CQC – Can’t Quite Cope

The Care Quality Commission’s failure to stop the torture of patients at Winterbourne View Private Hospital in Bristol, despite the repeated pleadings of a whistleblower, is yet more evidence that it isn’t fit for purpose. And the CQC knows it. Last month, the Health Service Journal published minutes of a recent CQC board meeting, which acknowledged it faced ‘three major areas of risk, all of which were likely to happen.’ ‘1. Failure to effectively identify or deal with non compliance leading to persistently poor quality care for users. 2. Lack of volume and/or type of resource to meet the demands placed on it, leading to unacceptable levels of performance. 3. Failure to operate in line with required standards of probity and value for money.’

A key issue is whether the CQC should be both an investigator and a regulator. As the Eye argued 12 years ago (Eye November 1999), the NHS needs a lean and fast independent inspection team in every region, staffed by experienced clinicians, rather than ex-policemen, that can go into any hospital or GP surgery after one unexpected death or serious injury, complaint or staff concern, rather than wait for a whole pile of bodies to mount up. Labour created a Commission for Health Improvement (CHI) that started off well, but their reports were so hard hitting and politically embarrassing they soon fell out of favour. CHI was replaced by a Healthcare Commission (HCC) which lost independence when its inspection standards were decided by the Department of Health. A National Patient Safety Agency was set up to monitor NHS errors, but wouldn’t share its information with the HCC. And yet another regulator, Monitor, was set up for Foundation Trusts and didn’t want anything to do with the HCC.

The HCC’s Annual Health Check for hospitals was just a simplistic check list of supposed standards that managers found it very easy to game, and told patients little about the quality and safety of their hospital. Dr Foster’s mortality rates should have blown the whistle on Mid Staffs but instead were dismissed by both the Trust and West Midlands Strategic Health Authority (chief exec Cynthia Bower, now chief exec of the CQC). The HCC had at least retained a proper investigative arm which belatedly went into Mid Staffs and unearthed appalling care and between 400 and 1200 avoidable deaths, which they passed onto the CQC. The CQC were so angry they gagged the lead investigator, Dr Heather Wood, until she was finally allowed to give her explosive evidence to the Mid Staffs inquiry. Dr Wood – one of the HCC’s best investigators – has no confidence that the CQC, in its current form, would have unearthed Mid Staffs.

The retrospective  ‘system management’ of regulatory bodies is incapable of picking up scandals until the body count is too big to ignore, which is why it’s vital to listen to staff brave enough to speak up. But this is not the first time the regulators have palmed off a whistleblower. Dr Pal identified serious shortcomings in the nursing and medical care of patients on Ward 87 of City General hospital, Stoke on Trent, when she started working there in August 1998 (Eye April 8, 2009). She complained to all three regulators – CHI, the HCC and the CQC. She found out from the CQC that the regulators didn’t even pass information on when they were closed down and opened up again with a different name. ‘As you can appreciate we had no knowledge or information about your concerns that you had raised with HCC or CHI in the past.’ A subsequent review in May 1999 by Mrs T Fenech from the Infectious Diseases Unit found ‘serious deficiencies in nursing practice’ and that ‘the level of care demonstrated for some patients on the ward at the time of my audit was nothing short of negligent’. But this failure, on the doorstep of Mid Staffs, did not warrant investigation by the regulator.

The CQC has neither the money, the methods nor the staff to competently inspect and regulate the whole of health and social, in both the NHS and the private sector. They failed to meet their own standards and timescales in registering dentists, and imposed inflexible paper-based policies and vast amounts of red tape that have merely succeeded in taking dentists away from teeth. Now they move on to GPs. The Health Bill should merge regulators – there aren’t the resources for both a functioning CQC and Monitor, and you can’t separate the money from the quality of care. More urgently, we need a truly independent inspectorate in every region that staff and the public trust,  that goes in hard and fast to investigate patient harm and publishes its findings in time to save lives.  MD