Care Quality Commission: should it stay or should it go?

The Care Quality Commission (CQC), the regulator of health and care services in England, has come under intense scrutiny this week after allegations that former managers were involved in covering up a report into the deaths of babies at Furness General Hospital in Cumbria.

After the publication of the Francis report into Mid Staffordshire NHS Foundation Trust, the latest revelations have caused yet more damage to public confidence in the NHS. There is a growing feeling that institutional secrecy and putting self-interest ahead of patient safety has become the norm and that protecting the reputation of the NHS is somehow more important than protecting patients.

Among the outrage and disgust surrounding this latest scandal, there have been calls to dismantle the CQC, as it clearly has not done its job: that is one of ensuring that hospitals, care homes and GPs are providing safe, high-quality compassionate care.

There have been many difficulties at the CQC. At the outset it had to introduce new monitoring systems, heavily relying on self-assessment by trusts. With limited amount of staff, it also focused too much on registering providers rather than inspecting them.

But let’s face it, the CQC is not alone amongst regulators for being found ‘wanting’. The FSA (Financial Service Authority) is a good example of the regulatory system failing to spot problems in time and shutting the stable door well after the horse has bolted. Yet it is still going.

So what alternatives would there be if the CQC were to go? Self-regulation first springs to mind. However, given the current state of the NHS, where according to Health Minister Dr Dan Poulter, in hospitals such as Morecambe Bay and Mid Staffs a ‘rotten culture’ has taken hold, this does not seem viable.

Alternatively, why not use previous whistleblowers as regulators? We should be able to trust them more to not cover anything up. They could be supported by patient groups with the power to thoroughly investigate when things go wrong.

The British Medical Association is urging caution and asking that the government to “resist the temptation to reorganise the CQC and instead allow the changes that are underway to bed in.” This seems the most sensible option.

A new leadership team is in place at the CQC and there are plans for NHS inspections to be more like Ofsted. This has been welcomed by the Nuffield Trust, however they believe that for such a system to work, the CQC would need extra resources, political support and time to develop. It remains to be seen if the Secretary of State, Jeremy Hunt will deliver on this.

As more senior NHS figures are being drawn into the CQC scandal, it seems that the NHS needs to purge itself. To regain the confidence of the public the NHS will need to embrace a new credo, one of accountability and transparency and a responsibility to ensure that patients receive the care they deserve.

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