Care Quality Commission Performance and Capability Review published by Department of Health

The Department of Health has today published the Performance and Capability Review of the Care Quality Commission, on the same day that CQC chief executive Cynthia Bower has resigned.

The review acknowledges that the CQC has made considerable achievements since being established in 2009 as the new watchdog for health and social care services in England. By bringing together three different organisations, it has created the largest organisation of its kind in the world, setting up a new system of regulation. The review states that the CQC has delivered a challenging programme of work registering more than 21,000 providers since April 2010 and is increasing the number of inspections taking place.

However, the review also found that the scale of this task had been underestimated and more could have been done to manage the risks during the early years; and that the role of the CQC has not been as clear as it needs to be to health and care providers, patients and the public.

The Performance and Capability Review recognises that over the last nine months, the CQC has made significant improvements. They have increased inspection staffing and are focusing more on the core duties of registering and inspecting healthcare providers.

Recommendations from the review are designed to support CQC’s continuing improvement by strengthening the CQC board and building further on what has already been learnt:

• The CQC must become more strategic and set out more clearly what success looks like.

• The board should be strengthened with the appointment of additional members and that there should be clearer arrangements between the board and the executive to ensure that the board is holding the operation of the CQC to account.

• The CQC should build an evidence base for its regulatory model to demonstrate and ensure confidence in its effectiveness.

• Frontline inspectors should have greater access to individuals with professional experience, such as doctors, nurses or social care experts. There should also be more consistency in how inspections are carried out and there should be enough inspectors to meet future demand.

The review recognises that the Department of Health needs to do more to support the CQC, ensuring it is held to account for its role in regulating health and social care. The Department of Health confirmed it will be working with the CQC to recruit additional non-executive members to the board with the recruitment process starting imminently.

In a letter to the chair of the CQC, Una O’brien, Department of Health permanent secretary said: ‘Over the last nine months, CQC has made significant improvements in performance and in focus on core purpose. However, the evidence has clearly shown there is more work to do to build on recent successes to ensure the organisation has the capability and capacity to respond to patient, public and Parliamentary expectations in the future. Lessons need to be learned from the performance shortcomings of the early years. The leadership of the organisation are willing to listen and act on issues raised about the organisation’s performance.’

Jo Williams, chair of the CQC has responded in letter to the review saying: ‘I would like to give a broad welcome to the findings of the review. The process has recognised the context and complexity of CQC’s work, progress made and where more work is needed to further develop our regulatory approach. We take seriously the recommendations of the review and have a desire to make further progress on all areas of the review.’

Simon Lawton-Smith, head of policy at the Mental Health Foundation has also responded to the review: 'The CQC was set a difficult and complex task and it is not surprising that it has sometimes failed to meet the demands on it. It has done some good work, for instance we welcomed the decision to produce an annual report on the use of the Mental Health Act. But concerns still remain, notably that there are not enough visits and inspections of mental health and learning disability services, and there are too few Second Opinion Appointed Doctors (SOADs) to operate the Mental Health Act effectively.

'We must make sure that we never again allow the appalling practice that was found at Winterbourne View, where staff have admitted to physically and verbally abusing patients. The CQC must do more to ensure that the safeguards for people detained under the Mental Health Act and supported under the Mental Capacity Act are fully complied with by local services.

'In particular we strongly endorse the recommendations around safeguarding and risk. Even within the strongest governance framework, it is ultimately the front-line staff, their training and culture that requires the greatest scrutiny and focus.'

The review can be found at http://www.dh.gov.uk/health/2012/02/cqc-performance-review/