CQC moots chief inspector of social care role in wake of Mid Staffs

The Care Quality Commission may appoint a chief inspector of social care as part of moves to differentiate the way it regulates social care and health services, it has announced.

The move follows prime minister David Cameron’s announcement that the CQC would appoint a chief inspector of hospitals to lead a new specialist hospitals inspection regime that would sharpen up the monitoring of acute trusts. Cameron’s announcement was in response to yesterday’s final report of the public inquiry into the Mid Staffordshire NHS Foundation Trust Public Inquiry, which found that significant monitoring failings delayed the exposure of neglect and excessive deaths at Stafford Hospital.

The inquiry, by Robert Francis, called for a new set of “fundamental standards” to be introduced for hospitals, policed by a specialist team of CQC inspectors. Though the government will respond to the inquiry’s 290 recommendations in full next month, Cameron said yesterday that the CQC should appoint a chief inspector of hospitals to establish a new inspections regime based on “quality of care”, not “bureaucratic box ticking”, starting this autumn.

Shift to specialist inspection

This would initiate a shift away from the CQC’s approach to date of regulating health and social care providers against the same set of essential standards, with the same inspectors monitoring both sets of services, towards differentiated regulation led by specialist inspectors. The CQC’s strategic review, published last September for consultation, announced plans to regulate different sectors differently.

Responding to both Cameron’s announcement and the Francis inquiry, CQC chief executive David Behan said it was looking at developing specialist teams to inspect hospitals and making greater use of clinical experts in supporting inspections.

He added: “We believe that Robert Francis’s recommendations in relation to a positive patient culture apply across all health and social care and we also will consider appointing a chief inspector for social care.”

Generic inspectors ‘a matter of concern’

In his report, Francis said the use of generic inspectors was “a matter of concern”, adding: “The needs of an inspector of a small home for the elderly and a large NHS teaching hospital are very different. Both require training and a degree of specialist knowledge, without which there is a danger of missing important indicators of specialist knowledge.”

This view was echoed in a separate report into the evidence base for CQC’s regulatory approach, commissioned by the regulator as part of its strategic review.

Research literature and comparisons with other regulators “did not provide much if any support for the use of a generic inspection workforce”, with expertise in the service area being regulated being important, found the study by Manchester University’s Kieran Walshe and Denham Phipps.

Lack of guidance for providers

Walshe and Phipps’ report also questioned CQC’s use of generic standards against which to regulate both health and social care providers. Their report found a lack of guidance for particular sectors in how they should interpret the essential standards, making them difficult for providers and inspectors to interpret.

The report also found that other regulators took a much more differentiated approach to regulating different sectors than the CQC and that this appeared to be necessary for the commission to account for differences between care homes, hospitals and home care providers, but also differences within sectors based on provider size, ownership and level of risk.

Responding to the Walshe and Phipps report, a spokesperson for the regulator said: “CQC commissioned this report to support its strategic review and has already set down plans to revise the regulatory model and standards. CQC will be working closely with patients, the public and the health and social care industry to help it shape its future and make sure people who use services get the best outcomes. We will consider the review’s findings alongside recommendations made by Robert Francis and the Nuffield Trust Review [into care ratings].”

The CQC will set out its full proposals for reform at the end of next month when it reports back from the consultation on its strategic review. 

• The review of CQC’s approach to regulation, Developing a strategic framework to guide CQC’s programme of evaluation, is available from the agenda for the CQC board’s meeting today (item 5). It drew on interviews with CQC staff, a review of existing literature on different approaches to regulation and a comparison with four other regulators including Ofsted and social housing regulator the Homes and Communities Agency.

More on the Mid Staffs review

Support workers face compulsory regulation on back of Mid Staffs probe

Mid Staffs inquiry is a wake-up call for social work

More on the future of the CQC

Winterbourne-style services could face more frequent inspections 

Behan to tell CQC staff: back new mission statement or leave

Staff more positive about CQC but bullying concerns emerge