Tuesday's (15 November) Guardian carries a story about the Department of Health’s (DH) capacity review of CQC. The article suggests that the review is urgent and prompted by concerns about CQC’s performance. This is not the case.
All of the DH’s arm’s length bodies will have an annual capacity review, including CQC and Monitor. The reviews were announced by the Department’s Permanent Secretary, Una O’Brien, on 22 September.
The story also repeats a number of claims and issues that have been well publicised previously and about which we have been careful to set out the facts and clarify misunderstandings.
As well as sensationalising the DH’s capability review of CQC, the Guardian’s story contained a number of errors and ‘imaginative’ interpretations of facts.
You can read our response to specific issues below.
What did the Department of Health say about the story?
The Guardian published this letter from the Department of Health on 16 November:
"Your front page article (Health watchdog faces investigation as concerns mount, 15 November) misunderstands a normal part of Government business. The Care Quality Commission (CQC) is funded and sponsored by the Department of Health, and it is only right that the Department should periodically take a view about the organisation's capability.
"All of the Department of Health's arm's length bodies are subject to a similar process. In this case it is being undertaken with the full cooperation and participation of the CQC."
Richard Douglas, Director General – Policy, Strategy and Finance, Department of Health
What is CQC saying about the capacity review?
This capacity review was announced on 22 September by Una O'Brien as part of her evidence to the Mid Staffs review: "I have initiated a process whereby we are going to establish what I would term as performance and capability reviews annually of each of our arm's length bodies, of which the regulators will be included. That's the Care Quality Commission and Monitor."
News of this was announced on our intranet and Chief Executive’s message, and the Department also wrote to and spoke to a range of CQC’s stakeholders. More than 40 staff from across CQC – including inspectors – were interviewed by a team from the Department of Health (DH), led by the Permanent Secretary. We are arranging for the DH team to visit our Newcastle customer services centre and one of our regional offices. We have found it an extremely helpful process.
Accusation that CQC ‘neglected its core duty’
The Guardian wrote: "In September the prime minister endorsed a damning report by the health select committee on the CQC, which accused the regulator of neglecting its core duty of scrutinising patient care in favour of bureaucratic 'registration' of care providers."
The reporter did not ask us for a comment on this. CQC was obliged by law to register care providers. We have acknowledged that, during the period of particularly heavy workload that was required to register nearly 30,000 care services under the new legislation, inspection levels dropped. The numbers have been rising and we carried out more than 1,100 unannounced inspections in September alone.
Incorrect inspections figures in CQC’s Annual Report
Our Annual Report overstated the number of inspections completed in 2010/11 owing to a transposition error. When we realised this error, we submitted a correction via DH Parliamentary Branch and amended the Annual Report on our website. The Stationery Office has published an erratum slip.
We also informed the Mid Staffs Inquiry via Amanda Sherlock's statement on 5 September. This statement was then discussed in public session and reported on by the Health Service Journal.
This was an error that was not picked up in proofing of the publication, was not repeated elsewhere, and which we have gone to considerable efforts to correct.
Criticism for ‘disbanding the investigations team’ and not carrying out more investigations
CQC operates under different legislation based on registration and on monitoring providers against essential standards. Any compliance team in England can carry out an unannounced inspection of an NHS trust and take enforcement action against poor care whenever they find it.
As we told the Mid Staffs Inquiry (also covered by the witness statements and transcripts) CQC’s approach is to assemble bespoke teams to carry out investigations, comprising staff both from within CQC and external partners with the relevant expertise, whenever the need to arises.
CQC has so far carried out three formal investigations (at two NHS trusts and into the Take Care Now out-of-hours doctors’ provider).
CQC inherited the investigations team from the Healthcare Commission. A new regulator, bringing together three organisations under new legislation and a new remit, needed internal structures suited to its role, not those of the commissions it replaced. Many other aspects of how those commissions worked were also changed.
Criticism of CQC’s use of ‘gagging orders’
CQC staff are often privy to confidential information about service providers and people who use services. CQC’s agreements with some staff who leave contain standard terms in relation to confidentiality and non-disparagement. These do not, in any way, prevent former employees participating in public inquiries connected to their work for CQC. This was confirmed at the Mid Staffs Inquiry.
Suggestion that if CQC had been in existence at the time, it would not have investigated Stafford Hospital
Our belief is that, had our current systems been in place at the time, they would have picked up problems at Mid Staffs some 18 months earlier than the Healthcare Commission was able to spot them. There may, therefore, have been no need for an investigation as poor care would have been identified and dealt with at an early stage.
Criticism that CQC does not regularly carry out unannounced inspections
The vast majority of our inspections have always been unannounced. In September alone we carried out more than 1,100 unannounced inspections.
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