CQC must do more to ensure quality inspections and value for money says watchdog

The Care Quality Commission has taken measures to address concerns from members of the public about how it regulates and inspects care providers, but more needs to be done to ensure value for money and quality service is being provided.

In the past, the CQC has been the subject of criticism from the NAO, the Department of Health, Public Accounts Committee, and the Francis Report. Criticisms include suggestions of weakness in direction and leadership, insufficient skills and failure to intervene quickly or strongly enough with failing care providers.

The CQC implemented significant changes to the leadership and structure of the commission by launching a new regulatory model, designed to improve the ways in which care facilities are inspected and monitored and as a result employed new staff with skills to carry out this model.

'Further challenges lie ahead for the Commission to demonstrate, effectiveness and value for money'

The report was published by the National Audit Office (NAO) and is titled: 'Capacity and capability to regulate the quality and safety of health and adult social care'.

Commenting on the report, head of the National Audit Office, Amyas Morse said: "The Commission has made substantial progress in the face of sustained criticism, and is developing a more intelligence-driven approach to regulation. Further challenges lie ahead for the Commission to demonstrate, in practice, effectiveness and value for money. It now needs to build an organisational culture that gives its people the confidence, as well as the skills, to apply the regulatory model assertively, fairly and consistently."

The report raised concerns over a lack of staff to carry out inspections, while the CQC has previously delayed target dates for inspections due to staff through various areas of the Commission.

In April 2015, the CQC had successfully recruited an additional 300 inspectors to help carry out inspections to support its increased responsibility to oversee the financial sustainability of the UK’s largest adult social care providers. The new responsibility makes the CQC accountable for informing local authorities if any of the 43 largest adult social care providers are at risk of leaving the social care sector.

The newly published report by the NAO reveals the CQC is using data effectively to plan inspections, however the Commission does not have access to thorough information on adult social care, sufficient to monitor risk and prompt inspections.

The study highlights the need for more complete data about regulated bodies within the adult social care sector. As a result, the CQC plans to introduce an online system for adult social care providers registering during 2015-2016 as paper applications often contain mistakes.

'A revolution is needed in the amount and quality of routine information available to the CQC'

Director of policy and external relations at Independent Age, Simon Bottery, said: “Today's report by the National Audit Office shows that, unlike in health care, the CQC remains heavily reliant on its inspections to make an assessment of safety and quality in care homes and home care agencies.

"While these inspections have improved significantly, lack of staff means that the schedule is falling behind and it will be October 2016 before all providers have been inspected. This is a real concern for older people using care services.

"The report also suggests that a revolution is needed in the amount and quality of routine information about social care providers available to the CQC, similar to that already available about hospitals and GP surgeries. This would provide the underlying data for CQC to make intelligent risk assessments of care homes and home care agencies and help the CQC to prioritise its inspections on those most at risk of providing poor care."

Currently, CQC in inspections are conducted based on what is important to service users, to check they are safe, caring, and responsive the needs of those in their care. Services are then rated Outstanding, Good, Requires Improvement or Inadequate, allow people to make informed decisions about their care and the care of a loved one.

'The CQC has made substantial progress in developing, testing and rolling out the new inspection model'

Chief executive of the CQC, David Behan welcomed the publication of the report and said: "We welcome the publication of the NAO’s report and the scrutiny it has given to how we work to make sure people in England get safe, high-quality and compassionate health and adult social care. As the independent regulator, we remain central to the delivery of this vision and we want to use transparency to drive improvement in the interests of people who use services.

"I am greatly encouraged that the NAO has recognised the substantial progress that CQC has made in developing, testing and rolling out our new inspection model, which has people at its heart and which delivers a deep insight into the quality and safety care that they are receiving.

"This has required significant staff investment both at leadership and inspection levels, as well as time to work with our partners, providers, commissioners, staff, people who use services and those who represent them to get our approach right.

"We know we are not at the end of this journey and that there is more to be done. In particular, recruiting, training and supporting our staff is a key priority of ours, as is a complete overhaul to our registration process for providers to improve its efficiency and overall experience.

"We appreciate that our model is still maturing, having inspected less than 10 per cent of providers by the end of the period of time that the NAO’s report focuses on. We hope that providers, and importantly people who use their services, are seeing the benefits of our inspections so far, which allow us to root out bad practice and to identify and celebrate what is working well better than ever before. We are confident that this, and being open about what we are finding, will lead to real change and improvement. We are determined to demonstrate our impact and to deliver value for money.

"We take the NAO’s report seriously and together with our Board, will consider its recommendations in full."

The CQC recently published its annual report, highlighting that more than 60 per cent of services, provide good or outstanding care, while over 70 per cent of care providers said inspections provided them with information that helped them to improve the quality of service provided.

The read the report, visit: http://www.nao.org.uk/wp-content/uploads/2015/07/Capacity-and-capability-to-regulate-the-quality-and-safety-of-health-and-adult-social-care.pdf