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Care Quality Commission regulating health and social care

The Care Quality Commission has improved as an organisation, but now needs to overcome some persistent issues with the timeliness of some of its regulation activities if it is to sustain further improvement, the National Audit Office has found.

Today’s report found that the Commission has completed its inspection and rating programme comprising more than 28,000 provider locations, which provides a benchmark of the quality of health and social care services. It has significantly reduced staff vacancies and is increasing its focus on cost savings. In addition, the Commission has improved how it measures its performance, and takes action to correct poor performance.

Inspection staff, however, highlighted concerns to the NAO about how well the broader information systems currently supported them. The NAO also found that Commission does not meet its timeliness targets for some of its regulation activities, such as registration and publication of inspection reports.

According to the NAO, although most providers and inspectors think that the Commission’s judgements are fair, stakeholders have concerns about consistency. The Commission is seeking to address consistency issues through its quality assurance processes and training.

The Commission is taking more enforcement action when care falls below fundamental standards, and there is evidence that it influences providers to improve quality, with most of the providers rated either inadequate or requires improvement having improved their rating on re-inspection. The number of completed enforcement actions increased over 2015-16 and 2016-17, while the number of providers entering special measures remained steady. The Commission links the increase with a focus on improving its inspectors’ skills and knowledge about enforcement. Poor recording, however, means the Commission cannot be assured that enforcement action is always completed.

The Commission made progress in implementing its new strategy during 2016-17 although it missed early milestones on rolling out use of resources assessments and designing its approach to the next phase of inspection. It is preparing for new ways that care might be delivered and is already responding to changes such as online primary medical services.

According to the NAO, the Commission’s ambition to base more of its regulatory activities on intelligence and risk based information introduces significant challenges. These must be carefully managed, and supported by digital systems and capabilities if it is to minimise the risk of missing poor care. In addition, the Department of Health and the Commission must also be realistic about its capacity to take on new responsibilities in this period of change.

The Commission has improved as an organisation. Value for money is getting better and the Commission can secure further improvement, if it continues its current direction of travel. Its main challenge now is to develop its digital systems and capabilities to support its move to a more intelligence driven and risk based approach to regulation.

Amyas Morse, Head of the National Audit Office, 13 October 2017

Notes for Editors

the Commission's operational expenditure in 2016-17

reduction in the Commission's funding between 2015-16 and 2019-20

number of active provider locations regulated by the Commission as at June 2017

January 2017
date at which the Care Quality Commission (the Commission) completed its inspection and rating programme of hospitals, adult social care providers and GP practices

proportion of all providers (hospitals, adult social care providers and primary medical services providers) with a ‘good’ or ‘outstanding’ rating as at quarter one 2017-18

proportion of the Commission's funding that came from provider fees in 2016-17

number of enforcement actions that the Commission took during 2016-17

£13 million
reduction in the Commission's spending in 2016-17 compared with 2015-16

vacancy rate for inspectors as at the end of June 2017

1. Press notices and reports are available from the date of publication on the NAO website. Hard copies can be obtained by using the relevant links on our website.

2. The National Audit Office scrutinises public spending for Parliament and is independent of government. The Comptroller and Auditor General (C&AG), Sir Amyas Morse KCB, is an Officer of the House of Commons and leads the NAO, which employs some 785 people. The C&AG certifies the accounts of all government departments and many other public sector bodies. He has statutory authority to examine and report to Parliament on whether departments and the bodies they fund have used their resources efficiently, effectively, and with economy. Our studies evaluate the value for money of public spending, nationally and locally. Our recommendations and reports on good practice help government improve public services. Our work led to audited savings of £734 million in 2016.





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