Parliamentary Committees and Public Enquiries
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Care Quality Commission has much to do to earn public confidence, warns Health Committee

Despite sustained criticism over a prolonged period the Care Quality Commission has not yet successfully defined its core purpose or earned public confidence, according to MPs on the Health Select Committee.

Launching a report from the second annual accountability hearing held with the regulator (HC 592), Committee Chair Stephen Dorrell MP said,

"The CQC's primary focus should be to ensure that the public has confidence that its inspections provide an assurance of acceptable standards in care and patient safety. We do not believe that the CQC has yet succeeded in this objective.

The CQC needs to ensure that its inspections represent a challenging process which is designed to find service shortcomings where they exist, ensure, when appropriate that service providers address them rapidly, and report promptly both to providers and users of the service. The CQC also needs to show that it treats feedback from the public as free intelligence and that it acts swiftly when serious complaints are brought to light this way.

We welcome the fact that the CQC has undertaken a consultation exercise about its key objectives; we also recommend that, before our accountability hearings take place in 2013, the CQC should undertake an open consultation designed to develop a clearer understanding of effective regulatory method, including consulting on how inspectors should assess the culture which prevails amongst professional staff within individual care providers.

The essential standards applied by the CQC should reflect a current understanding of good clinical practice.

An inspection should be much more that a review of facilities and records. It should include an assessment of the quality of the professional culture within the organization.

Care providers need to show they have robust procedures which foster a culture of challenge and response in which the requirement to recognize and address service shortcomings is a standard process for all staff in pursuit of their professional duties.

Organisations which cannot meet this obligation should be refused registration by the CQC.

The CQC also needs to be more diligent about communicating the prompt, accurate and complete outcomes of its inspections directly, operators, residents and relatives, as well as to public sector commissioners. No-one who relies upon a service should be expected to scour the CQC website for inspection results, or chance upon them in a local newspaper report.

We welcome the CQCs decision to strengthen its inspection process by including expert clinical advisers but remain concerned that such expertise is not always available when necessary - some 87% of inspections carried out since this resource became available did not use it. The regulator needs to develop a consistent methodology for Inspectors to follow that will ensure clinical experts are available when required.

Looking ahead to the challenge of GP registration my committee will examine carefully in 2013 the extent to which the CQC has learnt from its experience of dental registration and is able to deliver a streamlined process that limits the burdens placed upon GPs.

Public confidence in the CQC was further undermined last year by its failure to address issues identified within its own management, organisation, functions and culture by its own board member Kay Sheldon. It is regrettable that she felt compelled to approach the Mid Staffs Public Inquiry to secure a hearing for her concerns. It is essential that the CQC reforms its culture and working practices to address these shortcomings.

The new CQC Chair must, as a matter of urgency, overhaul its governance structures to ensure the Board sets clear objectives for the organisation, holds the executive effectively to account against these objectives, and regularly assesses its own performance and effectiveness."

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