Care Quality Commission
The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health of the United Kingdom. It was established in 2009 to regulate and inspect health and social care services in England.
|Type||Non-departmental public body|
|Headquarters||151 Buckingham Palace Road
Chief Inspector of Hospitals
|Prof Sir Mike Richards|
Chief Inspector of Adult Social Care
|Chief Inspector of Primary Care: Prof Steve Field|
|£166m gross expenditure (2012/13)|
|2,147 whole time equivalents (2012/13)|
It was formed from three predecessor organisations:
- the Healthcare Commission
- the Commission for Social Care Inspection (CSCI)
- the Mental Health Act Commission (MHAC)
The CQC's stated role is to make sure that hospitals, care homes, dental and general practices and other care services in England provide people with safe, effective and high-quality care, and to encourage them to improve. It carries out this role through checks it carries out during the registration process all new care services must complete, inspections and monitoring of a range of data sources that can indicate problems with services.
Part of the commission's remit is protecting the interests of people whose rights have been restricted under the Mental Health Act.
Until 31 March 2009, regulation of health and adult social care in England was carried out by the Healthcare Commission and the Commission for Social Care Inspection. The Mental Health Act Commission had monitoring functions with regard to the operation of the Mental Health Act 1983.
The commission was established as a single, integrated regulator for England's health and adult social care services by the Health and Social Care Act 2008 to replace these three bodies. The Commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.
- Chair: Peter Wyman, formerly chair of Yeovil District Hospital NHS Foundation Trust
- Chief executive: David Behan, formerly Director General of Social Care, Local Government and Care Partnerships at the Department of Health, the President of the Association of Directors of Social Services, and Chief Inspector of the Commission for Social Care Inspection.
- Dr Malte Gerhold, Interim Executive Director of Strategy and Intelligence
- Eileen Milner, Executive Director of Customer and Corporate Services
The Commission has three chief inspectors who are also board members:
- Sir Mike Richards: chief inspector of hospitals
- Andrea Sutcliffe: chief inspector for social care
- Dr Steve Field: chief inspector of general practice
- Louis Appleby, National Clinical Director for offender health, formerly the National Director for mental health. Appointed 3 June 2013.
- Paul Corrigan, former health policy advisor to Tony Blair and former special advisor to Alan Milburn and John Reid. Appointed 3 June 2013.
- Jennifer Dixon, chief executive of the Nuffield Trust and past board member of the Healthcare Commission. Appointed 3 June 2013.
- Robert Francis QC Appointed 4 June 2014.
- Michael Mire, a senior partner at McKinsey & Company. Appointed 3 June 2013.
- Jane Mordue, interim chair of Healthwatch England, former deputy chair of Citizens Advice
- Paul Rew Appointed 4 June 2014.
Previous board membersEdit
Previous board members have included:
In August 2013 the CQC stated that it was finding it difficult to meet their inspection target of GP practices and had therefore drafted in 'bank' inspectors and authorised staff overtime to deal with the backlog.
In October 2014 Field announced that the Commission was going to begin inspecting health systems across whole geographical areas from 2015, including social care and NHS 111. There are suggestions that it could inspect clinical commissioning groups.
Behan admitted in March 2015 that the Commission would not be able to inspect all acute trusts before the end of 2015 as it had intended. In February 2015 it reported that it was missing its targets for following up on the safeguarding information it received that might indicate that patients are at risk. He also said the CQC would update its oversight in line with the growth of new provider models and would begin looking at care quality along pathways to a greater degree and, for the first time, across localities.
The organisation failed to meet its inspection targets during the second quarter of 2015-16. 70% of adult social care inspections had been undertaken and 61% of primary medical services. An exception to this was inspections of hospital acute services where targets were slightly exceeded, an additional 2 inspections having been made in this sector.
In December 2015 the Public Accounts Committee (PAC) was critical of the regulator, and said that it was "behind where it should be, six years after it was established”. Meg Hillier MP, the chair of the PAC, noted that reports prepared by the CQC contained many errors; one foundation trust said that their staff had found more than 200 errors in a draft CQC report. Hillier said "The fact these errors were picked up offers some reassurance, but this is clearly unacceptable from a public body in which taxpayers are placing their trust.”
In July 2016 the commission issued an apology after admitting that up to 500 Disclosure and Barring Service (DBS) certificates submitted by applicants to become registered managers and providers had been lost during a planned office refurbishment; a locked filing cabinet had been incorrectly marked up to be taken away and destroyed.
In the period of August 2016 to January 2017 the CQC sent questionnaires to inpatients of NHS hospitals who had been service users in the month of July 2016. 77,850 surveys were sent out.
In October 2016 a briefing paper issued by the organisation stated that no directorate was meeting objectives for producing reports on time. Of services which had been inspected over half had not improved their rating when re-inspected, with 45% staying at the same rating and 10% having a lower rating.
Following the cyber attacks on NHS systems in May 2017 it was announced that the CQC will be asking probing questions to assess data security as part of its inspection process.
After the Grenfell Tower fire in June 2017 letters were sent to around 17,000 care homes, hospitals and hospices requesting that they review fire safety processes, paying particular attention to the sarety of service users who were more vulnerable due to mobility issues or learning disabilities.
Basildon and Thurrock University Hospitals NHS Foundation TrustEdit
In November 2009 Barbara Young, then the CQC chair, resigned from the commission when a report detailing poor standards at Basildon and Thurrock University Hospitals NHS Foundation Trust was leaked to the media. The report found that "hundreds of people had died needlessly due to appalling standards of care." One month earlier the commission had rated the quality of care at the hospital as "good."
Grant Thornton reportEdit
In August 2012 chief executive David Behan commissioned a report by management consultants Grant Thornton. The report examined the CQC's response to complaints about baby and maternal deaths and injuries at Furness General Hospital in Barrow-in-Furness, Cumbria and was instigated by a complaint from a member of the public and "an allegation of a "cover-up" submitted by a whistleblower at CQC." It was published on 19 June 2013.
Among the findings, the CQC was "accused of quashing an internal review that uncovered weaknesses in its processes" and had allegedly "deleted the review of their failure to act on concerns about University Hospitals of Morecambe Bay NHS Trust." One CQC employee claimed that he was instructed by a senior manager "to destroy his review because it would expose the regulator to public criticism." The report concluded: "We think that the information contained in the [deleted] report was sufficiently important that the deliberate failure to provide it could properly be characterised as a 'cover-up'." David Prior, who joined the commission as chairman in January 2013, responded that the organisation's previous management had been "totally dysfunctional" and admitted that the organisation was "not fit for purpose."
On 20 June 2013, Behan and Prior agreed to release the names of previously redacted senior managers within the Grant Thornton report, who it is alleged had suppressed the internal CQC report. The people named were former CQC Chief Executive Cynthia Bower, deputy CEO Jill Finney and media manager Anna Jefferson. All were reportedly present at a meeting where deletion of a critical report was allegedly discussed. Bower and Jefferson immediately denied being involved in a cover-up. The Guardian newspaper reported on 19 June 2013 that Tim Farron MP had written to the Metropolitan Police asking them to investigate the alleged cover-up.
Following an investigation, CQC found that Jefferson had not been party to any alleged 'delete' instruction. Jefferson was cleared of any wrong-doing and CQC apologised for the distress caused by the allegation.
Finney subsequently started litigation seeking at least £1.3 million libel damages from the CQC on the basis that the CQC’s current chair David Prior and chief executive David Behan abused their power and acted maliciously in publishing allegations that she ordered a “cover-up” of its failings. The Grant Thornton report said it was “more likely than not” that Ms Finney had ordered the deletion of an internal report by Louise Dineley, the CQC’s head of regulatory risk. The CQC started litigation against Grant Thornton claiming a contribution towards any “damages, interests and/or costs” incurred in the case.
Residential establishments, unlike hospitals, can easily be closed, or sold, and reopened with a new identity. Private Eye reported in November 2015 that most of the 34 homes closed under Cynthia Bower after failing their inspection later reopened with a new name or under new ownership, but with similar problems. Compassion in Care told the magazine that if a home changed name or ownership it was then listed by the CQC as "new services" and "uninspected" by the CQC, and there was no link to reports on the same establishment under different ownership, even if the new owners were linked to the previous owners, and there was no follow up inspection if problems had been identified. They had found 152 homes reregistered as new, when they had only changed owner or name. The Commission had identified safety concerns in more than 40% of the homes it had inspected, and 10% were rated as inadequate.
In April 2016 it was reported that 44% of care homes in the South East inspected over an 18 month period were rated as inadequate or requiring improvement. Only 0.9% of the 1200 homes inspected were rated as outstanding.
In September 2016 the CQC said that 40% of nursing homes in the country were rated as "requiring improvement" or "inadequate".
It is a legal requirement for homes to clearly display their CQC ratings on their websites but a July 2017 survey carried out by Which? found that 27% of care homes surveyed either completely failed to display them or placed them where they were very difficult to find.
Winterbourne View was a private hospital at Hambrook, South Gloucestershire, owned and operated by Castlebeck. It was exposed in a Panorama investigation into physical and psychological abuse suffered by people with learning disabilities and challenging behaviour, first broadcast in 2011. One senior nurse had reported his concerns directly to CQC, but his complaint was not taken up. The public funded hospital was shut down as a result of the abuse that took place. Cynthia Bower, then the chief executive of the commission, resigned ahead of a critical government report in which Winterbourne View was cited.
Ash Court is a residential nursing home for the elderly in London, operated by Forest Healthcare. In April 2012 hidden camera footage was broadcast in a BBC Panorama exposé which showed an elderly woman being physically assaulted at Ash Court by a male carer and mistreated by four others. The standard of care at the nursing home had been rated "excellent." The victim was an 81-year-old woman suffering Alzheimer's disease and severe arthritis. Although the commission's primary function is to enforce national standards including safeguarding the vulnerable and "enabling them to live free from harm, abuse and neglect" the CQC responded by stating that they "should not be criticised for failing to protect people from harm" and could not be expected to spot abuse "which often takes place behind closed doors."
In January 2015 the Commission for the first time took action in respect of primary care. Three GP practices were put into special measures after unsatisfactory inspection results: Priory Avenue Surgery in Reading, Berkshire; Dr Michael Florin’s surgery in Sale, Greater Manchester; and Dr Srinivas Dharmana’s family and general practice in Walton, Liverpool.
Priory Avenue Surgery was taken out of the special measures category later in 2015; it was rated "good" for being caring and "requires improvement" for being safe, effective, responsive and well led.
The CQC considered cancelling the registration of Dharmana’s Family and General Practice, which would have forced it to close. This did not come about as Dr Dharmana voluntarily closed the service in December 2015.
In October 2016 the CQC's annual report stated that around 800,000 patients were registered with a GP practice assessed as inadequate on safety grounds by their inspectors.
By February 2017 the CQC had completed inspections of all GP practices which were registered before 1 October 2014. This amounted to more than 8,000 inspections.
In a report to the audit committee revealed by the Health Service Journal in July 2014 it was reported that the Commission had employed 134 applicants in 2012 who “failed some or all of its recruitment activities”. Of that group 121 were still in post. The report said: “This in essence implies that our regulatory judgments may be impaired as we have not always appointed staff with the core competencies required to do the job properly, and they may not have received appropriate training to bring them up to the standard required.” In the same month the chief executive David Behan said that recruiting extra inspectors was taking longer than expected due to the "high standards" set for new recruits. As a result some teams were operating at 50% capacity. In response to this situation the number of inspections scheduled for the second half of 2014 was scaled back.
A report of the CQC board in December 2014 showed the organisation had 852 full-time equivalent inspectors in post but a target of 1,411 by December 2015 - the number needed to “discharge the commitments that we’ve made in our business plan”.
The budget for 2015/6 was £249 million, but is to be reduced to £236 million for 2016/7. It is anticipated that by 2019/20 the budget will be £217 million. It had a budget of £1.1 million for “travel and subsistence” for hospital inspections in 2014-15, but actually spent £4.4 million. In response to a Freedom of information request in November 2015 it was stated that CQC have a database support contract with Computacenter which costs approximately £700,000 per annum; the contract expires in September 2016 with the option of a 1 year extension.
Substantial increases are expected in future years as it moves to a full cost recovery basis. NHS Providers described the decision to increase fees as "regrettable". For 2016/7 fees will increase by 75% as its government funding is reduced by 25%. The increase in fee levels has been criticised by the Registered Nursing Home association (RNHA), Care England and the Voluntary Organisations Disability Group (VODG).
Fees relate to the size and type of organisation and have been increased on a yearly basis:
|Year||GP Practice on one site with 5,000-10000 patients||NHS Trust, with turnover between £125 million and £225 million||Care Home 26-30 residents|
- "Our annual report for 2012/13". Care Quality Commission. 11 July 2013. Archived from the original on 14 July 2013. Retrieved 20 July 2013.
- "Office of Public Sector Information - Health and Social Care Act 2008". Opsi.gov.uk. 2011-05-27. Retrieved 2013-06-24.
- "Office of Public Sector Information - Health and Social Care Act 2008 (pdf)" (PDF). Retrieved 2013-06-24.
- "Care Quality Commission" (Press release). Department of Health. 2007-11-16. Retrieved 2008-09-16.
- "Peter Wyman CBE – our new Chair". Retrieved 22 March 2016.
- "David Behan announced as the new Chief Executive of CQC". Care Quality Commission. 8 June 2012. Archived from the original on 21 June 2013. Retrieved 21 June 2013.
- "Archived copy". Archived from the original on 9 May 2016. Retrieved 2016-04-30.
- "Steve Field appointed as chief inspector of general practice". Health Service Journal. 28 August 2013. Retrieved 27 October 2014.
- "Manchester expert appointed to Care Quality Commission". The University of Manchester. 12 June 2013. Retrieved 21 June 2013.
- "Care Quality Commission appoints new board members". Care Quality Commission. 3 June 2013. Archived from the original on 18 November 2013. Retrieved 21 June 2013.
- "Archived copy". Archived from the original on 31 May 2016. Retrieved 2016-05-19.
- CQC website CQC welcomes new Board members
- "CQC to inspect whole health systems". Health Service Journal. 6 October 2014. Retrieved 27 October 2014.
- "CQC to assess whole health systems". Health Service Journal. 11 August 2015. Retrieved 5 October 2015.
- "CQC will miss own inspection deadlines, regulator admits". Health Service Journal. 25 March 2015. Retrieved 28 March 2015.
- "CQC falls short in responding to safeguarding alerts". Health Service Journal. 26 February 2015. Retrieved 28 March 2015.
- "CQC unveils new approach to regulating forward view care models". Health Service Journal. 10 March 2015. Retrieved 5 April 2015.
- Matthews-King, Alex (29 July 2016). "GPs' details included in 500 confidential records lost by CQC". Pulse. Retrieved 12 September 2016.
- "Baroness Young, health watchdog chief, to stand down". The Daily Telegraph. London. 4 December 2009. Retrieved 20 June 2013.
- "Taskforce sent in to raise standards at Essex NHS trust". BBC News. 26 November 2009. Retrieved 20 June 2013.
- Campbell, Denis (4 December 2009). "NHS watchdog chief Barbara Young quits after Essex hospital furore". The Guardian. London. Retrieved 20 June 2013.
- Dominiczak, Peter (19 June 2013). "NHS Watchdog accused of hospital 'cover-up' still not fit for purpose, chairman admits". The Daily Telegraph. London. Retrieved 19 June 2013.
- "The Care Quality Commission re: Project Ambrose" (PDF). Care Quality Commission. 14 June 2013. Archived from the original (PDF) on 17 July 2013. Retrieved 19 June 2013.
- "Healthcare regulator CQC 'may have covered up failings'". BBC News. 19 June 2013. Retrieved 19 June 2013.
- Cooper, Charlie (19 June 2013). "NHS watchdog covered-up scandal at hospital where eight babies died of neglect". The Independent. London. Retrieved 19 June 2013.
- Donnelly, Laura (18 Jun 2013). "Cover-up over hospital scandal". The Daily Telegraph. London. Retrieved 19 June 2013.
- Siddique, Haroon (19 June 2013). "NHS regulator exposed as 'not fit for purpose' by maternity deaths". The Guardian. London. Retrieved 19 June 2013.
- Triggle, Nick (20 June 2013). "NHS 'cover-up' names revealed by CQC". BBC News. Retrieved 20 June 2013.
- Randeep Ramesh, social affairs editor (2013-06-19). "Met asked to investigate NHS regulator after Morecambe Bay trust report | Society | guardian.co.uk". London: Guardian. Retrieved 2013-06-24.
- "CQC official Anna Jefferson cleared over 'cover-up'". BBC News. Retrieved 22 March 2016.
- "CQC drags Grant Thornton into libel court case". Health Service Journal. 28 July 2014. Retrieved 27 August 2014.
- "Sleeping Watchdog" (1405). Private Eye. 13 November 2015. p. 37.
- "Four arrests after patient abuse caught on film". BBC News. 1 June 2011. Retrieved 20 June 2013.
- "Winterbourne View 'failed to protect people'". BBC News. 18 July 2011. Retrieved 20 June 2013.
- "Winterbourne View 'abuse' hospital closes on Friday". BBC News. 24 June 2011. Retrieved 20 June 2013.
- Campbell, Denis (23 February 2013). "NHS watchdog chief Cynthia Bower resigns". The Guardian. London. Retrieved 20 June 2013.
- "Abuse secretly filmed in 'excellent' London care home". BBC News. 23 April 2012. Retrieved 21 June 2013.
- "Regulator criticised after woman assaulted in care home". BBC News. 23 April 2012. Retrieved 21 June 2013.
- Carvel, John (1 May 2012). "Stafford hospital investigator berates CQC regulator". The Guardian. London. Retrieved 21 June 2013.
- "The National Standards: Safeguarding people". Care Quality Commission. Archived from the original on 23 June 2013. Retrieved 21 June 2013.
- Foot, Tom (26 April 2012). "Ash Court abuse leads to calls for public inquiry into care watchdog". Camden New Journal. London. Retrieved 21 June 2013.
- "Three GP surgeries put into special measures over patient safety concerns". The Guardian. 22 January 2015. Retrieved 22 January 2015.
- "CQC hired inspectors who failed recruitment criteria in 'flawed' process". Health Service Journal. 9 July 2014. Retrieved 27 August 2014.
- "CQC needs to increase inspection workforce by 66pc in one year". Health Service Journal. 18 December 2014. Retrieved 2 February 2015.
- "CQC's budget cut further". Health Service JOurnal. 20 April 2016. Retrieved 2 May 2016.
- "Hospital inspections exceeded hotel and travel budget by four times". Health Service Journal. 16 November 2015. Retrieved 19 December 2015.
- "Trust CQC fees could increase by 75 per cent next year". Health Service Journal. 2 November 2015. Retrieved 12 December 2015.