The Care Quality Commission (CQC) was set up by the last Labour administration, under the terms of the 2008 Health and Social Care Act, and began operating under the umbrella of the Department of Health & Social Care the following year.

It replaced three existing organisations – the Commission for Social Care Inspection, the Healthcare Commission and the Mental Health Act Commission – and was tasked with the registration and monitoring of all health and social care facilities in England and Wales.

The CQC currently defines its role as ensuring, through regular inspections, that these facilities are safe, effective, caring, responsive to people’s needs, and well-led.

If a facility fails on any of these scores, the commission suggests it has a range of sanctions it can impose. These include:

– using requirement notices or warning notices to set out what improvements the care provider must take, and by when

– making changes to a care provider’s registration to limit what they can do

– placing a provider in special measures, under close supervision by the CQC

– issuing cautions or fines

– prosecuting when patients are harmed or in danger of being harmed

However, confusion over its role, inadequate resourcing, poor monitoring and an apparent reluctance to impose sanctions effectively, led to criticisms of the CQC’s performance from the very start.

A damning report from the Commons Public Accounts Committee in 2012 – echoing concerns raised in earlier reports from the Commons Select Committee and the National Audit Office – noted the following:

– the CQC’s focus was on activity levels rather than the quality of inspectors’ work

– inspectors had not been given enough training or support to assess good quality care

– no provider had ever been prosecuted

– the CQC only assessed compliance, not quality of care

– the commission had scrapped its dedicated whistleblower helpline

– inspectors had no clinical expertise

– the CQC had taken no follow-up action following a whistleblower alert on patient abuse at Winterbourne View, later exposed in a BBC Panorama exposé.

The predilection of Tory-led administrations since 2010 for the private provision of care – particularly in the mental health sector, where there are now almost 6,000 fewer beds (a drop of 25 per cent) in the NHS than there were a decade ago, despite the number of detentions under the Mental Health Act rising by 50 per cent over the same period – has inevitably impacted the commission’s performance ever since, as commercial operators appear to undermine the regulatory framework.

Between 2010-15 around 25 per cent of mental health contracts were awarded to private providers, yet the CQC struggled to successfully monitor these new entrants to the sector. Private Eye reported in 2015 that most of the residential establishments closed down after failing a CQC inspection simply re-opened under a new name or new ownership, losing their negative ratings in the process. And in 2017 Which? found that more than 25 per cent of care homes were failing to display their CQC ratings online, which is a legal requirement.

Three years ago, in 2018, delegates at the Royal College of GPs annual conference argued that CQC-style inspections were ineffective in raising standards or ensuring patient safety. The following year the Commons Joint Committee on Human Rights recommended that the CQC make more unannounced inspections at night or over weekends, and use covert surveillance, in order to better inform inspection judgments.

But the failings persist. During this month’s investigation into the deaths of three vulnerable people at the private Cawston Park hospital – which was closed down in May this year by owner the Jeesal Group, after the CQC had put the facility into ‘special measures’ – the Norfolk Safeguarding Adults’ Board suggested that the commission could have removed the hospital’s registration sooner.

The Lowdown’s sister website www.nhsforsale has previously documented a litany of care failures – including patient deaths – reported by the CQC at facilities owned and run by the Priory group, the UK’s leading provider of mental health services and recipient of huge sums from NHS and local councils’ social services budgets.

Despite this – and despite one of its facilities, Barnt Green, having just been rated by the commission as ‘overall inadequate’ – the group’s website proudly proclaims, “Because of the hard work and commitment of all our staff teams across all our 84 CQC-registered hospitals, 87 per cent of our sites are rated as ‘Good’ or ‘Outstanding’, compared to 78 per cent in the NHS or other independent providers.”

So never mind their clinical value, CQC ratings now clearly have considerable marketing value too. Perhaps it’s no surprise then that several companies have taken to offering ‘boost your cqc rating’ software packages – possibly much cheaper for service providers than actually investing in staff and patient care.

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