Select committee inquiry
2013 accountability hearing with the Care Quality Commission
Closed
What the inquiry looked at
“Although there were no formal terms of reference for this inquiry, submissions of no more than 2,500 words were invited by the deadline of midday on Tuesday 15 October 2013.”
The committee's words, from the inquiry page on parliament.uk ↗.
What the government said
The government responded on 14 April 2014.
Summary written by Accountability Index from the government's response.
The Care Quality Commission welcomes the Committee's report and sets out its responses to each recommendation, agreeing with some, such as writing to people using services, while keeping the market oversight role and not accepting fixed staffing ratios.
- On the Committee's call to give financial oversight of adult social care to Monitor, the CQC states it believes it "is the right place for this function", which it will introduce in April 2015.
- On staffing, the CQC says "We do not believe that there should be fixed ratios of staff to patients", and that levels should be flexible. It plans a thematic probe of staffing levels in social care "this summer".
- On writing to people after inspections, the CQC says "We will implement this recommendation" and is piloting providers sharing an inspection summary from April 2014. It adds that consideration is being given to whether an additional regulation will be needed.
- On the NPSA's functions, the CQC says it "understand[s]" the recommendation but the important point is access to the NRLS database. It will discuss with NHS England "in due course" where the database is best housed.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 16 July 2013 to 14 April 2014.
- Oral evidence 22 Oct 2013
- Written evidence 17 submissions
- Report 22 Jan 2014
- Government response 14 Apr 2014
What it recommended 1 recommendation · 24 conclusions
1The Committee welcomes the fact that the CQC has now set out its objectives in...
Concluded (the committee's words)
The Committee welcomes the fact that the CQC has now set out its objectives in clear terms. This in turn has helped to provide clarity to a regulatory landscape the committee described in 2012 as “cluttered and opaque”. The Committee believes that the CQC is now ready to undertake a programme of substantial reform to develop and improve its regulatory functions.
2The Committee welcomes the fact that the Chief Inspectors are accountable to the CQC Board.
Concluded (the committee's words)
The Committee welcomes the fact that the Chief Inspectors are accountable to the CQC Board. As the methodology for registration, inspection and rating of health, social care and primary care advances over time the Chief Executive, acting on the authority of the Board, will play an important role in coordinating the approaches of the Chief Inspectors in order to maintain a consistent approach on these key issues across the activities of the CQC.
3The Committee notes the intention to revise the CQC’s powers to enhance its ability to...
Concluded (the committee's words)
The Committee notes the intention to revise the CQC’s powers to enhance its ability to quickly prosecute directors and corporate bodies in the most serious cases. We believe, however, that in most cases, the ability to close a unit or a department by cancelling a provider’s registration and withdrawing their licence is of more immediate significance to patient care. The Government and the CQC should keep these powers under review to ensure the CQC enjoys a sufficient range of sanctions to levy against failing providers.
4The committee believes that the CQC’s broad approach of linking five key questions to the...
Concluded (the committee's words)
The committee believes that the CQC’s broad approach of linking five key questions to the inspection of expected standards and linking immediate regulatory action to breaches of fundamental standards has the potential to simplify the regulatory process. Provided the CQC focuses on evidence of outcomes achieved, there is now an opportunity to move away from a system that focused on inputs and failed to illustrate a realistic picture of the standards of care offered by providers.
5The ultimate test of the new standards will be whether they are meaningful in relation...
Concluded (the committee's words)
The ultimate test of the new standards will be whether they are meaningful in relation to the everyday experiences of patients, care home residents and the public. The committee welcomes the commitment on the part of CQC to take immediate action against providers who fail to meet fundamental standards and therefore breach their registration requirements. If applied firmly, we believe this measure has the potential to considerably enhance the credibility of the new system.
6If the CQC seeks to prioritise everything then they will prioritise nothing, but they must...
Concluded (the committee's words)
If the CQC seeks to prioritise everything then they will prioritise nothing, but they must now begin to provide detailed information to the full breadth of health and social care providers to build support for reform across the system. At our next accountability hearing we expect the CQC to present clear details of how the effective registration, surveillance and inspection procedures will be extended beyond hospitals to cover adult social care and general practice. In particular the CQC should by then have developed clear and creative proposals for scrutinising the quality of care delivered by providers in a person’s own home.
7If it is to build public confidence in a risk based regulatory system the CQC...
Concluded (the committee's words)
If it is to build public confidence in a risk based regulatory system the CQC will require early identification of developing problems. The surveillance system must identify problems and trigger inspections before they become widely publicised by the media, patient groups or local representatives. If the CQC’s surveillance model cannot pre-empt high profile failings it will be viewed as purely reactive and will not be regarded as a credible basis for regulatory activity.
8The Committee welcomes the importance attached to staffing levels by the CQC.
Concluded (the committee's words)
The Committee welcomes the importance attached to staffing levels by the CQC. We believe that analysis of staffing figures should not only be part of inspection but should also form a fundamental part of the surveillance model. Staffing data should extend beyond the ratio of registered nurses to patients working on a hospital ward and should examine other measures, such as consultant coverage in emergency departments, which is a crucial factor in improving patient outcomes. Information gathered from surveillance which suggests that staffing levels are inadequate should be a trigger for inspection as “the quality of care that people receive is related to the number of staff on duty.”
9The Committee welcomes the commitment made by the CQC that the fundamental standards by which...
Concluded (the committee's words)
The Committee welcomes the commitment made by the CQC that the fundamental standards by which providers are registered will incorporate appropriate staffing levels. It is essential that those providers that fail to achieve adequate staffing levels are aware that they are in breach of fundamental standards and therefore liable not only to inspection but also to regulatory action including prosecution. The regulations have yet to be published and it is vital that the public have the opportunity to scrutinise how they define an ‘appropriate staffing level’.
10The committee is pleased that the CQC is, in principle, willing to take on the...
Concluded (the committee's words)
The committee is pleased that the CQC is, in principle, willing to take on the responsibilities that once resided with the NPSA. It is illogical to split different aspects of patient safety between NHS England and the CQC and this reform would simplify the regulatory environment. The Committee believes that would allow more information to be quickly factored into the CQC’s surveillance model which already includes ‘never events’ in its first tier of indicators.
11Undertaking the financial monitoring of adult social care is a significant challenge for the CQC...
Concluded (the committee's words)
Undertaking the financial monitoring of adult social care is a significant challenge for the CQC and it is essential that they procure the right skills to fulfil this role. David Behan noted in his evidence that there was a close correlation between poor quality and poor financial performance, saying that “[m]aking a distinction between finance and quality is a false distinction.” We do not dispute this point, but the Committee believes that, ultimately, it is easier to identify and address poor quality at an early opportunity than it is to demonstrate that a provider is financially distressed.
12We recommend that the Government should reconsider its decision to allocate this responsibility to CQC...
Recommended (the committee's words)
We recommend that the Government should reconsider its decision to allocate this responsibility to CQC and that it should ask Monitor to undertake this role. Although this development would divide oversight of adult social care between Monitor and the CQC, it would facilitate the reduction of boundaries between healthcare and social care and would maintain the existing distinction of principle between the CQC, which focuses on care quality, and Monitor, which focuses on financial performance.
13The Committee welcomes the introduction of the fit and proper person test for senior governance...
Concluded (the committee's words)
The Committee welcomes the introduction of the fit and proper person test for senior governance positions, but does not understand why it is proposed to exclude Chairs of NHS Trusts and NHS Foundation Trusts from the scope of this test. It does not believe that this exclusion will be understood or accepted by public or patients.
14The CQC has an important role in providing quality assurance for a vital public service,...
Concluded (the committee's words)
The CQC has an important role in providing quality assurance for a vital public service, but it cannot guarantee care quality. Primary responsibility for the quality of care delivered to patients rests unambiguously on the staff and management of care providers.
15The Committee believes that generic inspection was a failure and the new model is a...
Concluded (the committee's words)
The Committee believes that generic inspection was a failure and the new model is a necessary step towards making the CQC an effective regulator. The proposed system represents a comprehensive improvement but the CQC must ensure that inspection is accurately targeted at risk. Surveillance will not always identify specific risks in outstanding hospitals and some high risk services will require frequent inspection even if they are regularly classified as ‘outstanding’.
16The Committee welcomes the CQC adopting our recommendation to assess the culture of providers as...
Concluded (the committee's words)
The Committee welcomes the CQC adopting our recommendation to assess the culture of providers as a core part of the inspection process. This assessment must be developed so that it does not simply measure Board level governance practices, but properly assesses whether a culture of openness and challenge exists amongst frontline staff.
17In the report on the Committee’s 2012 accountability hearing with the CQC we concluded that:...
Concluded (the committee's words)
In the report on the Committee’s 2012 accountability hearing with the CQC we concluded that: A key element of this assessment [of culture] should be a judgement about the ability of professional staff within the organisation to raise concerns 2013 accountability hearing with the Care Quality Commission 41 about patient care and safety issues without concern about the personal implications for the staff member concerned. The Committee believes that the CQC should undertake an assessment of both the number of concerns raised by staff members and the way in which those concerns have been addressed. This would serves as a useful proxy by which the CQC can begin to measure the culture of an organisation.
18The CQC is planning to recruit an additional 150 inspectors to increase their establishment from...
Concluded (the committee's words)
The CQC is planning to recruit an additional 150 inspectors to increase their establishment from 950 to 1,100. This process is vital to improving the effectiveness of the organisation; we therefore recommend that the CQC set an early target date for the achievement of this increase and provides regular reports to Parliament on progress towards delivery of this objective.
19Substantial additional resource is being directed towards the CQC; the Committee recommends that the CQC...
Concluded (the committee's words)
Substantial additional resource is being directed towards the CQC; the Committee recommends that the CQC Board reach early decisions about the allocation of this additional resource and that it make its decision public.
20The Committee welcomes the decision to publish ratings for all health and care providers.
Concluded (the committee's words)
The Committee welcomes the decision to publish ratings for all health and care providers. It is essential that the CQC act quickly to establish public understanding of, and confidence in, the ratings system.
21David Prior informed the committee that the CQC was “going to consider writing to residents...
Concluded (the committee's words)
David Prior informed the committee that the CQC was “going to consider writing to residents of a care home, for example, telling them in words of plain English, ‘This is what we have found’.” The Committee is disappointed that the CQC is still “going to consider” this issue. It regards early action as fundamental to delivery of the core purpose of the CQC. It recommends that this recommendation of last year’s report is adopted and implemented by the CQC no later than 30 June 2014.
22The Committee welcomes the CQC management’s commitment to this process of culture change within the...
Concluded (the committee's words)
The Committee welcomes the CQC management’s commitment to this process of culture change within the organisation and, in particular, their commitment to monitor progress in delivering this objective.
23Creating a mechanism for staff to report bullying and harassment to a director at a...
Concluded (the committee's words)
Creating a mechanism for staff to report bullying and harassment to a director at a very senior level will help the executive team and the Board maintain a realistic understanding of the experiences of the CQC’s frontline workforce. Whilst this is an important step that delivers necessary senior oversight, this system, in itself, is not enough to eliminate the culture that has produced bullying and harassment.
24Concern has been expressed to the Committee about the impact of individual workload on the...
Concluded (the committee's words)
Concern has been expressed to the Committee about the impact of individual workload on the culture of the organisation. Management of workload is an important part of business planning. At our next accountability hearing the Committee will seek assurances that workforce planning associated with the new 42 2013 accountability hearing with the Care Quality Commission regulatory model has not repeated the mistakes of the past and that inspectors are be able to complete their work thoroughly (including weekend and out-of-hours inspections) without being required to manage unreasonable workloads.
25The Committee welcomes the commitment that has been given to ensure adequate funding for the...
Concluded (the committee's words)
The Committee welcomes the commitment that has been given to ensure adequate funding for the CQC. In the longer term, however, the independence of the CQC will be substantially reinforced when arrangements are in place to ensure that the cost of regulation is met by the registrant community.
Evidence
Oral evidence sessions 1
- 22 Oct 2013No witnesses recordedparliament.uk ↗
Written evidence 17 submissions
Listed here by submitter; the evidence itself is on Parliament's website.
- 4 Dec 2013Care Quality CommissionACQ0020
- 31 Oct 2013The King's FundACQ0019
- 31 Oct 2013Margaret and Janet BrooksACQ0005
- 31 Oct 2013South West Whistleblowers Health Action GroupACQ0009
- 31 Oct 2013Dr Mark TattersallACQ0007
- 31 Oct 2013David HogarthACQ0006
- 31 Oct 2013Relatives and Residents AssociationACQ0017
- 31 Oct 2013The Royal College of PathologistsACQ0015
- 31 Oct 2013Foundation Trust NetworkACQ0013
- 31 Oct 2013General Medical CouncilACQ0010
- 31 Oct 2013Royal College of NursingACQ0008
- 31 Oct 2013Dr Richard FairburnACQ0004
- 31 Oct 2013LifewaysACQ0003
- 31 Oct 2013English Community Care AssociationACQ0002
- 31 Oct 2013The Royal College Of RadiologistsACQ0001
- 31 Oct 2013Care Quality CommissionACQ0018
- 31 Oct 2013Department of HealthACQ0014