Care Quality Commission one year on

As the Care Quality Commission celebrates its first birthday, Mithran Samuel evaluates the regulator’s turbulent year

The Care Quality Commission has done a lot of juggling in its first year. First, its staff have had to create an organisation from the merger of the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission. On top of this it has had to continue its predecessors’ roles in assessing adult social care provision, evaluating health services and monitoring the treatment of detained mental health patients.

It has also had to implement a new registration system for English health and social care providers, the first time the NHS has been bound by such regulations.

And it has had to cope with the loss of its first chair, Barbara Young, and the departure of director of operations David Johnstone, after just a few months in post.

While trying to keep all of these balls in the air, the CQC has endured several spats.

Last September, the Department of Health’s national director for mental health Louis Appleby accused it of “deliberately distorting” the results of a survey of mental health inpatients to grab headlines.

In December, the Association of Directors of Adult Social Services criticised the commission’s treatment of eight councils when it published its annual performance assessment. Adass said the eight were highlighted as “priority for improvement” – thereby attracting media ire – despite little warning from the CQC.

And, last month, the United Kingdom Homecare Association and the Registered Nursing Home Association attacked what it perceived as the CQC’s lack of communication over the registration system, which begins this month.

Sector leaders have linked the CQC’s problems to its workload. Sarah Norman, joint chair of the Association of Directors of Adult Social Services’ standards and resources network, says: “It has been stretched at senior management level and we’ve had quite short notice of a number of initiatives. It’s been a bit hand-to-mouth in terms of its ability to make decisions.”

She points to the fact that final guidance on how councils were to be assessed in 2009-10 was only published three-quarters of the way through the year.

Colin Angel, head of policy and communication at the UKHCA, says: “The CQC has lost valuable time restructuring, leaving insufficient time for over 24,000 social care providers to adapt to new standards before they are required to re-register.”

But Amanda Sherlock, head of operations at the CQC, says it has “been an outstanding achievement to pull together the three commissions, deliver business as usual as well as bring in a new regulatory model”, while building a new organisation.

She says that some things could have gone better, saying that the CQC has worked on how it handles national announcements, so councils and other bodies face “no surprises” when these happen.

Norman acknowledges the CQC has “shown itself willing to listen” and “accepted the concerns that we’ve had”.

On provider registration, Sherlock says: “We are keen to hear how we can do things better and how we can tailor our approach and communication.” She says the CQC has an “absolute focus” on making sure providers are “clear what is expected between April and October” when they must register.

National Care Forum executive director Des Kelly says for its part the provider sector needs to work with the CQC to ensure registration succeeds.

Sherlock admits the CQC has “put a lot of time” into organisational development but says this has paid off in establishing an organisation that has an “absolute commitment to driving up quality and safety across health and social care without defining any sector as special”.

A year ago, many in social care, including former CSCI chair Dame Denise Platt, feared the health service’s high political and public profile would make it “special”.

And since Johnstone’s departure last autumn, there has been no one with a social care background on CQC’s executive team below chief executive Cynthia Bower, who left social services in 1995.

Sherlock insists such fears have proved unfounded, but says the CQC has been helped by adult care’s rising profile.

Sherlock, who worked for the CSCI and its predecessor, the National Care Standards Commission, points to her own centrality to CQC’s strategic direction, despite not being on the executive team. She also reveals that the CQC will soon appoint a national social care adviser, to provide “external challenge” and strengthen links with the sector.

Kelly says the issue of social care’s priority has “gone better than I would have predicted 12 months ago”.

Concerns have also been raised that the CQC would not maintain the CSCI’s focus on user involvement. Sue Bott, director of the National Centre for Independent Living, which provides users to act as “experts by experience” on inspection teams, says involvement is “nowhere near as prevalent” as it was in the CSCI.

The CQC produced a statement on user involvement last June, pledging to conduct surveys and set up consultative panels.

Sherlock agrees there is more to do but says the statement has been implemented and the CQC’s user involvement team, led by Frances Hasler, who performed the same role for the CSCI, “actively challenges all parts of the organisation”.

One of the key objectives of the CQC is to support the integration of health and social care. Kelly says he has not seen “a great deal of evidence as yet” of progress on this front. But Sherlock points to the special reviews that the CQC has been doing on issues that cross the divide, including the quality of healthcare for care home residents, which she says will identify good practice and any gaps.

These will report in 2010-11, alongside the roll out of registration for adult care providers and a reformed performance assessment for councils. It will be another busy year.

ONE YEAR OF THE CQC

April 2009

The Care Quality Commission starts work. Outgoing Commission for Social Care Inspection chair Dame Denise Platt raises concerns over its potential to sufficiently prioritise social care and involve service users.

May 2009

Former Association of Directors of Adults Social Services standards lead David Johnstone appointed director of operations at the CQC. He leaves the organisation after only a few months.

June 2009

Statement on service user involvement published. The CQC announces series of special reviews for 2009-10, including of healthcare needs of care home residents and impact of recession on services.

July 2009

The CQC says NHS trusts are failing to comply with child protection requirements in areas such as staff training in report sparked by Baby Peter case.

September 2009

DH mental health director Louis Appleby says the CQC’s portrayal of results of an in-patient survey was “deliberately distorting” and simply highlighted negative findings. The CQC says many survey results were poor.

October 2009

The CQC publishes draft standards for health and social care providers, and holds meeting with mental health leaders over its presentation of the results of its in-patient survey.

December 2009

Adass criticises the CQC for its treatment of eight councils labelled “priority for improvement” following annual performance assessment (APA). Councils improve for seventh year running.

February 2010

The CQC says £2bn could be saved a year from reduced hospital admissions if joint working improves between health and social care in first State of Care report. It promises 2010-11 APA for councils will be tougher.

March 2010

Care provider bodies slam the CQC for an alleged lack of communication of the process for registration under its new system. The CQC claims it has engaged extensively.

April 2010

The CQC is one year old. It starts process of registering adult care providers under new system. National social care adviser appointed.

This article is published in the 8 April 2010 edition of Community Care under the headline “Many happy returns?”