Care Quality Commission
The Care Quality Commission (CQC) is an executive non-departmental public body of the Department of Health and Social Care of the United Kingdom. It was established in 2009 to regulate and inspect health and social care providers in England.
It was formed from three predecessor organisations:
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 those providers to improve. It carries out this role through checks during the registration process which all new care services must complete, as well as through 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.
History[edit]
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[3][4] to replace these three bodies. The commission was created in shadow form on 1 October 2008 and began operating on 1 April 2009.
Operations[edit]
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.[34]
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.[35] There are suggestions that it could inspect clinical commissioning groups.[36]
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.[37] 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.[38] 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.[39]
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 two inspections having been made in this sector.[40]
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."[41]
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.[42]
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.[43]
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.[44]
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.[45]
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 safety of service users who were more vulnerable due to mobility issues or learning disabilities.[46]
In March 2018 the Public Accounts Committee reported that although the regulator had "improved significantly" there was "no room for complacency" in the organisation which had "persistent weaknesses and looming challenges". Whilst there had been improvements in the timeliness of hospital inspection reports since 2015, only 25% of reports on hospitals where less than 3 services were inspected were published within the target of 50 days. It was intended that 90% of reports should meet the target. The PAC also noted that GPs had felt burdened by the CQC's regulation practices. In response David Behan stated that he accepted the committee's recommendations and did not underestimate the task at hand.[47]
In July 2018, the CQC stated that 96 safeguarding concerns had not been passed on to local authorities over the last 12 months. Andrea Sutcliffe, acting chief executive of the CQC said that an urgent review was carried out when the issue was discovered and it was found that "none of these referrals contained information about immediate risk of severe harm to people". Sutcliffe apologised for the error and said an independent investigation "will assist us in ensuring we improve our systems to avoid something like this happening again".[48]
In October 2018 CQC's Chief Executive Ian Trenholm stated that he wanted to make the information held by the organisation more widely available to the public and that he also intended to make CQC an easier organisation to do business with and a better place to work. A chief digital officer was to be appointed as part of this process.[49] In January 2019 it was announced that Mark Sutton would take on the role of chief digital officer from April 2019.[50]
In April 2019 a study by the University of York published in the Journal of Health Services Research and Policy studied rates of falls which led to harm and pressure ulcers in more than 150 hospitals following CQC inspections. Rates of improvements in these criteria slowed after the inspections. Lead researcher Ana Cristina Castro stated that the inspection regime "creates a significant pressure on staff before and during the inspection period, and also significant costs, not just of the CQC inspectors but also the NHS staff who are diverted from other activities." They suggested a less resource-intensive approach should be adopted. A spokesman from the CQC responded: "To use rates of reported falls and pressure ulcers in isolation to determine CQC's impact is a crude measure and presents an overly simplistic view that is not borne out in the quality and safety improvements we have seen through our hospital inspections. It also fails to recognise that increased reporting of such incidents may be a result of an improved risk management and a stronger learning culture." They also said the research was based on a limited sample of inspections which took place over five years ago.[51]
In August 2019 the Avon and Wiltshire Mental Health Partnership NHS Trust was fined £80,000 as a result of a prosecution brought to court by the CQC. This followed the fall of a patient from a hospital roof which led to serious injury. The service had been warned of the potential risk in 2011. A spokesman for the trust said they were working with NHS England to make improvements.[52]
In September 2019 the Barking, Havering and Redbridge University Hospitals Trust stated their inspection by the CQC had become drawn out "due to availability of inspectors". In response, the CQC's deputy chief inspector of hospitals Nigel Acheson said that the inspection "remains within the published CQC timeframes for inspection." The inspection began on 3 September and is expected to be completed in mid November.[53]
In October 2019 Professor Ted Baker, the Chief Inspector of Hospitals at the CQC stated that "little progress" has been made on improving patient safety in the NHS over the last 20 years.[54] In the same month the CQC published their State of Care report. This stated that 44% of A&E departments were rated as requiring improvement and 8% were rated as being inadequate. 36% of NHS Hospitals were given ratings of requiring improvement on safety with 3% considered inadequate in that area. Over the previous five years the 18-week waiting list for planned hospital treatment had increased from involving 3 million patients to 4.4 million.[55]
In March 2020 it was announced that most inspections would continue as planned following the outbreak of the coronavirus, and that this position would be kept under review.[56] It was subsequently announced on 16 March that routine inspections were being temporarily paused,[57] however the CQC continued to respond to concerns raised by staff.[58] In October 2020 the Department of Health asked the CQC to investigate the use of Do Not Resuscitate (DNACPR) decisions early in the COVID-19 pandemic,[59] when blanket DNACPR decisions were applied to all care home residents without considering individual circumstances.[60]
In March 2024, it was announced that psychotherapist Sue Evans, who was the first to raise concerns about Gender Identity Development Service at the Tavistock and Portman NHS Foundation Trust when she worked there in 2005, along with a parent of a fifteen-year-old, were challenging the CQC in the High Court over its decision to license the Gender Plus Hormone Clinic, accusing the CQC of breaching its statutory duties under the Health and Social Care Act 2008.[61]
The CQC regulates providers of "health or social care in, or in relation to, England",[62] where:
While the Health and Social Care Act 2008 does not distinguish between types of health or social care service, in practice, the CQC has different regulatory approaches for:
Cross-sector inspections
Hospital inspections[edit]
Basildon and Thurrock University Hospitals NHS Foundation Trust[edit]
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."[78] One month earlier the commission had rated the quality of care at the hospital as "good."[79][80]
Staffing[edit]
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."[116] 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.[117]
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".[118]
