however, focus on the culture of the organization to ensure that professionalism is respected and that the proper systems of reporting and accountability operate effectively.

“We are often asked what assurance can be given to whistleblowers. The best answer is to secure an open culture in which the professional obligation to raise concerns is embedded and respected. That is what CQC inspectors should be looking for – and why their inspection activity is so important to patients."

In its response, the CQC pointed out that the committee had highlighted the major challenges the Commission had faced in merging three existing regulators, setting up a new regulatory model, and registering over 39,000 provider locations – including previously unregulated sectors – “against aggressive Parliamentary deadlines and with a 30% budget reduction”.

The CQC said inspection figures were now rising rapidly again – there were 2,527 inspection reports on NHS and social care providers published in April to June 2011, compared to 886 published in the third quarter of 2010/11.

The watchdog is also in the process of recruiting 100 new inspectors after the government’s recruitment freeze was lifted. It has asked the Department for Health for more funds to boost numbers further and to allow it to conduct unannounced inspections of every hospital and care home once a year from April 2012.

The Commission will also consult on changes to the way it regulates. “These changes will simplify, strengthen and improve the way we inspect providers and how we take action where standards are not being met,” it said.