Editor's blog Wednesday 14 September 2011: CQC's "significant distortion of priorities" criticised by health select committee

The Commons health select committee continues its good work with the publication of the reports of its first annual accountability hearings with the Care Quality Commission and Monitor.

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Its strongest criticism is reserved for the former. The committee concludes that ”the organisation's priorities became distorted by a statutory deadline for the registration of dentists and that this distortion led directly to a drop of 70% in inspection activity during the second half of 2010-11 compared with the same period in the previous year.

“The primary causes of this distortion, which resulted in increased risk to patients, were the unrealistic statutory obligations imposed on the CQC”.

It also concludes that the CQC was established without sufficiently clear and realistic definition of its priorities and objectives. The timescales and resource implications of the functions of the CQC were not properly analysed, and the registration process itself was not properly tested and proven before it was rolled out.

Eating strategy for breakfast
The issue of organisational culture is never far from discussion of performance, and the committee report finds that ”it should be a key objective of CQC inspections to ensure that each provider organisation recognizes and respect this professional obligation (to raise concerns if they recognize, or ought to have recognized, evidence of failure of professional standards) and provides proper security to those professional staff who discharge it effectively”.

It makes two further excellent points: ”Quality and risk profiles have the potential to be a useful auxiliary tool for inspectors, but in their present form the quality of data is limited in reliability and coverage. The CQC should work towards broadening the range of data included, in particular whener little data supports a particular outcome”.

It also suggests that “low staffing ratios can have such exceptional impact on quality of care we belive monitoring of staffing levels is an essential part of monitoring quality outcomes”. This could be an excellent check and balance.

Most damningly for the CQC – the quality regulator of health and social care, whose role is to highlight problems - the report finds that the CQC failed to draw the implications of these failures adequately to the attention of ministers, Parliament and the public.

The CQC was, of course, meant to be a ‘light-touch regulator’, in line with Gordon Brown’s 2005 budget proposals.

An eye on Monitor
The report on Monitor is more laconic – appropriately, given that its proposed role as an economic regulator whose prime aim was to promote competition was one of the key issues for protest against the Health And Social Care Bill. Monitor also doesn’t have a substantive chief executive, partly as a result of the uncertainty over its future.

The committee welcomes the strengthening of Monitor’s role with regards to ongoing oversight of foundation trusts. It also concludes that the removal of the 2014 drop-deadline for all providers to achieve FT status is sensible, and the commitment to ensure that standards to achieve FT status are to be maintained.

The report does not investigate the potential tension between Monitor’s sector regulator role over NHS providers with a duty to prevent anti-competitive behaviour and its ongoing oversight role. In the short term, this may be unproblematic; in time, there will be issues. As we discussed here.

Press briefing
In the press briefing, Health Policy Insight asked health select committee chair Stephen Dorrell MP about the issue of whistleblowing; specifically, how far the NHS is from having an open culture, and more broadly in terms of system-wide openness, what he anticipates under the current period of at least two years of re-centralisation of powers to the NHS Commissioinng Board?

Dorrell replied, “the culture has quite long way to go. It will be a clear sign of success when professional NHS staff can raise concerns without being called whistleblowers: that will show us that the culture’s right.

“Currently, the popular impression of a whistleblower is of an individual in a hospital environment telling the truth against the odds. We want a culture when people with real concerns about safety tell the truth and when they do so, it must be an obligation of their organisation to recognise the fact they are doing so. Things will be better when the term ‘whistleblowing’ becomes redundant”.

On the risks of NHS Commissioning Board centralisation of power, Dorrell observed, ”we asked Sir David Nicholson about that, and when we do the pre-appointment hearing with the candidate for NHS Commissioning Board chair, that will be a major issue. The Government’s policy is clear on its intent to achieve more decentralised NHS management, but there is a clear danger in recent events of greater centralisation - which Sir David Nicholson  himself admitted, and committed himself to a self-denying ordnance. We’ll see”.

We will. Indeed we will.