Regulating health: can the CQC do more for less?

The Care Quality Commission (CQC) certainly has its work cut out. As the independent regulator of the health and social care sector, it is responsible for ensuring every hospital, mental health trust, social care provider, care home (and many more settings beside) are safe and delivering a minimum standard of care for patients/residents.

This is undoubtedly a big job and some people accuse the CQC of not doing it very well.

Last week, the House of Commons health select committee published its report on their recent performance. While accepting there had been additional pressures placed on the CQC, one of the committee’s headline findings was that inspections were down 70% on the previous year.

So that means that the body ensuring safety and standards in health and social care settings carried out 70% fewer inspections to make sure that care was being delivered properly.

Age UK has also challenged the quality of healthcare inspection with its campaign Hungry to be Heard which raised awareness of malnutrition in hospitals. We believe it is a serious failure of care that people are not being supported to eat in hospital and some of the responsibility for this failure must arrive at the door of the CQC.

The campaign did result in a series of spot-checks examining nutrition and dignity in hospital. The outcome has been a number of settings being found to be non-compliant with “essential standards”, so CQC should take credit for responding positively to these issues. Arguably, it shouldn’t need a charity to highlight them in the first place.

The CQC does, however, find itself between a rock and a hard place. On the one hand, the Government is seeking to reduce so-called bureaucracy in the health service and wants to offer greater freedom from centralised control.

There are also the perennial issues of what is proportionate and what can guarantee standards which challenges any system of regulation. The Government’s wider efforts to cut “red-tape” and its ideological bearings will always send the message that less administrative burden is better.

At the same time, failures of care persist. The Health Service Ombudsman’s report Care and Compassion? is an obvious recent example of where the lesser seen elements of care relating to dignity and compassion are simply not up to scratch.

In a system that relies on data returns and fewer inspections, whether or not someone is treated with dignity can fall through the gaps. Put simply, it is much more difficult to capture compassion in a spreadsheet.

Unfortunately, older people are most commonly subject to such failures of care.

The CQC told the health select committee that the number of inspections will start to return to previous levels. It has certainly been under a lot of pressure to register a huge amount of providers since it took on its responsibilities in 2009. This came at a time when their budget was cut from £240 million (the combined budget of its predecessor organisations) to £161 million.

And life is not going to get easier for the CQC. The NHS reforms currently going through parliament foresee an expanded, vibrant market of healthcare providers, all of which must be licensed by the CQC. More than this, having more providers is at the heart of these reforms.

Do we believe, in this age of austerity, that the CQC will have more money to meet the requirements of a growing healthcare sector? To say very unlikely would be generous.

The Government anticipates that choice and competition will be the main driver of quality in the NHS in the future. The message will be: if you’re concerned about the care you’re receiving, go somewhere else.

This could indeed be a powerful mechanism for getting the type of care you want. But ultimately, most people will want the confidence that when they enter hospital, for example, you will at the very least be fed, treated with compassion and leave there feeling better than when you came in.

The CQC has a vital role in making that a reality, particularly for older people as the NHS’s largest users.

For its faults, the CQC is working to a shrinking budget and growing expectations and there’s a great deal it does for which it deserves praise. For example, their Experts by Experience programme (run in part by Age UK) involves service-users in the inspection of care homes and was used on the nutrition and dignity spot-checks. There should also be no doubt that the CQC helps to ensure safe care in the majority of NHS services.

As I said at the beginning, the CQC have a huge amount on their plate and Age UK believes they need more funding to do their role effectively. In an age of austerity and attacks on “red tape”, the Government needs to remember that there is a cost to being the guardians of patient safety.

The potential cost of weak regulation is substantially higher.

Find out more about our care in crisis campaign

Author: Tom Gentry

Policy adviser - health services @tomogentry

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