NAO warns over extending responsibilities of Care Quality Commission

Proposals to extend the Care Quality Commission's role risk distracting the organisation from its core work of regulating health and social care, the National Audit Office has warned.

Additional responsibilities that the Department of Health expects the CQC to assume include oversight of fertility clinics and responsibility for HealthWatch England, the new national consumer body for health and social care.

In a report the NAO said the public’s expectations of the Commission were high, but this was based on a misunderstanding of what it could achieve as a regulator.

The report also said that the CQC’s role – although clearly defined – had not been communicated effectively to the public and providers.

The Commission was set up under the Health and Social Care Act 2008 to act as the independent regulator of health and adult social care services in England.

It took over responsibilities from three bodies – the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission – and began operating on 1 April 2009.

The National Audit Office said the CQC had had “a difficult task in establishing itself and has not so far achieved value for money” in its key role.

The Commission has faced a number of problems since its launch. According to the NAO, these included:

• missed deadlines for registering health and social care providers, other than NHS trusts. This happened at the same time as levels of compliance and inspection activity were falling significantly
• a significant number of staff vacancies with 14% of posts empty at the end of September 2011. This followed government-wide recruitment constraints
• difficulties with the process for registering care providers, which “did not go smoothly”. The NAO said the timetable for two of the three tranches of registrations was not met, with the CQC forced to divert inspectors from compliance activity to registration work to rectify the problem. Together with the vacancy rates, this meant the Commission completed only 47% of the target number of compliance reviews between October 2010 and April 2011.

Amyas Morse, head of the National Audit Office, said: "Against a backdrop of considerable upheaval, the Care Quality Commission has had an uphill struggle to carry out its work effectively and has experienced serious difficulties. It is welcome that it is now taking action to improve its performance.

"There is a gap between what the public and providers expect of the Care Quality Commission and what it can achieve as a regulator. The Commission and the Department of Health should make clear what successful regulation of this critical sector would look like."

In its response to the NAO report, the CQC acknowledged it had been through a “challenging period” but insisted that it was now “firmly on the right track and making rapid progress”.

It said it was committed to increasing the numbers of unannounced inspections in order to identify and tackle poor care.

Chief Executive Cynthia Bower said: “As the NAO report makes clear, we faced a difficult task. We had to bring together the work of three organisations and bring in a new model of regulating health and adult social care. Not everything has gone smoothly, but we have learned, reviewed what we do and made changes – often with support of others involved in health and social care.

"We are a young organisation and we are still evolving - but I firmly believe that we are making real progress. In October alone, we conducted more than 1,400 unannounced inspections. In the last three months we have recruited and trained over 100 additional inspectors.”

Bower claimed the CQC’s report on its Dignity and Nutrition inspection programme, which looked at the care older people receive in 100 acute hospitals, showed how effective its regulatory system could be. This programme will shortly be rolled out to social care, she added.