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Auditor says CQC itself requires improvement

Regulator has made progress but needs to overcome persistent issues with timeliness

Louise Prime

Tuesday, 17 October 2017

The Care Quality Commission (CQC) itself requires improvement, according to the National Audit Office (NAO). In its latest report the NAO identified improvements that the CQC has already made but said it “needs to overcome some persistent issues” with the timeliness of some of its regulation activities, and to develop its digital systems and capabilities.

NAO noted that the regulator has completed its inspection and rating programme comprising more than 28,000 provider locations; and that it has significantly reduced staff vacancies and is increasing its focus on cost savings. It also acknowledged that the CQC has improved how it measures its performance, and takes action to correct poor performance.

However, CQC inspection staff told the NAO that they were concerned about how well the CQC’s broader information systems supported them. The auditor also found that the CQC does not meet its timeliness targets for some of its regulation activities, such as registration and publication of inspection reports. Furthermore, it said, although most providers and inspectors regard the CQC’s judgements as fair, it found that stakeholders have concerns about consistency, which the CQC is seeking to address through its quality assurance processes and training.

NAO reported that, where care falls below fundamental standards, the CQC is taking more enforcement action, and it found evidence that it influences providers to improve quality, with most of the providers rated either ‘inadequate’ or ‘requires improvement’ having improved their rating on re-inspection. But it added that although the CQC links the increase in completed enforcement action to its focus on improving its inspectors’ skills and knowledge about enforcement, poor recording on its part means it can’t be assured that enforcement action is always completed.

The report’s authors noted that the CQC faces ‘significant challenges’ with its ambition to base more of its regulatory activities on intelligence and risk-based information. The report said these must be carefully managed, and supported by digital systems and capabilities, if the regulator is to minimise the risk of missing poor care. Also, at a time of change, it urged both the Department of Health and the CQC to be realistic about the CQC’s capacity to take on new responsibilities.

Comptroller and Auditor General of the NAO, Sir Amyas Morse, concluded: “The Commission has improved as an organisation. Value for money is getting better and the Commission can secure further improvement, if it continues its current direction of travel. Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.”

CQC chief executive Sir David Behan responded: “This report recognises the good progress we have made whilst at the same time confirming those areas where we need to continue to improve.

“I want to pay tribute to the CQC staff and Board for the commitment and energy they invest every day. It is their hard work and progress which is recognised by the NAO in its report.”

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