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The Care Quality Commission: Regulating the quality and safety of health and adult social care

The Care Quality Commission had a difficult task in establishing itself and has not so far achieved value for money in regulating the quality and safety of health and adult social care in England, according to a report by the National Audit Office today. The Commission missed deadlines for registering health and social care providers, other than NHS trusts, at the same time as levels of compliance and inspection activity were falling significantly.

The Commission, formed in 2009, had to merge three existing regulators to establish a new organisation and implement a new regulatory approach, which for the first time integrates health and social care. The Commission’s budget is less than the combined budget of its predecessor bodies, even though it has more responsibilities. Even so, it underspent against budget in both 2009-10 and 2010-11. This was partly because it had a significant number of staff vacancies. At the end of September 2011, 14 per cent of staff positions were vacant. The Commission was unable to fill vacancies as quickly as it might, because of government-wide recruitment constraints.

The process for registering care providers did not go smoothly. Although 21,600 providers are now registered, the timetable for two of the three tranches of registrations was not met. The Commission diverted inspectors from compliance activity to registration work in a bid to meet the timetable. As a result of this and the number of inspector vacancies, the Commission completed only 47 per cent of the target number of compliance reviews between October 2010 and April 2011.

Public expectations of the Commission are high, arising from a misunderstanding of what it can achieve as a regulator. Although clearly defined, the Commission’s role as a regulator has not always been communicated effectively to the public and providers. In addition, proposals to extend the Commission’s role risk distracting the Commission from its core work of regulating health and social care.

In the absence of measures of impact, the National Audit Office assessed value for money in terms of whether the Commission delivered what it set out to deliver.

"Against a backdrop of considerable upheaval, the Care Quality Commission has had an uphill struggle to carry out its work effectively and has experienced serious difficulties. It is welcome that it is now taking action to improve its performance.

"There is a gap between what the public and providers expect of the Care Quality Commission and what it can achieve as a regulator. The Commission and the Department of Health should make clear what successful regulation of this critical sector would look like."

Amyas Morse, head of the National Audit Office

Notes for Editors

  • The Care Quality Commission is the independent regulator of health and adult social care services in England. Its objective is to protect and promote the health, safety and welfare of people who use these services. The Commission is a non-departmental public body, overseen by the Department of Health. In 2010-11, its expenditure was £139 million, funded by grant-in-aid and fees paid by health and social care providers.
  • The Commission was established under the Health and Social Care Act 2008 and began operating on 1 April 2009. It took over responsibilities from three bodies: the Healthcare Commission, the Commission for Social Care Inspection, and the Mental Health Act Commission. The Department proposes that the Commission should assume a variety of additional responsibilities, such as oversight of fertility clinics and responsibility for HealthWatch England, the national consumer body for health and social care.
  • The Commission's safety and quality assurance work comprises: registering providers against 16 essential standards of quality and safety; checking that registered providers are complying with the essential standards, including by carrying out inspections; taking enforcement action against providers where services fail to meet the essential standards; and undertaking special reviews of particular on aspects of care, and investigations where concerns about quality have been identified.
  • Press notices and reports are available from the date of publication on the NAO website, which is at Hard copies can be obtained from The Stationery Office on 0845 702 3474.
  • The Comptroller and Auditor General, Amyas Morse, is the head of the National Audit Office which employs some 880 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

PN: 70/11